Tertiary students are at high risk of contracting mumps, says Dr Ayesha Verrall, an infectious diseases physician and researcher at the University of Otago, Wellington.
“As New Zealand students return to school and travel to tertiary institutions around the country, the Ministry of Health needs to urgently fund and offer a third dose to these people aged 10 to 29 even if they have received two doses already,” she suggests.
New Zealand is in the grip of its worst mumps outbreak in decades. From having a handful of cases reported annually, the Auckland Regional Health Public Health Service has now had close to 1200 reported cases since 1st January 2017 with that number expected to rise. The outbreak began in Auckland and was initially focused on schools in the west and south of the city, the areas with the lowest vaccination rates.
Dr Verrall explains that many in the “lost generation” those aged 10 – 29 who missed out on the mumps part of the MMR vaccine, or missed out on the vaccine altogether, are at risk as they have not been told they need to be immunised. They will then be travelling to different parts of the country, living at close quarters in the likes of flats and halls of residence and risking a serious illness. And a costly illness, she says, as students need to stay away from anywhere other people are , including lecture theatres, playing contact sports, and socialising.
“The outbreak is the result of a perfect storm of low childhood vaccination in today’s young adults, as well as waning vaccine protection over time in those who were vaccinated in childhood. Seventy five per cent of cases have been in this age group,” says Dr Verrall.
“Young adults in high risk settings can benefit from a third dose of the Measles Mumps and Rubella (MMR) vaccine, even if they completed their two doses as a child. The vaccine is about 90 per cent effective against mumps, but its protection reduces over time so young adults who received two doses might have lost their protection from the vaccine.
“Previously vaccinated people need to know that they might also be susceptible. Failing to communicate this risks undermining public confidence in vaccines,” says Dr Verrall.
She is critical of the Ministry of Health’s catch up plan announced in December 2017 which would see students encouraged to have their third dose of the MMR vaccine. The programme is yet to be rolled out.
“New Zealand needed to start a catch-up vaccination campaign for adolescents and young adults five years ago if we were serious about preventing this outbreak. But starting one during this historically large outbreak will have limited benefit,” she says.
Mumps is a viral illness which is infectious from when the cheeks begin to swell until five days after the swelling has gone. It is spread from an infected person by saliva or mucous droplets when coughing, sneezing or talking. It can be spread via face to face contact within a metre, or by touching an object infected from saliva and mucous, such as a used tissue or keyboard.
While most recover well, some people can be hospitalised; and on rare occasions result in severe complications including swollen ovaries and swollen testes. Boys and men can become infertile if the illness spreads to their testes.
The Auckland Regional Public Health Service’s Dr Bryn Thompson explains that they are working with the most at risk groups.
“Some of those affected are from the Pasifika community, where students born outside of New Zealand will have been immunised against Measles but not for Mumps and Rubella.
“The mumps outbreak necessitates learning institutions carry out an exclusion process to protect those students who are not immunised and ensuring children with the mumps don’t come to school during the infectious period,” he says.
This has created controlled havoc at schools such as Laingholme Primary in West Auckland who had to cancel a production at the end of last year and others where principals have asked un-immunized pupils to stay home to avoid affection who then missed sitting exams on the expected dates.
Overseas studies have shown that giving a third dose makes university students much less likely to get mumps than those who only had the two childhood doses, says Dr Verrall.
“Failing to address this fact limits our ability to respond to control the outbreak, meaning mumps will disrupt education, sports and community activities for young people for the next several years.”
The Ministry of Health said in a statement that their data says the outbreak has stayed localised in the Auckland area; that there has been a significant increase in the uptake of MMR vaccines given to young people since November 2017; and reminds people the MMR vaccine is free at their GP for all those born from 1 January 1969.