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Mumps Overview


Quick Facts

Mumps

mumps disease
Image source: CDC PHIL
  • Mumps is a contagious viral infection and symptoms begin with a headache, muscle aches, tiredness, and loss of appetite1. 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 mumps2;
  • 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 person3;
  • The time between when a person comes into contact with a person infected with mumps and first begins to experience symptoms of mumps (incubation period) ranges from 12 to 25 days4. The illness lasts for an average 7-10 days but may last longer before symptoms completely disappear5;
  • The typical “signature” physical sign of mumps is visible swelling of one or both sides of the face under the ears and chin.6 Males, who are past puberty, can experience pain and extreme swelling of the testes and rarely, become sterile.7 Mumps is very rarely fatal8;
  • There is no specific treatment for mumps except alleviation of symptoms with rest, pain relievers and cool compresses9

Mumps Vaccine

  • Currently there are two mumps containing vaccines available in the U.S.  MMR II,10 manufactured by Merck, containing live attenuated measles, mumps, and rubella; and ProQuad (MMR-V),11 also manufactured by Merck, containing live attenuated measles, mumps, rubella, and varicella.  The CDC recommends that children get two doses of a Mumps containing vaccine with the first dose given between ages 12-15 months, and the second dose given between ages 4-6 years;12
  • Common side effects from the MMR or MMR-V vaccine include low-grade fever, skin rash, itching, hives, swelling, reddening of skin, and weakness. Reported serious adverse reactions following MMR and MMR-V vaccination include seizures, brain inflammation and encephalopathy; thrombocytopenia; joint, muscle and nerve pain; gastrointestinal disorders; measles like rash; conjunctivitis and other serious health problems;13 14
  • Since 2006, multiple outbreaks of mumps have occurred in the U.S. and abroad in vaccinated children and young adults, occurring often on college campuses.15 In 2017, the CDC recommended a third dose of a mumps containing vaccine to be administered in the event of an outbreak.16 Numerous studies examining mumps outbreaks that have occurred in highly vaccinated populations have experts suggesting that both the waning of vaccine induced immunity and an ineffective mumps vaccine may be to blame.17 18 19 20 21 22 23 24           
  • In 2010, 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. Court proceedings on the case were expected to begin in 2018,25 however, have been delayed until late 2019 and is still pending.
  • As of January 2, 2019, there had been 1,091 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following mumps-containing vaccination, including 63 deaths and 1,028 serious injuries.
  • Using the MedAlerts search engine, as of December 31, 2018, there have been more than 92,451 reports of mumps vaccine reactions, hospitalizations, injuries and deaths following mumps vaccination made to the federal Vaccine Adverse Events Reporting System (VAERS), including 423 related deaths, 6,795 hospitalizations, and 1,725 related disabilities.
  • 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) 

Centers for Disease Control (CDC)

Vaccine Reaction Symptoms & Ingredients

Our Ask 8, If You Vaccinate webpage contains vaccine reaction symptoms and more.

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.

IMPORTANT NOTE: NVIC encourages you to become fully informed about Mumps and the Mumps vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

What Is Mumps?

Mumps virus is a contagious paramyxovirus that is comprised of a single-stranded RNA genome.26 Respiratory secretions transmit the virus and the infection begins in the nasopharynx and regional lymph nodes. After exposure, it generally takes 12 to 25 days for symptoms to develop.27 These symptoms typically include headache, muscle aches, tiredness, and loss of appetite.28 During this time, the virus is present in the blood and spreads throughout the body’s tissues.29 Parotitis, swelling of the parotid gland on one or both sides of the face under the ears and chin, is the most common clinical feature of a mumps infection, and typically occurs within the first two days.30 Up to 30 percent of people infected with mumps will have no symptoms of infection and up to 50 percent may exhibit signs of a mild nonspecific illness.31

Mumps is generally a mild disease in childhood, but it can result in complications, though mostly in adults.32 Complications of mumps include inflammation of the testicles in males, inflammation of the breast tissue and ovaries in females, meningitis, encephalitis, and loss of hearing. Fertility problems following mumps infection are rare.33 Mumps rarely results in death34 and most people recover from mump infection within a few weeks.35

Is Mumps Contagious?

The mumps virus is contagious and can be found in the saliva, throat, and urine of an infected person. It is spread through the air by respiratory droplets or by contact with the saliva of an infected person.36 The mumps virus has been detected from seven days prior to, and up to fourteen days following the onset of parotitis, however, the highest viral levels generally occur just prior to the onset of parotitis and decrease quickly. It is generally believed that transmission of the virus typically occurs a few days before and after the onset of parotitis.37 A person infected with mumps can spread the virus to others though:38

  • talking, coughing, sneezing
  • improper hand washing
  • sharing utensils or cups

It is also likely that the virus can be transmitted from individuals who are asymptomatic or who show signs of a nonspecific illness.39

Frequently, mumps outbreaks occur where many people live in close proximity to one another, such as close-knit communities, prisons, and college campuses.40 Recently, the majority of mumps outbreaks have occurred in fully vaccinated populations.41 42 43

What is the history of Mumps in America and other countries?

The earliest reports of mumps dates back to Hippocrates in the 5th century BC. Hippocrates reported on an illness that involved swelling just below one or both ears and sometimes involved the swelling and pain of one or both testicles.44 In 1934, researchers determined that the mumps virus that was present in the saliva could be spread from an infected individual to rhesus monkeys.45 The mumps virus was isolated in 1945 and researchers began work on the development of a vaccine against mumps.46

Prior to widespread vaccination programs, mumps outbreaks occurred in the U.S. every 2 to 5 years, mainly among children and in crowded, confined populations such as schools and military bases.47 Currently in countries where there are no widespread mumps vaccination programs, higher incidences of mumps outbreaks occur every 2 to 5 years, and typically affect children between the age of 5 and 9 years.48 Mumps outbreaks occur more often in the winter and spring49 however outbreaks are possible at any time of the year.50

