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Mumps
Topic Table of Contents

Quick Facts 

Mumps
  • Mumps is a contagious viral infection and symptoms begin with a headache, muscle aches, tiredness, and loss of appetite. A stiff neck just before, during or after mumps infection is a sign that aseptic meningitis (inflammation of the lining of the brain) may have developed, which is a rare complication of mumps.
  • Mumps virus can be found in the saliva, throat and urine of an infected person and mumps is usually spread through the air by respiratory droplets or by contact with the saliva of an infected person. 
  • The time between when a person comes in contact with a person infected with mumps and first begins to experience symptoms of mumps (incubation period) ranges from 7 to 23 days. The illness lasts for an average 7-10 days but may last longer before symptoms completely disappear.
  • The typical “signature” physical sign of mumps is visible swelling of one or both sides of the face under the ears and chin. Males, who are past puberty, can experience pain and extreme swelling of the testes and rarely, become sterile. Mumps is very rarely fatal.
  • There is no specific treatment for mumps except alleviation of symptoms with rest, pain relievers and cool compresses. 
Mumps Vaccine
  • Currently there is only one mumps vaccine available in the U.S., which is manufactured by Merck and included in the combination live attenuated MMR (measles-mumps-rubella) vaccine. (There is another vaccine that contains mumps but it is not currently being distributed in the U.S.)
  • The CDC recommends that children get two doses of MMR vaccine with the first dose given between ages 12-15 months, and the second dose given between ages 4-6 years.
  • Common side effects from the MMR vaccine include low-grade fever, skin rash, itching, hives, swelling, reddening of skin, and weakness. Reported serious adverse reactions following MMR vaccination include seizures, brain inflammation and encephalopathy; thrombocytopenia; joint, muscle and nerve pain; gastrointestinal disorders; measles like rash; conjunctivitis and other serious health problems;
  • As of September 1, 2015, there had been 10 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following MMR vaccination.
  • Using the MedAlerts search engine, as of September 30, 2015 there had been 7,508 serious adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with MMR vaccines since 1990. Over half of those serious MMR vaccine-related adverse events occurring in children three years old and under. Of these MMR-vaccine related adverse event reports to VAERS, 360 were deaths, with over 60% of the deaths occurring in children under three years of age.
  • In 2006 and 2009, there were outbreaks of mumps in the U.S. in vaccinated children. In 2012, new information questioning the efficacy of the mumps portion of MMR vaccine emerged when two former Merck employees filed a lawsuit alleging the company altered testing results and studies to make the mumps vaccine in MMR appear to be more effective than it really is in preventing mumps infection.
  • NVIC “Quick Facts” is not a substitute for becoming fully informed about mumps and the mumps vaccine. NVIC recommends consumers read the more complete information following the "Quick Facts", as well as the vaccine manufacturer product information inserts, and speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child.

NVIC “Quick Facts” is not a substitute for becoming fully informed about mumps and the mumps vaccine. NVIC recommends consumers read the more complete information following the "Quick Facts", as well as the vaccine manufacturer product information inserts, and speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child.

Food & Drug Administration (FDA) 

Vaccine Reaction Symptoms & Ingredients
 
Our Ask 8, If You Vaccinate webpage contains vaccine reaction symptoms and more. Calculate vaccine ingredients for potential toxic exposures & print a vaccination plan with the Vaccine Ingredients Calculator.

Search for Vaccine Reactions
 
NVIC hosts MedAlerts, a powerful VAERS database search engine. MedAlerts examines symptoms, reactions, vaccines, dates, places, and more.

Reporting a Vaccine Reaction

Since 1982 NVIC has operated a Vaccine Reaction Registry, which has served as a watchdog on VAERS. Reporting vaccine reactions to VAERS is the law. If your doctor will not report a reaction, you have the right to report a suspected vaccine reaction to VAERS is the law.
 
