At one time, the mere mention of mumps could strike fear in the population. The viral infection was known for causing a variety of short term symptoms, such as swollen salivary glands and reproductive organs as well as inflammation of the pancreas and meningitis. But the real worry came in the form of long-term consequences, including a risk for diabetes and infertility. Thankfully, the introduction of vaccines to prevent the infection calmed people's nerves and led to a massive reduction in the number of cases.
Despite the success of vaccines, mumps wasn't eradicated. Small pockets of infection continued to appear. These small outbreaks were difficult to control but eventually burned out such that they disappeared. For the most part, these isolated events were considered part of the ongoing reality of an ever-present virus.
But in the mid-2000s that all changed. Those pockets began to turn into mini-epidemics and countries all over the world began to see sharp increases in cases. At first, a lack of vaccination was considered to be the cause. Indeed, in many cases, those affected had not received the shot. But many of the patients had been vaccinated suggesting something more troublesome was happening.
Eventually, the answer was determined although it was rather disconcerting. The trouble wasn't due to the vaccine. Instead, it was virus. It had changed.
Although we may think of mumps as one virus, there are actually twelve different groups, known as genotypes. They are named alphabetically from A to L. Most are related to one another yet some are completely different suggesting one vaccine may not be enough to cover the spectrum.
The current mumps vaccine was developed in the mid-1960s from a virus isolated from a young girl, named Jeryl Lynn Hilleman. Her father, Maurice, was a vaccine maker and felt her infection could lead to protection for millions. At the time, there was no knowledge of the different genotypes. Only much later did the virus variety become known. Going back, researchers realized Jeryl Lynn's infection was caused by the A group.
As for the more recent outbreaks, public health officials found the virus was from the G genotype. Rather than panic, however, researchers provided some perspective by noting there were enough similarities between the A and G types to suggest the vaccine may still offer some protection. By 2008, this theory was realized; the vaccine strain could help the immune system fight off the G genotype.
There was, however, a catch. The strength of the vaccinated immune response against the G type was only about a half as effective compared to the A variety. This meant the immune system had to be at its strongest to be able to fight off the invader. From a vaccination perspective, the best way to achieve this goal was to provide booster shots. Many countries, including Canada already had adopted a 2-dose policy (we did it in 1996). Yet, even this extra step at times was not enough to stop wider spread.
This inconvenient reality has plagued public health officials for over ten years and the answers are still elusive. One suggestion involves using vaccines containing strains other than the virus isolated from Jeryl Lynn. While this may appear to be an easy path forward, potential health complications are associated with these different virus types. Another option is to develop a new vaccine capable of providing protection against the G genotype Such efforts are underway but they won't be seen in the public anytime soon. in the meantime, the most feasible option according to many researchers is to seek out a third mumps vaccination.
The booster shot has proven to increase the effectiveness of immunity of an individual against the G type and may provide the protection needed. Indeed, this approach has shown to be worthwhile as in 2012. The addition of a third dose has significantly reduced the impact of previous outbreak, such as one in California. However, this option continues to be a hotly debated topic as it may only be useful once an outbreak initiates.
Until we are able to sort out how to effectively reduce the chances for outbreaks, the best policy to stay safe is the same as one would have with colds and flu. Never share bodily fluids, including saliva, with others, even if you don't feel sick. It may take two weeks for symptoms to develop. Always keep those hands clean with soap and water or hand sanitizer.
Perhaps most importantly, make sure to know your vaccination record. If mumps does happen to appear in your area, you want to be aware of your immune's strength. If you have had a second dose of the MMR vaccine within the last few years, you are probably good to go. But if it's been ten or more years, you may want to talk with your doctor about getting a third booster.
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