Mumps / MMR

I did a shift for Devon Doctors this weekend.
On an admittedly quiet Sunday morning I saw 3 cases of Mumps. 2 from Totnes, 1 from Ivybridge.
We generally have a few Mumps cases coming up now and again, but having seen a couple in the week, then these at the weekend, it makes me wonder whether we are looking at something more like an outbreak.
I can't help but link it in with the few cases of Measles we had a month or two ago. Both things together make me concerned that the degree of immunity we have become used to in the community may be falling. MMR vaccination is clearly key here. We know that rates of vaccination across the country had been falling for a long time.
This of course stemmed back to when the Surgeon Andrew Wakefield decided he had skills as an epidemiologist and paediatrician and whipped up a scare about a link with measles and Crohns disease/autism together. Subsequent studies by people who do this sort of study for a living have showed no such association, but people are still scared off despite all the evidence to the contrary.
This now means that herd immunity has fallen and outbreaks can occur.
Herd immunity is the idea that a disease needs a certain proportion of susceptible people in a population in order to spread. If most people are immune, then if someone coughs out their germs in a room then the majority of people will be fine. If a couple of people get it though and, themselves each pass it on to a couple more people, then it is spreading.
We rely on most people being immune.
This is where those people who have chosen not to have vaccinations fall into a false sense of security. They had been relying on everyone else (the responsible people) getting their children vaccinated in order that their own vulnerable unvaccinated child would be safe in the relatively immune herd. Now that enough people had felt so secure (due to the effectiveness of vaccination) that they felt they didn't need to get their kids jabbed, we are getting outbreaks.
The Department of Health has been pushing an MMR catch-up campaign. At the Surgery we recently invited several hundred unvaccinated children for catch-up jabs. It was good that a few came along. Many still didn't.

Part of the problem is, I think, that because vaccination programmes have been so effective, most people these days have never seen a case of measles.
More have probably seen mumps. Rubella does a little turn occasionally. But by and large, for todays cohort of parents, these diseases are unknown. Diphtheria is another good case. After vaccination was intrduced in 1940 cases reduced dramatically. I've not seen a case at all, ever, after 21 years in healthcare. It still has potential to spread though, and to kill, so we still vaccinate. Smallpox is eradicated entirely worldwide- due solely to vaccination.

I can see that when you are faced with giving your child a vaccination (with its perceived risk) against a disease which is entirely unknown to you, which you have never seen, then there would be a tendency to be reluctant. To some extent that next step relies ultimately on trust. Trust in the health authorities in our country to recommend what is right and beneficial for us. We can't all spend the time needed to educate ourselves in the science of immunology and infection in order to make an informed choice.

So, back to Mumps: The incubation period is 14-21 days and mumps is transmissible from several days before the parotid swelling to several days after it appears. Symptoms begin with a headache and fever for a day or two before the disease which is characterised by swelling of the parotid glands which may be only on one side. At least 30% of cases in children have no symptoms. Complications of mumps include swelling of the ovaries or testes (Orchitis in up to 25% of post-pubertal males), aseptic meningitis (10%) and deafness. Cases may have no salivary gland involvement but develop symptoms elsewhere. There is no firm evidence that orchitis causes sterility. Contagiousness is similar to that of influenza and rubella but not as infectious as chickenpox or measles. Exposed individuals should be considered infectious from 12 to 25 days after exposure.