It is not mandatory to report mumps infections, however most health departments will notify the Centers for Disease Control (CDC) in the event of an outbreak.51 Mumps was considered a nationally reportable infection between 1922 and 1950, however, it was removed from the list in 1951.52 53 In 1968, one year after the introduction of Mumpsvax, a live virus vaccine manufactured by Merck, 54 the CDC resumed data collection on mumps infections. 55 In 1968, there were 152,209 reported cases in the United States.56 Reported cases of mumps continued to decrease and by 1977, there were only 21,436 cases reported in the United States.57 By 1985, the number of reported cases had decreased further with only 2,982 cases of mumps reported to the CDC.58 However, between 1985 and 1987, a resurgence of mumps occurred and by 1987, the number of reported cases had risen to 12,848.59 The demographics of mumps infection shifted during this resurgence, with nearly one third of cases occurring in individuals 15 years of age and older. Prior to 1985, mumps infections predominantly affected children between the age of 5 and 9 years of age.60

After 1987, mumps infections continued to decrease again and by 1989, when the CDC’s Advisory Committee on Immunization Practices (ACIP) voted to recommend two doses of the MMR vaccine due to the resurgence of measles in the United States61, only 666 cases of mumps were reported to the CDC.62

However, in late 2004, an outbreak of mumps disease occurred in the United Kingdom and by late 2005, 56,390 cases of mumps had been reported, with the majority occurring in persons aged 15 to 24 years of age, most of whom had not previously been vaccinated for mumps.63 

In the U.S., infections continued to decline until December of 2005, when a large outbreak began at an eastern Iowa university.64 The outbreak continued to spread, affecting many fully vaccinated college students,65 66 and by the end of 2006, 6,584 cases of mumps infection had been reported to the CDC.67

In 2009 and 2010, the U.S., Canada, and Guam experienced mumps outbreaks. 68 69 In the U.S., the majority of cases occurred in the Northeast, affecting mainly adolescent Orthodox Jewish boys.70 There were 4,603 cases of mumps reported to the CDC as a result of the outbreaks that occurred in 2009 and 2010.71 72 As with the 2006 outbreak, most persons affected with mumps were previously vaccinated for mumps.

Outbreaks in the United States have continued to occur in highly vaccinated populations, especially among young adults residing on college campuses.  In 2011, an outbreak occurred on a university campus in California.73 In 2015-2016, several Midwest universities experienced outbreaks, again, affecting highly vaccinated students.74 75 In 2016-2017, nearly 3000 people living in a close-knit community in Northwest Arkansas were infected with mumps.76 In October 2017, as a result of the continued outbreaks among highly vaccinated individuals, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended that a third dose of a mumps containing vaccine be administered in the event of an outbreak of the illness.77

Mumps outbreaks continue to occur in the United States and between January 1 and December 29, 2018, there were 2,251 cases of mumps reported to the CDC.78 It is not mandatory for mumps infections to be reported to the CDC, therefore the actual number of mumps infections may be significantly higher that the reported number of cases.79 Further, as up to 30 percent of people infected with mumps infection are asymptomatic and up to 50 percent may exhibit signs of a mild nonspecific illness,80 it is very likely that mumps infection rates are significantly higher than the number of reported cases.

Can Mumps Cause Injury and Death?

Complications and death from mumps infections are rare.81 Complications include inflammation of the testicles in males, which can, in rare cases, result in atrophied testicles and lead to sterility.82

Aseptic meningitis may also develop as a complication of mumps.83 Rarely, mumps may also cause pancreatitis,84 encephalitis,85 86 oophoritis,87 hearing loss,88 89 mastitis,90 91 myocarditis,92 93 thyroiditis,94 nephritis,95 96 arthritis,97 98 diabetes,99 and thrombocytopenic purpura.100 Spontaneous abortions (miscarriage) in pregnant women infected with mumps have also been reported101.

No mumps related deaths have been reported in recent years.102

Who is at highest risk for getting Mumps?

Prior to the recommendation of routine mumps vaccination, mumps infections most commonly affected children between the ages of 5 and 9 years of age.103 However, since the mid 1980’s, the demographic of mumps infection in the U.S. has shifted, resulting in a higher risk of mumps infection in older children, adolescents, and young adults.104  People who travel to high-risk countries where mumps is endemic105 and those who spend a great deal of time in crowded, confined settings such as daycare centers, schools, college dormitories and military bases, are also at higher risk.106

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 for contracting mumps infection.107 108

Who is at highest risk for suffering complications from Mumps?

Adults are more likely to suffer complications from mumps infection.109 As well, pregnant women may also be at a higher risk of miscarriage should infection occur early in pregnancy.110

Complications from mumps infection are rare but can lead to hearing loss, pancreatitis, swelling of the ovaries in women, swelling of the testicles in post-pubertal males, meningitis and encephalitis.111

Can Mumps be prevented and are there treatment options?

Prevention of mumps involves reducing the transmission of infections. This includes:112

  • not sharing eating utensils or drink containers;
  • washing hands often with soap and water;
  • 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, hydration, soft diet, pain relievers, cool compresses and avoidance of acidic foods and beverages.113

What is Mumps vaccine?    

There are two mumps containing vaccines available for use in the United States - MMRII114 - a combination measles-mumps-rubella (MMR) live virus vaccine and ProQuad115 -  a combination measles-mumps-rubella-varicella (MMR-V) live virus vaccine. Both products are manufactured and distributed by Merck.