Centers for Disease Control (CDC)

Table of Contents 

What is mumps? History of mumps vaccine use in America
Is mumps communicable? How effective is mumps vaccine?
History of mumps in America? Can mumps vaccine cause injury and death?
Can mumps cause injury and death? Questions to ask doctors about mumps vaccine
Who is at highest risk for getting mumps? Additional bibliography of references
Who is at highest risk for suffering complications from mumps? Endnotes
Mumps prevention and treatment options Quick Facts
What is mumps vaccine?  

  
What Is Mumps?

Mumps is a contagious viral infection and symptoms begin with a headache, muscle aches, tiredness, and loss of appetite. A stiff neck just before, during or after mumps infection is a sign that aseptic meningitis (inflammation of the lining of the brain) may have developed, which is a rare complication of mumps.
 
The time between when a person comes in contact with a person infected with mumps and first begins to experience symptoms of mumps (incubation period) ranges from 7 to 23 days. The illness lasts for an average 7-10 days but may last longer before symptoms completely disappear.
 
The typical “signature” physical sign of mumps is visible swelling of one or both sides of the face under the ears and chin. Males, who are past puberty, can experience pain and extreme swelling of the testes and, rarely, become sterile.
 
There is no specific treatment for mumps except alleviation of symptoms with rest, pain relievers and cool compresses. Mumps is very rarely fatal.[1],[2],[3]
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Is Mumps Communicable?

Yes. Mumps virus can be found in the saliva, throat and urine of an infected person. Mumps is usually spread through the air by respiratory droplets or by contact with the saliva of an infected person. It is also possible for as many as one-third of infected individuals to “shed” the virus before the symptoms―if any―develop.[4],[5],[6],[7]

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History of Mumps in America

According to Harrison’s Principles of Internal Medicine, before widespread vaccination programs began in 1967, mumps outbreaks used to occur in the U.S. every 2 to 5 years, mainly among children and in crowded, confined populations such as schools and military bases.[8]
 
There have also been sporadic mumps outbreaks in the U.S. over the years among both vaccinated and unvaccinated individuals.
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Can Mumps Cause Injury and Death?

In about 20 percent of cases of in post-pubertal males, mumps can cause tender, painful swelling of the testicles, sometimes causing them to enlarge several times their normal size. According to Harrison’s Principles of Internal Medicine, in rare cases mumps in post-pubertal males, who had enlarged testicles, can result in atrophied testicles and, in about 15 percent of these cases, the men may become sterile.
 
Aseptic meningitis may also develop as a complication of mumps. Rarely, mumps may also cause encephalitis, myocarditis, mastitis, thryoidits, nephritis, arthritis, and thrombocytopenic purpura, as well as spontaneous abortions (miscarriage) in pregnant women, who are infected.

Who Is at Highest Risk for Getting Mumps?

Historically, children between the ages of two and 12 years old have been at highest risk for getting mumps. People, who travel to high-risk countries where mumps is endemic, and those, who spend a lot of time in crowded, confined settings such as daycare centers, schools, college dormitories and military bases, are also at higher risk.
 
Individuals with compromised immune systems, such as those infected with HIV/AIDS, those on chemotherapy for cancer, and those taking oral steroids, may also be at higher risk.[9],[10]

Who Is at Highest Risk for Suffering Complications of Mumps?

According to the CDC, severe complications from mumps is rare but can be severe and  lead to hearing loss in children, miscarriage in pregnant women, swelling of the ovaries in women, and swelling of the testicles in post-pubertal males.[11],[12]
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Mumps Prevention and Treatment Options

According to the CDC, the transmission of infections, incuding mumps, can be reduced by: 
  • not sharing eating utensils or drink containers;
  • washing hands often with soap and water;
  • by cleaning surfaces frequently handled by others, such as toys, doorknobs, tables, and counters;
  • staying home if sick;
  • covering the mouth and nose with a tissue when coughing or sneezing and disposing of the tissue immediately.
There is no specific treatment for mumps except alleviation of symptoms with rest, pain relievers and cool compresses.  [13]
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What Is Mumps Vaccine?

