Mumps Vaccination for Outdoor Travelers

Mumps (a viral infection) is making a comeback in the U.S. and other countries because of failure to vaccinate. It is not a trivial disease, particularly in adults, and is highly communicable. In children, mumps typically causes fever, headache, muscle aching, fatigue, loss of appetite, and swelling of salivary glands, in particular the parotid glands, which are located in the cheeks directly in front of the ears. In all age groups, patients suffer from fever and inflamed salivary glands, which causes the "chipmunk" appearance, as if the person was a small animal storing nuts in his or her cheeks. In male adults, mumps can cause inflammation of the testicles (orchitis), which can become quite painful and debilitating. In other cases, mumps can cause deafness and inflammation of the brain and sensitive tissues around the brain. It can also cause ovarian or breast inflammation, miscarriage, and deafness. The severity of infection tends to increase with age.

In an article entitled "Recent Resurgence of Mumps in the United States" (New England Journal of Medicine 2008;358:1580-9), Gustavo H. Dayan, M.D. and his co-authors describe that the largest mumps outbreak in two decades in the U.S. occurred in the year 2006. This was in a population that received the proper immunization regimen of two doses of vaccine. Their conclusions were that it may be necessary to develop a more effective mumps vaccine or to make a change(s) in mumps vaccination policy (e.g., institution of a recommendation for a third dose of vaccine).

Why did the incidence of mumps increase? Some factors cited by the authors include declining immunity, high population density and contact rates among college students, the possibility that the vaccine did not provide sufficient immunity against certain ("wild") strains of the virus, and that perhaps the virus was transmitted by persons with very mild ("subclinical") disease or vaccine-modified disease.

What does this mean for the wilderness or foreign traveler? Outbreaks have certainly occurred in other countries, such as Canada. For now, it is just a reminder that all childhood immunizations should be brought up to date prior to travel, because exposure to mumps and other normally childhood diseases may periodically be higher in countries outside the U.S.

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

Tags: mumps, immunizations, wilderness medicine, outdoor medicine, healthline

Labels: immunization, mumps, parotid gland, vaccination

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Nasal Influenza Vaccine for Younger Children and 2007 Updates

The fall, winter, and spring are terrific for outdoor activities, but they are also the peak seasons in the U.S. for being exposed to the influenza virus. Young children and elders are particularly prone to severe infections and the attendant complications. It has been suggested that a nasal vaccine (sprayed into the nose), such as FluMist, containing a weakened form of the live virus, provides better protection against influenza than does an intramuscular injection of inactivated (“killed”) virus, currently provided as trivalent inactivated vaccine (TIV).

The U.S. Food and Drug Administration has just approved expanding the population for use of FluMist to include children between the ages of 2 and 5 years. Previously, the lower age limit was felt to be 5 years of age. In the clinical study cited by the FDA to support their new recommendation, it was observed that children under the age of 2 years had an increased risk for wheezing and hospitalization.

As with certain other immunizations, there can be side effects, which in the case of FluMist include runny nose and/or nasal congestion, as well as fever in children ages 2 to 6 years. It should not be used in any person who suffers from asthma or in children under the age of 5 years with recurrent wheezing.

For 2007, here are important updates on current recommendations for immunization:

1. The trivalent inactivated vaccine (TIV) is supplied as a 0.5 milliliter dose containing 15 micrograms each of A/Solomon Islands/3/2006 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia2506/2004-like antigen. Trade names for this vaccine are Fluzone and Fluvirin.
2. Two doses of TIV administered at least 1 month apart are recommended for children aged 6 months to 8 years who are receiving TIV for the first time. Those who only received one dose in their first year should receive two doses the following year.
3. For FluMist, two doses administered at least 6 weeks apart are recommended for children aged 2 to 8 years who are receiving this vaccine for the first time. Those who received only 1 dose in their first year of vaccination should receive 2 doses in the following year.

Tags: influenza vaccine, influenza, flu, wilderness medicine, outdoor medicine, healthline

Labels: flu, FluMist, influenza, vaccination, vaccine

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