MMRII is licensed and recommended for individuals aged 12 months or older. It is a live attenuated virus vaccine propagated in chick embryo cells and cultured with Jeryl Lynn live attenuated virus mumps and Meruvax II, a live attenuated virus vaccine propagated in WI-38 human diploid lung fibroblasts.116 The WI-38 human diploid cell line was derived from the lung tissue of a three-month human female embryo.117 The growth medium used was salt solution and 10 percent calf (bovine) serum.118

ProQuad is licensed and recommended for individuals aged 12 months to 12 years of age. ProQuad (Measles, Mumps, Rubella and Varicella Virus Vaccine Live) is a combined, attenuated, live virus vaccine containing measles, mumps, rubella, and varicella viruses. ProQuad is a sterile lyophilized preparation of the components of M-M-R II (Measles, Mumps, and Rubella Virus Vaccine Live): Measles Virus Vaccine Live, and Varicella Virus Vaccine Live (Oka/Merck), the Oka/Merck strain of varicella-zoster virus propagated in MRC-5 cells. MRC-5 cells are derived from a cell line that was developed in 1966 from lung tissue taken from a 14 week aborted fetus and contains viral antigens.119

The growth medium for measles and mumps for both MMRII120 and ProQuad121 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. In the ProQuad vaccine,122 the Oka/Merck strain of the live attenuated varicella virus, initially obtained from a child with wild-type varicella, then introduced into human embryonic lung cell cultures, adapted to and propagated in embryonic guinea pig cell cultures and finally propagated in human diploid cell cultures (WI-38) is added to the MMRII component.

According to Merck, both MMRII and ProQuad vaccines are screened for adventitious agents. Each dose of MMRII contains sorbitol, sodium phosphate, sucrose, sodium chloride, hydrolyzed gelatin, recombinant human albumin, fetal bovine serum, other buffer and media ingredients and neomycin.123 Each dose of ProQuad contains sucrose, hydrolyzed gelatin, sorbitol, MSG, sodium phosphate, human albumin, sodium bicarbonate, potassium phosphate and chloride, neomycin, bovine calf serum, chick embryo cell culture, WI-38 human diploid lung fibroblasts and MRC-5 cells.124 125

The MMRII vaccine product information insert states that the MMRII vaccine should be given one month before or one month after any other live viral vaccines.126 The ProQuad vaccine product information insert states that one month should lapse between administration of ProQuad and another measles containing vaccine such as MMRII and at least three months should lapse between ProQuad and any varicella containing vaccine.127

Currently, the CDC recommends that children receive two doses of a mumps containing vaccine, with the first dose between the ages 12-15 months, and the second dose between the ages 4-6 years.128 The CDC also recommends that individuals born after 1957 and have no laboratory evidence of immunity or documentation of vaccination should receive at least one dose of MMR vaccine.129 Two doses of MMR vaccine are also recommended for healthcare personnel, students entering college and other post-high school educational institutions, as well as international travelers.130

The CDC also recommends MMR vaccination for infants between 6 and 12 months of age who may be traveling internationally.131 However, both ProQuad132 and MMRII133 have been approved only for use in for children older than 12 months of age. The MMRII vaccine product insert states that effectiveness and safety of administration of MMRII has not been established in children between the ages of 6 and 12 months of age and if administered to this population, antibodies may not develop. According to the CDC, an infant vaccinated prior to 12 months of age would still require two additional doses of MMR vaccine.134

In October of 2017, following numerous outbreaks of mumps infections throughout the United States, most notably on college campuses, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended a third dose of a mumps containing vaccine be administered in the event of an outbreak.135

What is the history of Mumps vaccine use in America?

The mumps virus was detected in 1934, and isolated in 1945, however it took researchers until 1948 to grow the virus in a laboratory setting.136 The first mumps vaccine, a killed virus vaccine, was developed for use in the United States in 1948.137 This vaccine, producing only short-term immunity, was available and used from 1950 until its discontinuation in 1978.138

In 1963, vaccine researcher Maurice Hilleman used samples from his own daughter’s mumps case to isolate the mumps virus.139 This mumps strain, known as the Jeryl Lyn Strain named for his daughter, was used to create Mumpsvax, the first live mumps virus vaccine.140 Mumpsvax, manufactured by Merck, became available for use in the United States in 1967.141  In 1971, Mumpsvax was combined with the measles and rubella vaccine to become the MMR vaccine.142 Currently, mumps vaccine is only available in combination with measles and rubella (MMRII)143 and measles, rubella, and varicella (ProQuad)144. Both vaccines are manufactured by Merck.

In 1977, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended a single dose of mumps vaccine for all children at 12 months of age.145 However, in response to a resurgence of measles in the United States in 1989, the ACIP updated its recommendation, recommending that two doses of a measles containing vaccine, preferably the MMR vaccine, be administered to all children. In this recommendation, the ACIP acknowledged that mumps outbreaks have occurred in highly vaccinated populations and that an additional dose of mumps vaccine was important to assure immunity, however, there was no formal recommendation for a second dose of mumps vaccine to be administered.146 Recommendations were updated again in 1998 when the ACIP recommended that the MMR vaccine be the vaccine of choice and for all fifty states to adopt vaccine legislation requiring that children receive two doses of MMR vaccine, after the age of 12 months, and at least one month apart, for school entry.147 At the time of this recommendation, the ACIP did not consider the second dose of MMR vaccine to be a booster dose for mumps or rubella, reporting “a primary immune response to the first dose provides long-term protection.”148 They did, however, report that field studies on the mumps vaccine indicated an estimated vaccine effectiveness to be between 75 and 95 percent.149

Mumps infections in the U.S. remained low until late 2005, when the Midwest experienced a large outbreak in a highly vaccinated population that included several college campuses.150 151 As a result of this outbreak, the ACIP formally recommended two doses of mumps vaccine for school aged children and high-risk adults in May 2006.152  High-risk adults were defined as college students, health care providers, and international travelers.153  Mumps outbreaks continued to occur both in the United States as well as abroad.154 155 156 157

In 2010, 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. The lawsuit, unsealed in 2012, also claimed that outbreaks in vaccinated populations were directly related to the falsification of the mumps efficacy data.

Specifically, the suit claims Merck manipulated the results of clinical trials beginning in the late 1990s so as to be able to report that the combined mumps vaccine, known as MMR-II (a revised version of the 1971 MMR shot containing a different strain of the rubella virus), is 95 percent effective, in an effort to maintain its exclusive license to manufacture it. This percentage is the benchmark used by the FDA to grant Merck approval to sell its original mumps vaccine in 1967.”158

Scientists involved in the whistleblower case claimed that Merck falsified vaccine efficacy testing by adding animal antibodies to the samples in order to demonstrate a vaccine effectiveness of 95 percent.159

Merck denied all charges in connection with the lawsuit and stated:

"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."160

In 2015, Merck was accused by attorneys representing the scientists of stonewalling the case by stating that they are unable to perform current clinical trials of the mumps vaccine to determine current efficacy of the vaccine and instead provided the court with 50-year old efficacy data.161 Trial proceedings in the case were expected to begin in 2018, however, was delayed until late 2019.