Merck’s MMRII, is the only measles vaccine currently available in the U.S. and is indicated for simultaneous vaccination against measles, mumps, and rubella in individuals aged 12 to 15 months or older.[14] It is a live attenuated virus vaccine propagated in chick embryo cell and cultured with Jeryl Lynn live virus mumps and Meruvax II, a live rubella virus vaccine propagated in WI-38 human diploid lung fibroblasts.[15]

The WI-38 human diploid cell line was derived from the lung tissue of a normal, 3-month human female embryo. The growth medium used in it was a medium of salt solution and 10 percent calf (bovine) serum.[16]
 
The growth medium for measles and mumps in MMRII is a buffered salt solution containing vitamins and amino acids and supplemented with fetal bovine serum containing sucrose, phosphate, glutamate, and recombinant human albumin, and neomycin. The growth medium for rubella is a buffered salt solution containing vitamins and amino acids and supplemented with fetal bovine serum containing recombinant human albumin and neomycin. Sorbitol and hydrolyzed gelatin stabilizer are added to the individual virus harvests.
 
According to the manufacturer, the vaccine is screened for adventitious agents. Each dose contains sorbitol, sodium phosphate, sucrose, sodium chloride, hydrolyzed gelatin, recombinant human albumin, fetal bovine serum, other buffer and media ingredients and neomycin.[17]
 
The CDC recommends that children get two doses of MMR vaccine, with the first dose given between ages 12-15 months, and the second dose between ages 4-6 years.[18]The CDC recommends that people should get at least one dose of MMR vaccine if they were born after 1957 and have no laboratory evidence of immunity or documentation of a MMR shot being given on or after 12 months old. The CDC recommends two doses of MMR for healthcare personnel, students entering college and other post-high school educational institutions, and international travelers.
 
According to Merck, MMR vaccine should be given one month before or one month after any other live viral vaccines.[19],[20]
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History of Mumps Vaccine in America

The mumps virus was isolated in 1934, but it took researchers until 1948 to grow the virus in a laboratory setting. In 1949, the first mumps vaccine was introduced in the U.S., and it was licensed in 1951. In 1963, vaccine researcher Maurice Hilleman used samples from his own daughter’s mumps case to isolate and create a mumps virus vaccine. He called it the Jeryl Lynn strain. It was licensed in 1967 and combined with the measles and rubella vaccine in 1973.
 
Today, mumps vaccine is only available in the U.S. in Merck’s combination MMR vaccine that contains vaccines for mumps, measles and rubella.[21],[22]
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How Effective Is Mumps Vaccine?

According to the manufacturer’s product insert, the mumps vaccine is 96 percent effective.[23] However, in 2012, two former Merck employees filed a lawsuit alleging that Merck altered testing and study results to make the mumps vaccine appear more effective than it is in preventing mumps in children. Specifically, the lawsuit claims that mumps outbreaks in vaccinated children are due to this alleged falsification of efficacy data:[24],[25]
 
“Specifically, in an effort to maintain its Food and Drug Administration (‘FDA’) approval and exclusive license to sell the vaccine, Merck has used improper testing techniques and falsified data to fabricate a vaccine efficacy rate of 95 percent or higher.”
 
Merck has denied all charges in connection with this lawsuit, saying:[26]
 
"Merck has presented information that demonstrated to the United States Department of Justice that these allegations are factually false, and after the Department conducted its own two-year investigation, it decided not to pursue this lawsuit. … {in addition, the FDA} "previously examined the issues raised in the lawsuit, and they were resolved to the agency's satisfaction."
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Can Mumps Vaccine Cause Injury & Death?

