Communicable Disease Control Directorate, Public and Aboriginal Health Division, Western Australia Department of Health, Perth, WA, Australia; National Centre for Epidemiology & Population Health, The Australian National University, Canberra, ACT, Australia.
Kimberley Population Health Unit, Western Australia Country Health Service, Broome, WA, Australia.
Lancet Infect Dis. 2019 Feb;19(2):177-184. doi: 10.1016/S1473-3099(18)30498-5. Epub 2018 Dec 14.
In 2007-08, a genotype J mumps outbreak occurred among Aboriginal people in northern Western Australia, despite high vaccine coverage. In March, 2015, a second protracted mumps outbreak occurred in northern Western Australia and spread widely across rural areas of the state. This time the outbreak was caused by a genotype G virus and again primarily affected Aboriginal people. We aimed to describe the epidemiology of this outbreak.
In this population-based surveillance study, we analysed statutory notifications and public health case follow-up data from the Western Australia Notifiable Infectious Diseases Database and vaccination information from the Australian Childhood Immunisation Register. An outbreak case of mumps was notified if the affected person was living in or visiting a community in Western Australia where there was active mumps transmission, and if mumps infection was confirmed by laboratory diagnosis or by an epidemiological link. We analysed case demographics, vaccination status, and age-standardised attack rates in Aboriginal and non-Aboriginal people by region of notification. Laboratory diagnoses were made by real-time RT-PCR, serology, or both, and carried out by the sole public pathology provider in Western Australia.
Between March 1, 2015, and December 31, 2016, 893 outbreak cases were notified. 798 (89%) of 893 outbreak cases were reported in Aboriginal people. 40 (4%) of 893 people were admitted to hospital, and 33 (7%) of 462 men reported orchitis. Mumps attack rates increased sharply with age, peaking in the 15-19 age group. 371 (89%) of 419 people aged 1-19 years were fully vaccinated and 29 (7%) were partly vaccinated. Of the 240 people who tested positive by real-time RT-PCR and had also been tested for mumps-specific IgG and IgM, 165 (69%) were positive for IgG but negative for IgM, indicating the importance of RT-PCR testing for diagnosis in vaccinated populations. None of the cases from the 2007-08 genotype J outbreak were re-notified.
The number of mumps outbreaks reported in recent years among highly vaccinated populations, including Indigenous populations, has been growing. More widespread and pre-emptive use of the third dose of measles, mumps, and rubella vaccine might be required to control and prevent future outbreaks in high-risk populations. Research should explore the benefit of increasing the intervals between vaccine doses to strengthen the durability of vaccine protection.
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2007-08 年，尽管疫苗接种率很高，但在西澳大利亚北部的原住民中爆发了基因型 J 腮腺炎。2015 年 3 月，西澳大利亚北部再次发生了第二次持续的腮腺炎爆发，并广泛蔓延到该州的农村地区。这一次的爆发是由基因型 G 病毒引起的，主要影响原住民。我们旨在描述这次爆发的流行病学情况。
在这项基于人群的监测研究中，我们分析了西澳大利亚传染病报告数据库中的法定通知和公共卫生病例随访数据，以及澳大利亚儿童免疫登记处的疫苗接种信息。如果受影响的人居住或访问西澳大利亚有腮腺炎传播活动的社区，并且如果实验室诊断或通过流行病学联系确认了腮腺炎感染，则报告腮腺炎爆发病例。我们分析了按地区通知的病例人口统计学、疫苗接种状况和年龄标准化发病率在原住民和非原住民中的情况。实验室诊断由实时 RT-PCR、血清学或两者结合进行，由西澳大利亚唯一的公共病理学提供者进行。
2015 年 3 月 1 日至 2016 年 12 月 31 日期间，共报告了 893 例爆发病例。893 例爆发病例中，798 例（89%）报告发生在原住民中。40 例（4%）患者住院治疗，462 例男性中有 33 例（7%）报告睾丸炎。腮腺炎发病率随着年龄的增长急剧上升，在 15-19 岁年龄组达到高峰。1-19 岁的 419 人中，有 371 人（89%）完全接种疫苗，29 人（7%）部分接种疫苗。在通过实时 RT-PCR 检测呈阳性并接受腮腺炎特异性 IgG 和 IgM 检测的 240 人中，165 人（69%）IgG 阳性但 IgM 阴性，表明在接种人群中 RT-PCR 检测对诊断很重要。2007-08 年基因型 J 爆发的病例无一例再次报告。
近年来，包括原住民在内的高度接种人群报告的腮腺炎爆发数量不断增加。可能需要更广泛和先发制人的使用麻疹、腮腺炎和风疹三联疫苗的第三剂，以控制和预防高危人群未来的爆发。研究应探讨增加疫苗剂量间隔以增强疫苗保护持久性的益处。
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