In 2017, as a result of continued outbreaks in fully vaccinated populations, the CDC’s Advisory Committee of Immunization Practices (ACIP) recommended that a third dose of a mumps containing vaccine be administered in the event of an outbreak, stating:

“Current routine recommendation for 2 doses of MMR vaccine appears to be sufficient for mumps control in the general population, but insufficient for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with 2 doses of MMR vaccine is high.”162

How Effective Is Mumps Vaccine?

According to the manufacturer’s product insert, the mumps vaccine is 96 percent effective.163 However, the Centers for Disease Control (CDC) reports that two doses of mumps vaccine are between 31 and 95 percent effective, while a single dose is 49 to 91 percent effective.164

Mumps outbreaks in highly vaccinated populations began in 2006 with the majority of cases occurring among young adults between the ages of 18 and 24. By the late 2000’s, researchers began speculating that the lack of natural boosting from exposure to wild-type mumps may be resulting in waning of vaccine acquired immunity. Moreover, the number of asymptomatic patients transmitting the infection to others may be higher than the estimated 30 percent, thus affecting public health measures designed to contain the outbreak. As a result of the resurgence in mumps cases among highly vaccinated individuals, experts reported that measures to locate unvaccinated individuals would not be helpful, and a third dose of mumps vaccine (MMR) was suggested as method of preventing and containing further outbreaks.165 166

Studies have noted mumps vaccine waning as evidenced by outbreaks occurring more frequently among adults, rather than children, 167 168 with researchers predicting an increase in mumps outbreaks as vaccine-induced immunity replaces natural immunity to the disease.169 The time between the last dose of mumps vaccine (MMR) and the onset of the disease appears to be a factor in outbreaks, suggestive of vaccine waning and its inability to confer long lasting immunity.170

Several researchers have reported the current two-dose MMR vaccine strategy to be ineffective at preventing mumps outbreaks. 171 172 Additionally, while health officials believe that the administration of a third dose of MMR vaccine may assist in controlling an outbreak, they have also indicated that routine recommendation of an additional dose will not prevent mumps outbreaks. 173 174 175 Both the rapid decrease in vaccine induced mumps antibody levels, as well as the emergence of mumps strains not targeted by the vaccine, may cause additional booster doses of mumps vaccine to be ineffective at preventing and controlling mumps outbreaks. The limited effectiveness of the current vaccine strategies to prevent mumps outbreaks has prompted several experts to recommend that more research be dedicated to examining the immune system’s response to mumps vaccination. 176 177 Numerous studies focused on the continued mumps outbreaks occurring in highly vaccinated populations have many researchers suggesting that both the waning of vaccine induced immunity and the lack of an effective mumps vaccine may be to blame.178 179 180 181 182 183 184 185

The MMRII and ProQuad (MMRV) vaccines contain mumps genotype A, the Jeryl Lynn strain, isolated from samples collected in 1963. However, since 2006, mumps genotype G has become the predominant circulating strain of mumps in the United States. The CDC reports that while studies have found the Jeryl Lynn (genotype A) strain effective at preventing mumps infections caused by genotype G, vaccine induced antibodies have been noted to be lower.186 In 2015-2016, a large mumps outbreak involving mumps genotype G in Norway concluded that the genotype A found in the MMR vaccine offered “suboptimal protection against mumps genotype G”.187 Additional studies have also reported that the Jeryl Lynn mumps strain to be inadequate to protect against the strains of mumps that are currently circulating.188 189

In 2010, two former Merck employees filed a lawsuit alleging that Merck altered the vaccine efficacy testing and study results in an attempt to make the mumps vaccine appear more effective than it is. Specifically, the lawsuit made claims that mumps outbreaks in vaccinated individuals were directly related to the alleged falsification of efficacy data.190 191 The lawsuit is still pending at this time.

In October of 2017, as a result of continual mumps outbreaks in highly vaccinated populations, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended a third dose of mumps vaccine (MMR) to be administered in the event of an outbreak. At the time of this recommendation, the use of a third MMR vaccine was reported to be between 61 and 88 percent effective at preventing mumps infection.192

Can Mumps Vaccine Cause Injury & Death?

The Centers for Disease Control (CDC) report minor side effects from the MMRII and ProQuad vaccines to include low-grade fever, injection site redness or rash, pain at the injection site, and facial swelling. Moderate side effects include a full body rash, temporary low platelet count, temporary stiffness and pain the joints and seizures, and seizures. 193 194 ProQuad, however, has a higher risk of seizure than separate administrations of MMR and varicella vaccines, especially when given as the first dose of the series.195   Rare serious side effects include brain damage, coma, chronic seizure disorder, lowered level of consciousness and loss of hearing.196 197

Serious complications reported by Merck in the MMRII product insert during vaccine post-marketing surveillance include:198

  • 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);
  • Henoch-Schönlein purpura (inflammation and bleeding in the small blood vessels);
  • acute hemorrhagic edema of infancy (rare vasculitis of the skin’s small vessels occurring in infants);
  • leukocytosis (high white blood cell count);
  • anaphylaxis (shock);
  • bronchial spasms;
  • pneumonia;
  • pneumonitis (inflammation of the lung tissues);
  • arthritis and arthralgia (joint pain);
  • myalgia (muscle pain);
  • polyneuritis (inflammation of several nerves simultaneously);
  • measles inclusion body encephalitis (disease affecting the brain of immunocompromised persons);
  • subacute sclerosing panencephalitis (fatal progressive brain disorder caused by exposure to the measles virus);
  • Guillain-Barre Syndrome (GBS)(disease where the body’s immune system attacks the nerves);
  • acute disseminated encephalomyelitis (ADEM) (brief widespread inflammation of the nerve’s protective covering);
  • transverse myelitis (inflammation of the spinal cord);
  • aseptic meningitis;
  • erythema multiforme (skin disorder from an allergic reaction or infection);
  • urticarial rash (hives, itching from an allergic reaction);
  • measles-like rash;
  • Stevens-Johnson syndrome (severe reaction causing the skin and mucous membranes to blister, die, and shed);
  • nerve deafness (hearing loss from damage to the inner ear);
  • otitis media (ear infection);
  • retinitis (inflammation of the retina of the eye);
  • optic neuritis (inflammation of the optic nerve);
  • conjunctivitis (pink eye);
  • ocular palsies (dysfunction of the ocular nerve);
  • epididymitis (inflammation of the epididymis);
  • paresthesia (burning or prickling of the skin);
  • death.