Common side effects from the MMR vaccine include low-grade fever, skin rash, itching, hives, swelling, reddening of skin, and weakness. Serious adverse events following MMR vaccination include seizures, severe headaches, double vision, vomiting, joint pain, or pain in the digestive system. [27]
 
Other more rare but serious complications reported by Merck in MMR vaccine post-marketing surveillance include: [28]
  • brain inflammation (encephalitis) and encephalopathy (chronic brain dysfunction);
  • panniculitis (inflammation of the fat layer under the skin);
  • atypical measles;
  • syncope (sudden loss of consciousness, fainting);
  • vasculitis (inflammation of the blood vessels);
  • pancreatitis (inflammation of the pancreas);
  • diabetes mellitus;
  • thrombocytopenia  purpura (blood disorder);
  • leukocytosis (high white blood cell count);
  • anaphylaxis (shock);
  • bronchial spasms;
  • arthritis and arthralgia (joint pain);
  • myalgia (muscle pain);
  • polyneuritis (inflammation of several nerves simultaneously).
According to MedAlerts.org, which facilitates an online search of the federal Vaccine Adverse Events Reporting System (VAERS) database, shows that as of  July 9, 2012, there have been 6,058 serious adverse events reported to VAERS following receipt of MMR vaccine since 1990. Half if the adverse events reported occured in children aged 3 years and younger. These adverse events following MMR vaccination reported to VAERS include: 
  • lupus (autoimmune connective tissue disorder);
  • Guillain-Barre syndrome (inflammation of the nerves);
  • Encephalitis;
  • aseptic meningitis (inflammation of the lining of the brain);
  • deafness;
  • cardiomyopathy (weakening of the heart muscle);
  • hypotonic-hyporesponsive episodes (collapse/shock);
  • convulsions;
  • subacute sclerosing panencephalitis (SSPE);
  • ataxia (loss of ability to coordinate muscle movements);
  • parathesia (numbness, burning, prickling, itching, tingling skins sensation indicating nerve irritation)
In its MMRII product information insert[29] Merck notes that during MMR vaccine post-marketing surveillance, there have been post-vaccination reports of: 
  • pneumonia;
  • erythema multiforme (skin disorder from an allergic reaction or infection);
  • urticarial rash (hives, itching from an allergic reaction);
  • measles-like rash;
  • burning/stinging at the injection site;
  • nerve deafness;
  • otitis media (ear infection);
  • retinitis (inflammation of the retina of the eye);
  • optic neuritis (inflammation of the optic nerve);
  • conjunctivitis.
There have also been 288 deaths reported to VAERS in association with the MMR vaccine. However, the numbers of vaccine-related injuries and deaths reported to VAERS may not reflect the true number of serious health problems that occur develop after MMR vaccination.
 
Even though the National Childhood Vaccine Injury Act of 1986 legally required pediatricians and other vaccine providers to report serious health problems following vaccination to federal health agencies (VAERS), many doctors and other medical workers giving vaccines to children and adults fail to report vaccine-related health problem to VAERS. There is evidence that only between one and 10 percent of serious health problems that occur after use of prescription drugs or vaccines in the U.S. are ever reported to federal health officials, who are responsible for regulating the safety of drugs and vaccines and issue national vaccine policy recommendations. [30],[31], [32],[33]
 
Also, as of March 1, 2012, there have been 898 claims filed so far in the Vaccine Injury Compensation Program (VICP), alleging 56 deaths in connection with the MMR vaccine, and 842 injuries. Of that number, VICP has compensated 324 of those claims.[34]
 
One example of an MMR vaccine injury claim awarded compensation in the VICP is the case of Madyson Williams. Madyson was growing and developing normally until May 12, 2006, when she was given MMR, varicella zoster and Hib vaccines simultaneously during an office visit. Six days later, she developed seizures and died.
 
