Marlow Mariel A, Moore Kelly, DeBolt Chas, Patel Manisha, Marin Mona
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Marlow, Patel, and Marin); Department of Health Policy, Vanderbilt School of Medicine, Nashville, Tennessee (Dr Moore); and Washington State Department of Health, Shoreline, Washington (Ms DeBolt).
J Public Health Manag Pract. 2020 Mar/Apr;26(2):101-108. doi: 10.1097/PHH.0000000000000965.
During January 2016 to June 2017, US health departments (HDs) reported 150 mumps outbreaks. Most occurred among populations with high 2-dose measles, mumps, and rubella (MMR) vaccine coverage, prompting the Advisory Committee on Immunization Practices to examine the evidence for use of a third dose of MMR vaccine.
To evaluate HD experiences with mumps outbreak control and use of a third MMR dose during outbreaks.
An online survey assessing mumps outbreak characteristics, outbreak response measures, challenges, and lessons learned from previous outbreaks was distributed to all 81 Council of State and Territorial Epidemiologists member HDs in August 2017.
Sixty-one (75%) HDs responded; 46 (75%) had experience with ≥1 mumps outbreak(s) during January 2016 to August 2017. Twenty (43%) HDs recommended a third or outbreak MMR dose during mumps outbreaks; of these, 19 completed the section on use of a third dose and 8 (40%) rated the intervention "somewhat effective" or better. Health departments that used a third/outbreak dose suggested implementing the recommendation early and to a targeted group. Forty-three (73%) HDs reported having a policy for excluding persons without presumptive immunity from outbreak settings; of these, 37 (86%) had some degree of legal authority to implement this policy. Exclusion compliance improved with the use of personalized notification letters, focus groups of excluded persons and the community, and standardized messaging. Other outbreak control measures included cohorting of exposed or susceptible persons, mobile vaccination clinics and home visits, contact monitoring via text messaging, and facilitating student isolation with meal delivery and excused class absences.
Our study revealed heterogeneity across HDs' mumps outbreak responses but also identified common challenges that will inform future Centers for Disease Control and Prevention guidance. These results were considered in the October 2017 Advisory Committee on Immunization Practices recommendation for use of a third dose of MMR vaccine for persons at increased risk for mumps during an outbreak and in the development of Centers for Disease Control and Prevention guidance for HDs when applying the Advisory Committee on Immunization Practices recommendation.
2016年1月至2017年6月期间，美国卫生部门报告了150起腮腺炎疫情。大多数疫情发生在两剂麻疹、腮腺炎和风疹（MMR）疫苗接种覆盖率高的人群中，这促使免疫实践咨询委员会审查使用第三剂MMR疫苗的证据。
评估卫生部门在控制腮腺炎疫情以及在疫情期间使用第三剂MMR疫苗方面的经验。
2017年8月，向州和领地流行病学家理事会全体81名成员卫生部门发放了一项在线调查问卷，评估腮腺炎疫情特征、疫情应对措施、挑战以及从以往疫情中吸取的教训。
61个（75%）卫生部门做出了回应；46个（75%）在2016年1月至2017年8月期间有过≥1起腮腺炎疫情的应对经验。20个（43%）卫生部门建议在腮腺炎疫情期间使用第三剂或疫情专用MMR疫苗；其中，19个完成了关于使用第三剂疫苗的部分内容，8个（40%）将该干预措施评为“有点有效”或更好。使用第三剂/疫情专用剂量的卫生部门建议尽早对目标群体实施该建议。43个（73%）卫生部门报告有一项政策，将没有推定免疫力的人员排除在疫情场所之外；其中，37个（86%）有一定程度的法律授权来实施这项政策。通过使用个性化通知信函、被排除人员和社区焦点小组以及标准化信息传递，排除政策的合规性得到了改善。其他疫情控制措施包括对暴露或易感人员进行分组、流动疫苗接种诊所和家访、通过短信进行接触者监测，以及通过送餐和批准缺课来促进学生隔离。
我们的研究揭示了各卫生部门在应对腮腺炎疫情方面的异质性，但也确定了一些共同挑战，这些挑战将为疾病控制与预防中心未来的指导提供参考。这些结果在2017年10月免疫实践咨询委员会关于在疫情期间为腮腺炎风险增加的人群使用第三剂MMR疫苗的建议中得到了考虑，并且在疾病控制与预防中心为卫生部门应用免疫实践咨询委员会建议制定指导意见时也得到了考虑。