Serious complications reported by Merck in the ProQuad product insert during vaccine post-marketing surveillance include199:

  • measles;
  • atypical measles;
  • vaccine strain varicella;
  • varicella-like rash;
  • herpes zoster;
  • herpes simplex;
  • pneumonia and respiratory infection;
  • pneumonitis;
  • bronchitis;
  • epididymitis;
  • cellulitis;
  • skin infection;
  • subacute sclerosing panencephalitis;
  • aseptic meningitis;
  • thrombocytopenia;
  • aplastic anemia (anemia due to the bone marrow’s inability to produce platelets, red and white blood cells);
  • lymphadenitis (inflammation of the lymph nodes);
  • anaphylaxis including related symptoms of peripheral, angioneurotic and facial edema;
  • agitation;
  • ocular palsies;
  • necrotizing retinitis (inflammation of the eye);
  • nerve deafness;
  • optic and retrobulbar neuritis (inflammation of the optic nerve);
  • Bell’s palsy (sudden but temporary weakness of one half of the face);
  • cerebrovascular accident (stroke);
  • acute disseminated encephalomyelitis;
  • measles inclusion body encephalitis;
  • transverse myelitis;
  • encephalopathy;
  • Guillain-Barré syndrome;
  • syncope (fainting);
  • tremor;
  • dizziness;
  • paraesthesia;
  • febrile seizure;
  • afebrile seizures or convulsions;
  • polyneuropathy (dysfunction of numerous peripheral nerves of the body);
  • Stevens-Johnson syndrome;
  • Henoch-Schönlein purpura;
  • acute hemorrhagic edema of infancy;
  • erythema multiforme;
  • panniculitis;
  • arthritis;
  • death

A 2014 published study on the MMR-V vaccine in Canada determined that the risk of febrile seizures to be double in children receiving the MMR-V vaccine when compared to those receiving the MMR and varicella vaccine separately.200 A 2015 meta-analysis concluded a two-fold increase in febrile seizures between 5 and 12 days or 7 and 10 days following MMR-V vaccination in children between the ages of 10 and 24 months.201

ProQuad vaccine contains albumin, a human blood derivative and as a result, a theoretical risk of contamination with Creutzfeldt-Jakob disease (CJD) exists. Merck states that no cases of transmission of CJD or other viral diseases have been identified and all virus pools, cells, bovine serum, and human albumin used in vaccine manufacturing are all tested to assure the final product is free of potentially harmful agents.

The MMRII and the ProQuad product inserts report that cases of measles inclusion body encephalitis, pneumonitis and death have occurred in severely immunocompromised individuals who were inadvertently vaccinated and disseminated mumps and rubella infections have also been reported in this population.

In the comprehensive report evaluating scientific evidence, Adverse Effects of Vaccines: Evidence and Causality202, published in 2012 by the Institute of Medicine (IOM), 30 reported vaccine adverse events following the Measles, Mumps, and Rubella (MMR) vaccine were evaluated by a physician committee203. These adverse events included measles inclusion body encephalitis, febrile seizures, arthritis, meningitis, Guillain Barre Syndrome, autism, diabetes mellitus, optic neuritis, transverse myelitis and more.

In 23 of the 30 measles, mumps, and rubella (MMR) vaccine-related adverse events evaluated, the IOM committee concluded that there was inadequate evidence to support or reject a causal relationship between the MMR vaccine and the reported adverse event, primarily because there was either an absence of methodologically sound published studies or too few quality studies to make a determination.204 The IOM committee, however, concluded that the scientific evidence “convincingly supports” a causal relationship between febrile seizures, anaphylaxis, and measles inclusion body encephalitis in immunocompromised individuals and the MMR vaccine and favored acceptance of a causal relationship between transient arthralgia in both children and women and the MMR vaccine.205 The IOM committee also concluded that it favored rejection of a causal association between both autism and the MMR vaccine and Type 1 diabetes and the MMR vaccine, however, both of these conclusions resulted following the review of only five epidemiological studies.206

A study published in 2012207 by the Cochrane Collaborative examined 57 studies and clinical trials involving approximately 14.7 million children who had received the MMR vaccine. While the study authors said they were not able to detect a “significant” association between MMR vaccine and autism, asthma, leukemia, hay fever, type I diabetes, gait disturbance, Crohn’s disease, demyelinating diseases or bacterial or viral infections, they added that:

“The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.”208

Published studies have shown that the MMR vaccine components or excipients, particularly egg antigens and porcine or bovine gelatin, can trigger both immediate and delayed anaphylactic reactions.209 210

In November 2014, the National Vaccine Information Center published a special report The Emerging Risks of Live Virus and Virus Vectored Vaccines: Vaccine Strain Virus Infection, Shedding and Transmission.211  This report reviewed the medical literature for evidence that live virus vaccine strain infection, shedding and potential for transmission occurs, including mumps vaccine strain infection and shedding.

In 2006, a published report confirmed the transmission of Leningrad-3 live attenuated mumps vaccine virus infection from healthy vaccinated children in Russia to close contacts of previously vaccinated children.212 The six vaccinated children had mumps symptoms, but the 13 close contacts did not have symptoms even though some of them tested positive for mumps vaccine strain infection.