On Oct. 10, 2008, the Department of Health and Human Services conceded Madyson died from a reaction to MMR vaccine and her parents were awarded $250,000, the maximum amount allowed for an acknowledged vaccine-related death in the VICP. [35],[36]
 
IMPORTANT NOTE: Even though ACIP says it’s safe to give other viral and bacterial vaccines at the same time as MMR vaccine, Merck’s MMRII product information insert states that other live virus vaccines—such as varicella[37] should NOT be given at the same time as MMR vaccine but rather should be administered one month prior or one month after MMR vaccination.[38]
 
Some studies have shown that there is an elevated risk of aseptic meningitis connected with the MMR vaccine containing the urabe strain of mumps.[39] (Merck’s MMRII vaccine used in the U.S. contains the Jeryl Lynn strain of mumps). Other studies have shown that the vaccine components or excipients, particularly egg antigens and porcine or bovine gelatin, can trigger anaphylactic reactions, both immediate and delayed.[40]
 
For more information on reported MMR vaccine risks, adverse events and contraindications, see Measles and Measles Vaccine here.  

Questions to Ask Doctors about Mumps Vaccine

NVIC’s If You Vaccinate, Ask 8! Webpage downloadable brochure suggests asking eight questions before you make a vaccination decision for yourself, or for your child. If you review these questions before your appointment, you will be better prepared to ask your doctor questions.  Also make sure that the nurse or doctor gives you the relevant Vaccine Information Statement (VIS) for the vaccine or vaccines you are considering well ahead of time to allow you to review it before you or your child gets vaccinated. Copies of VIS for each vaccine are also available on the CDC's website and there is a link to the VIS for MMR vaccine on NVIC's “Quick Facts” at the top of this page.
 
It is also a good idea to read the vaccine manufacturer product insert (in this case, Merck’s MMR vaccine information insert) that can be obtained from your doctor or public health clinic because federal law requires drug companies marketing vaccines to include certain kinds of vaccine benefit, risk and use information in product information inserts that may not be available in other published information. A link to Merck’s MMR vaccine product inssert is here
 
Other questions that may be useful to discuss with your doctor before getting the measles (MMR) vaccine are: 
  • If other vaccines in addition to MMR vaccine are scheduled for my child at this office visit, am I allowed to modify the schedule so fewer vaccines are given at once?
  • What should I do if my child has a high fever or appears very ill after vaccination?
  • What other kinds of reaction symptoms should I call to report after MMR vaccination?
  • If the MMR vaccine doesn’t protect my child, do I have any other options for preventing mumps infection?
Under the National Childhood Vaccine Injury Act of 1986, doctors and all vaccine providers are legally required to give you vaccine benefit and risk information before vaccination; record serious health problems following vaccination in the permanent medical record; keep a permanent record of all vaccines given, including the  manufacturer’s name and lot number; and report serious health problems, injuries and deaths that follow vaccination to VAERS.

Remember, if you choose to vaccinate, always keep a written record of exactly which shots/vaccines you or your child have received, including the manufacturer’s name and vaccine lot number. Write down and describe in detail any serious health problems that develop after vaccination, and keep vaccination records in a file you can access easily.  

It also is important to be able to recognize a vaccine reaction and seek immediate medical attention if the reaction appears serious, as well as know how to make a vaccine reaction report to federal health officials at the Vaccine Adverse Reporting System (VAERS). NVIC’s Report  Vaccine Reactions—It’s the Law webpage can help you file a vaccine reaction report yourself to VAERS if your doctor fails or refuses to make a report. 

Additional Bibliography of References

Other Institutions/Organizations 
 
CDC Press Briefing on Mumps Outbreak In the Midwest with Dr. Julie Gerberding, and Dr. Jane Seward - April 2006

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Endnotes


[1] CDC.gov. Fast Facts about Mumps. Mumps. March 24, 2010. Online. http://www.cdc.gov/mumps/about/mumps-facts.html. (Accessed July 2012)
 
[2] CDC.gov. About Mumps. Mumps. Nov 12, 2009. Online. http://www.cdc.gov/mumps/about/index.html. (Accessed July 2012)
 
[3] Kasper D, Fauci A, Longo D, et al. Mumps. Harrison’s Principles of Internal Medicine 16th Edition. 2005.
 
[4] CDC.gov. Fast Facts about Mumps. Mumps. March 24, 2010. Online. http://www.cdc.gov/mumps/about/mumps-facts.html. (Accessed July 2012)
 
[5] CDC.gov. About Mumps. Mumps. Nov 12, 2009. Online. http://www.cdc.gov/mumps/about/index.html. (Accessed July 2012)
 
[6] Kasper D, Fauci A, Longo D, et al. Mumps. Harrison’s Principles of Internal Medicine 16th Edition. 2005.
 
[7] CDC.gov. Fast Facts about Mumps. Mumps. March 24, 2010. Online. http://www.cdc.gov/mumps/about/mumps-facts.html. (Accessed July 2012)
 
[8] Kasper D, Fauci A, Longo D, et al. Mumps. Harrison’s Principles of Internal Medicine 16th Edition. 2005.
                              
[9] Kasper D, Fauci A, Longo D, et al. Mumps. Harrison’s Principles of Internal Medicine 16th Edition. 2005.
 
[10] Mersch J. What Are Risk Factors for Contracting Mumps? Mumps. MedicineNet.com. No date. Online. http://www.medicinenet.com/mumps/page3.htm. (Accessed July 2012)
 
[11] CDC.gov. Clinical Questions & Answers on Mumps. Mumps―Clinical Description. Nov. 12, 2009. Online. http://www.cdc.gov/mumps/clinical/qa-disease.html#b. (Accessed July 2012)
 
[12] Kasper D, Fauci A, Longo D, et al. Mumps. Harrison’s Principles of Internal Medicine 16th Edition. 2005.
 
[13] CDC.gov. Clinical Questions & Answers on Mumps. Mumps―Clinical Description. Nov. 12, 2009. Online. http://www.cdc.gov/mumps/clinical/qa-disease.html#b. (Accessed July 2012)
 
[14] FDA.gov. Vaccines, Blood & Biologicals. Measles, Mumps and Rubella. Aug. 8, 2011. Online. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm094050.htm. (Accessed March 2012)
 
[15][xv] FDA.gov. MMRII. Product Information Sheet. Dec. 2007. Online. http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM123789.pdf. (Accessed March 2012)
 
[16] ViroMed.com. Selected Profiles of Cell Cultures: WI-38 (Lung, Diploid, Human). No Date. Online. http://www.viromed.com/services/product/wi38.htm. (Accessed March 2012)
 
[17] FDA.gov. MMRII. Product Information Insert. Dec. 2007. Online. http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM123789.pdf. (Accessed March 2012)
 
[18] CDC.gov. Vaccines. Recommended Immunization Schedule for persons aged 0 through 6 years. Dec. 23, 2011. Online. http://www.cdc.gov/vaccines/recs/schedules/downloads/child/0-6yrs-schedule-pr.pdf. (Accessed March 2012)
 
[19] Immunize.org. Summary of Recommendations for Adult Immunization. Jan. 2012. Online. http://www.immunize.org/catg.d/p2011.pdf. (Accessed March 2012)
 
[20] FDA.gov. MMRII. Product Information Insert. Dec. 2007. Online. http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM123789.pdf. (Accessed March 2012)
 
[21] FDA.gov. Vaccines, Blood & Biologicals. Measles, Mumps and Rubella. Aug. 8, 2011. Online. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm094050.htm. (Accessed March 2012)
 
[22] Grabenstein JD. ImmunoFacts: Vaccines and Immunologic Drugs 2011. Wolters Kluwer. 2011.
 