In 2008, a published report confirmed the transmission of L-Zagreb mumps vaccine strain virus infection and transmission by three vaccinated children in Croatia to five adult parent contacts. Mumps symptoms began in the children within three weeks of vaccination and symptoms began in the parents within five to seven weeks after the children were vaccinated. One of the affected adults suffered mumps vaccine strain associated aseptic meningitis.213

Merck’s ProQuad vaccine product insert reports that transmission of varicella vaccine virus may occur between vaccine recipients and susceptible contacts, including high risk individuals resulting in both the development or non-development of varicella-like rash. As a result, Merck cautions that vaccine recipients should attempt to avoid close contact with high-risk individuals. This high-risk population includes pregnant women who lack a positive history of illness or vaccination and their newborn infants, any infants born prior to 28 weeks gestation, and all immunocompromised individuals.214

Both wild-type mumps and the live Urabe mumps vaccine strain are causally associated with aseptic meningitis (inflammation of the brain), a mumps virus infection complication.215 216 217 The MMRII and ProQuad vaccines contain the Jeryl Lynn mumps vaccine strain and both product inserts deny that this particular strain can cause aseptic meningitis.218 219

As of December 31, 2018, there have been 394 deaths reported to VAERS in association with the MMR vaccine and 23 deaths associated with the MMR-V 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.220 221 222 223 224

As of January 2, 2019, there have been 1,091 claims filed so far in the federal Vaccine Injury Compensation Program (VICP) for 63 deaths and 1,028 injuries that occurred after vaccination with a mumps containing vaccine (MMR, MMR-V, mumps). Of that number, the U.S. Court of Claims administering the VICP has compensated 423 children and adults, who have filed mumps vaccine injury.225

One example of an MMR vaccine injury claim awarded compensation in the VICP is the case of O.R. On February 13, 2013, O.R. received the MMR, Haemophilus Influenzae type B, Pneumonia (Prevnar 13), Hepatitis A, and Varicella vaccines. That evening, following vaccination, she became feverish and irritable prompting her mother to contact the doctor. The doctor advised O.R.’s mom to administer Benadryl and Tylenol for her symptoms. The fever persisted for several days and was followed by a severe seizure resulting in cardiac and respiratory arrest. The cardiac arrest and seizures caused O.R. to develop encephalopathy, kidney failure, severe brain injury, low muscle tone and cortical vision impairment. After several months of inpatient hospitalization, O.R. was discharged home with 24-hour supervised medical care.226 On November 20, 2017, the court conceded that the MMR vaccine caused her encephalopathy and O.R. was awarded a $101 million dollar settlement to cover medical expenses for the rest of her life.227 228

For more information on reported MMR vaccine risks, adverse events and contraindications, see Measles and Measles Vaccine here.  

Who is at highest risk for complications from Mumps vaccine?

According to the MMRII product insert,229 persons most at risk for complications from MMRII vaccine include individuals with both primary and acquired immunodeficiency such as AIDS, dysgammaglobulinemic and hypogammaglobulinemic states, and cellular immune deficiencies. Pneumonitis, measles inclusion body encephalitis, and death have also occurred as a result of being inadvertently vaccinated with a measles containing vaccine.

Persons with thrombocytopenia or history of the condition may also be at greater risk for exacerbation or redevelopment of thrombocytopenia with subsequent doses of MMRII vaccine.

Individuals with a personal history of cerebral injury, personal or family history of seizures, or any other health condition where stress related to fever should be avoided, may also be at greater risk for complications.

As both the live measles and live mumps vaccines are manufactured using chick embryo cell culture, individuals with a history of an immediate reaction, as well as those with anaphylactic and anaphylactoid reactions to eggs may be at greater risk of a reaction from the MMRII vaccine. MMRII contains neomycin and persons who have previously experienced an anaphylactic reaction to either systematic or topical neomycin should not be vaccinated with MMRII due to the risk of reaction and subsequent complications resulting from the reaction.

Merck’s ProQuad (MMR-V) vaccine product insert230 states that children between the ages of 12 and 23 months with no history of vaccination or wild-type infection with measles, mumps, rubella, and varicella have a higher risk of fever and febrile seizure between 5 and 12 days following vaccination with ProQuad in comparison with children who were vaccinated with separate doses of MMRII and Varicella vaccine. Children with a personal or family history of convulsion or a personal history of cerebral illness or medical condition where stress from fever should be avoided may also be at a greater risk of complications from ProQuad.

Individuals most at risk for complications from ProQuad vaccine include persons with both primary and acquired immunodeficiency such as AIDS, dysgammaglobulinemic and hypogammaglobulinemic states, and cellular immune deficiencies. Pneumonitis, measles inclusion body encephalitis, and death have also occurred as a result of being inadvertently vaccinated with a measles containing vaccine. As well, reports of disseminated varicella vaccine virus infection occurring in children with underlying immunodeficiency disorders inadvertently with a varicella-containing vaccine have also been documented.

Who should not get Mumps vaccine?

Contraindications to receiving the MMRII vaccine documented in Merck’s product insert include231:

  • Persons who have experienced a severe allergic reaction or anaphylaxis to any MMR vaccine component, including gelatin and neomycin, should not be vaccinated with MMR.
  • Pregnant women should not receive this vaccine, as well as women seeking to become pregnant should avoid become pregnant for 3 months following MMR vaccination.
  • Individuals receiving immunosuppressive therapy. Vaccination with MMR should be delayed for 3 months following the administration of human immune globulin, blood, or plasma.
  • Persons with leukemia, lymphoma, blood dyscrasias and other malignant neoplasms affecting the lymphatic systems or bone marrow.
  • Individuals with febrile respiratory illness or other active febrile infection should avoid MMR vaccine.
  • MMR and other measles-containing vaccines are not recommended for HIV-infected persons with evidence of severe immunosuppression.
  • Persons with a family history of hereditary or congenital immunodeficiency should not be vaccinated with MMR until the immune competence of the recipient has been determined.
  • Individuals with untreated tuberculosis should not be vaccinated with MMR vaccine.

Merck’s MMRII product insert also warns that caution should be taken when administering the vaccine to individuals with a history of cerebral injury, family or personal history of convulsions, or any other condition where stress related to fever should be avoided. As well, a person with thrombocytopenia may exacerbate their condition by receiving the MMR vaccine.

Both live measles and mumps vaccine are manufactured in chick embryo cell culture. Extreme caution should be taken when vaccinating individuals with a history of anaphylaxis or immediate hypersensitivity to eggs and Merck advises careful evaluation of the risks and benefits when considering vaccination in this population.

Rubella vaccine virus has been found in the breast milk of nursing mothers with documentation of its ability to be transferred to infants. Serological evidence of rubella infection and a case of mild clinical illness typical with an acquired rubella infection has also been documented in a nursing infant. As a result of these findings, Merck cautions the use of MMR vaccine in nursing women.

IMPORTANT NOTE: Even though the CDC’s Advisory Committee on Immunization Practices (ACIP) states that Merck’s MMRII vaccine can be administer at the same time as other viral and bacterial vaccines, Merck’s MMRII product information insert states that other live virus vaccines—such as varicella232 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.233

Additionally, Merck’s product insert does not recommend giving MMRII at the same time as DTP (diphtheria, tetanus, pertussis) and/or OPV (oral poliovirus vaccine) even though the Advisory Committee on Immunization Practices (ACIP) has stated that simultaneous administration of the entire recommended vaccine series is acceptable.234

MMRII vaccine is approved for use in persons 12 months of age and older. Despite recommendations by the CDC’s Advisory Committee on Immunization (ACIP) that children between 6 and 12 months who will be traveling or residing abroad be vaccinated with MMR prior to international travel,235 Merck’s MMRII product insert states that effectiveness and safety have not been established in this population.236

Contraindications to receiving ProQuad (MMR-V) vaccine documented in Merck’s product insert include:237

  • Persons who have experienced a severe allergic reaction or anaphylaxis to any MMR-V vaccine component, including gelatin and neomycin, should not be vaccinated with MMR-V.
  • Febrile illness or active untreated tuberculosis
  • Persons with acquired or primary immunodeficiency status and individuals receiving immunosuppressive therapy. Vaccination with MMR-V should be delayed for 3 months following the administration of human immune globulin, blood, or plasma.
  • Individuals with a family history of hereditary or congenital immunodeficiency.
  • Pregnant women.
  • Persons with leukemia, lymphoma, blood dyscrasias and other malignant neoplasms affecting the lymphatic systems or bone marrow.

Merck’s ProQuad(MMR-V) product insert warns of a higher incidence of fever and febrile seizures in children between the ages of 12 and 23 months following administration of ProQuad(MMR-V) in comparison with children who receive separate doses of MMR and varicella vaccines. Caution is advised when administering ProQuad(MMR-V) in children with a history of seizures, cerebral injury, or any other medical condition where stress from fever should be avoided.

Both live measles and mumps vaccine are manufactured in chick embryo cell culture. Extreme caution should be taken when vaccinating individuals with a history of anaphylaxis or immediate hypersensitivity to eggs and Merck advises careful evaluation of the risks and benefits when considering vaccination in this population.

Merck’s ProQuad (MMR-V) vaccine product insert reports that transmission of varicella vaccine virus may occur between vaccine recipients and susceptible contacts, including high risk individuals, resulting in both the development or non-development of varicella-like rash. As a result, Merck cautions that vaccine recipients should attempt to avoid close contact with high-risk individuals. This population includes pregnant women who lack a positive history of illness or vaccination and their newborn infants, any infants born prior to 28 weeks gestation, and any immunocompromised individuals.

Merck also advises careful evaluation of the risk and benefits of vaccination with ProQuad (MMR-V) in children with thrombocytopenia or history of the blood disorder as no clinical data on the development or exacerbation of this condition exists. Thrombocytopenia has been reported following vaccination with MMRII, measles vaccine, varicella vaccine and again following an addition dose of both measles and MMRII vaccines.

The safety or efficiency of ProQuad (MMR-V) has not been determined in children who are infected with human immunodeficiency virus (HIV).

Children between 12 months and 12 years of age who receive ProQuad (MMR-V) vaccine should avoid the use of salicylate (aspirin) or salicylate-containing products for 6 weeks following vaccination due to the risk of Reye Syndrome with aspirin and wild-type varicella disease.

ProQuad (MMR-V) is approved for use in children 12 months to 12 years of age. Children under the age of 1 year or older than 12 years of age should not receive ProQuad vaccine.

What questions should I ask my doctor about the 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 and MMR-V vaccines on NVIC's “Quick Facts” at the top of this page.

It is also a good idea to read the vaccine manufacturer product 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. Merck’s MMRII and MMR-V vaccine product inserts are located on the Food and Drug Administration’s website.

Other questions that may be useful to discuss with your doctor before getting the mumps (MMR or MMR-V) vaccine are: 

  • If other vaccines in addition to MMR/MMR-V 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/MMR-V vaccination?
  • If the MMR/MMR-V 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.

NVIC Press Releases, Statements, and Commentaries Related to Mumps

NVIC Reports

The Vaccine Reaction

Additional Bibliography of References

Manufacturer Product Information Inserts:

Centers for Disease Control (CDC)

Selected Media Articles

Medical Literature

References

1 CDC. Signs & Symptoms of Mumps. Jul. 27, 2016

2 CDC. Complications of Mumps. Jul. 27, 2016

3 CDC. Mumps - Pathogenesis Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

4 CDC. Signs & Symptoms of Mumps. Jul. 27, 2016

5 National Institute of Health (NIH) Mumps Summary. MedlinePlus. Apr. 30, 2018

6 CDC Signs and Symptoms of Mumps. Jul. 27, 2016

7 CDC. Mumps - Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

8 Ibid

9 Mayo Clinic Mumps treatment. Aug. 12, 2015

10 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

11 FDA PROQUAD. May 16, 2017

12 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. June 14, 2013; 62(RR04);1-34

13 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

14 FDA PROQUAD. May 16, 2017

15 CDC Mumps Cases and Outbreaks. Jun. 27, 2018

16 CDC Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR Jan. 12, 2018; 67(1);33–38

17 Principi N, Esposito S. Mumps outbreaks: A problem in need of solutions. J Infect. 2018 Jun;76(6):503-506

18 Fields VS, Safi H, Waters C et al. Mumps in a highly vaccinated Marshallese community in Arkansas, USA: an outbreak report. Lancet Infect Dis. 2019 Feb;19(2):185-192

19 L’Huillier AG, Eshaghi A,Racey CS et al. Laboratory testing and phylogenetic analysis during a mumps outbreak in Ontario, Canada Virol J. 2018; 15: 98.