[23] FDA.gov. MMR II Measles, Mumps, and Rubella Virus Vaccine Live Product Insert. Merck & Co. Dec 2007. Online. http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM123789.pdf.
(Accessed July 2012)
 
[24] Kamp J. Lawsuit Claims Merck Overstated Vaccine Effectiveness. Nasdaq. June 22, 2012. Online. http://www.nasdaq.com/article/lawsuit-claims-merck-overstated-mumps-vaccine-effectiveness-20120622-00532. (Accessed July 2012)
 
[25] Krahling S, Wlochowski, Plaintiffs, vs Merck. U.S. District Court for the Eastern District of Pennsylvania. Aug 27, 2010. Online. http://www.courthousenews.com/2012/06/27/MerckUnsealed.pdf. (Accessed July 2012)
 
[26] Kramer R. Class Says Merck Lied about Mumps Vaccine. Courthouse News Service. June 27, 2012. Online. http://www.courthousenews.com/2012/06/27/47851.htm. (Accessed July 2012)
 
[27] National Institutes of Health. Emerging & Re-emerging Infectious Disease—Student Activities 5—Making Hard Decisions Measles. No date. Online. http://science.education.nih.gov/supplements/nih1/diseases/activities/activity5_measles-database.htm
(Accessed March 2012)
 
[28] FDA.gov. MMRII. Product Information Sheet. Dec. 2007. Online. http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM123789.pdf. (Accessed March 2012)
 
[29] FDA.gov. MMRII. Product Information Sheet. Dec. 2007. Online. http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM123789.pdf. (Accessed March 2012)
 
[30] Kessler DA, the Working Group, Natanblut S, et al. A New Approach to Reporting Medication  and Device Adverse Effects and Product Problems. JAMA. 1993;269(21):2765-2768. Online. http://jama.ama-assn.org/content/269/21/2765.short. (Accessed March 2012)
 
[31] FDA.gov. Kessler DA. Introducing MEDWatch: A New Approach to Reporting Medication and Device Adverse  Effects and Product Problems. Reprint from JAMA. June 9, 1993. Online. http://www.fda.gov/downloads/Safety/MedWatch/UCM201419.pdf. (Accessed March 2012)
 
[32] Braun M. Vaccine adverse event reporting system (VAERS): usefulness and limitations. Johns Hopkins Bloomberg School of Public Health
 
[33] Rosenthanl S, Chen R. The reporting sensitivities of two passive surveillance systems for vaccine adverse events. Am J Public Health 1995; 85: pp. 1706-9. 
 
[34] U.S. Department of Health and Human Services. Statistics Reports. Claims Filed and Compensated or Dismissed by Vaccine—March 1, 2012. National Vaccine Injury Compensation Program. March 1, 2012. Online. http://www.hrsa.gov/vaccinecompensation/statisticsreports.html#Claims. (Accessed March 2012)
 
[35] Office of Special Masters. United States Court of Federal Claims. Garry and Rachel Williams, as Legal Representatives of Madyson Lee Williams. Oct. 10, 2008. Online. http://www.uscfc.uscourts.gov/sites/default/files/ABELL.Williams.08-0083.Dec.pdf. (Accessed March 2012)
 
[36] KansasCity-Law.com. Verdicts and Settlements. Williams, Minor. v. Secretary of HHS--$250,000 Settlement. Oct. 2008. Online. http://www.kansascity-law.com/Verdicts-Settlements/Vaccine-Injury-involving-paralysis-of-1-year-old-child.shtml. (Accessed March 2012)
 
[37] FDA.gov. Vaccines, Blood & Biologicals. Varicella. No Date. Online. http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM142813.pdf. (Accessed March 2012)
 
[38] FDA.gov. Vaccines, Blood & Biologicals. Measles, Mumps and Rubella. Aug. 8, 2011. Online. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm094050.htm. (Accessed March 2012)
 
[39] Dourado I, Cunha S, Teixeira MG, et al. Outbreak of Aseptic Meningitis Associated with Mass Vaccination with a Urabe-Containing Measles-Mumps-Rubella Vaccine: Implications for Immunization Programs. Am J Epidemiol. March 1, 2000; 151(5):524-30. Online. http://www.ncbi.nlm.nih.gov/pubmed/10707922. (Accessed March 2012)
 
[40] Lakshman R. MMR Vaccine and Allergy. Arch Dis Child 2000;82:93-95. Online. http://adc.bmj.com/content/82/2/93.full. (Accessed March 2012)



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