20 Lewnard JA, Grad, YH Vaccine waning and mumps re-emergence in the United States Sci Transl Med. 2018 Mar 21; 10(433): eaao5945.

21 Dayan GH, Quinlisk MP, Parker AA et al. Recent resurgence of mumps in the United States. N Engl J Med. 2008 Apr 10;358(15):1580-9.

22 Dayan GH, Rubin S Mumps outbreaks in vaccinated populations: are available mumps vaccines effective enough to prevent outbreaks? Clin. Infect. Dis. 2008; 47: 1458–1467

23 Peltola H, Kulkarni PS, Kapre SV et al. Mumps outbreaks in Canada and the United States: time for new thinking on mumps vaccines. Clin Infect Dis. 2007 Aug 15;45(4):459-66

24 Choi KM. Reemergence of mumps. Korean J Pediatr. 2010 May; 53(5): 623–628.

25 Mulder JT. Syracuse University mumps outbreak: Whistleblowers say vaccine is flawed. Syracuse.com. Nov. 14, 2017

26 CDC. Mumps - Mumps Virus Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

27 CDC. Mumps - Pathogenesis Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

28 CDC. Signs & Symptoms of Mumps. Jul. 27, 2016

29 Harvard Health Publishing Mumps – What is it? Harvard Medical School. March 2016

30 CDC. Mumps - Clinical Features Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

31 Minnesota Department of Health Mumps Clinical Information - Clinical Presentation. Dec. 1, 2017

32 World Health Organization (WHO) Mumps. Jan. 25, 2008

33 CDC. Complications of Mumps. Jul. 27, 2016

34 CDC. Mumps - Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

35 CDC. Mumps - Clinical Features Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

36 CDC Transmission of Mumps. May 29, 2015

37 CDC. Surveillance Manual - Chapter 9: Mumps – Infectious Period. 6th edition. 2013

38 WebMD. What are the Mumps? Jan. 6, 2017

39 CDC. Mumps - Epidemiology Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

40 CDC Mumps For Healthcare Providers - Background Feb. 16, 2018

41 CDC Notes from the Field: Absence of Asymptomatic Mumps Virus Shedding Among Vaccinated College Students During a Mumps Outbreak — Washington, February–June 2017. MMWR Dec. 1, 2017; 66(47);1307–1308

42 CDC Notes from the Field: Complications of Mumps During a University Outbreak Among Students Who Had Received 2 Doses of Measles-Mumps-Rubella Vaccine — Iowa, July 2015–May 2016 MMWR Apr. 14, 2017; 66(14);390–391

43 CDC Mumps Outbreak at a University and Recommendation for a Third Dose of Measles-Mumps-Rubella Vaccine — Illinois, 2015–2016. MMWR  Jul. 29, 2016 / 65(29);731–734

44 Choi KM. Reemergence of mumps. Korean J Pediatr. 2010 May; 53(5): 623–628.

45 Johnson CD, Goodpasture EW. AN INVESTIGATION OF THE ETIOLOGY OF MUMPS. J Exp Med. 1934 Jan 1; 59(1): 1–19.

46 CDC. Mumps - Mumps Vaccine Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

47 Kasper D, Fauci A, Longo D, et al. Mumps. Harrison’s Principles of Internal Medicine 16th Edition. 2005.

48 Galazka AM, Robertson SE, Kraigher A. Mumps and mumps vaccine: a global review. Bull World Health Organ. 1999;77(1):3-14.

49 Illinois Department of Public Health (IDPH) Mumps Frequently Asked Questions. No Date

50 CDC Mumps Cases and Outbreaks. Jun. 27, 2018

51 Ibid

52 CDC A Plan for revising morbidity reporting by states CDC Bull. 1951 Feb;10(2):4-12.

53 Barskey AE, Glasser JW, LeBaron CW. Mumps resurgences in the United States: A historical perspective on unexpected elements. Vaccine. 2009 Oct 19;27(44):6186-95

54 Merck Over 100 years of developing vaccines*. May 2017

55 CDC Reported incidence of notifiable diseases in the United States, 1968. MMWR Dec. 1968; 17(53)

56 Ibid

57 CDC Reported morbidity & mortality in the United States, 1977. MMWR. Sep. 1978. 26 (53)

58CDC Current Trends Mumps -- United States, 1985-1988. MMWR Feb. 24, 1989; 38(7);101-105

59 Ibid

60 Ibid

61 CDC Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR. Dec. 29, 1989; 38(S-9);1-18

62 CDC Summary of Notifiable Diseases, United States, 1998. MMWR. Dec. 31, 1999; 47(53);1-93

63 CDC Mumps Epidemic --- United Kingdom, 2004—2005 MMWR. Feb.24, 2006; 55(07);173-175

64 CDC Mumps Epidemic --- Iowa, 2006. MMWR. Apr. 7, 2006; 55(13);366-368

65 CDC Brief Report: Update: Mumps Activity --- United States, January 1--October 7, 2006. MMWR. Oct. 27, 2006; 55(42);1152-1153

66 CDC Update: Multistate Outbreak of Mumps --- United States, January 1--May 2, 2006. MMWR. May 26, 2006; 55(20);559-563

67 CDC Summary of Notifiable Diseases --- United States, 2006. MMWR. Mar. 21, 2008; 55(53);1-94

68 CDC Mumps Outbreak --- New York, New Jersey, Quebec, 2009. MMWR. Nov. 20, 2009; 58(45);1270-1274

69 Nelson GE, Aguon A, Valencia E, et al. Epidemiology of a mumps outbreak in a highly vaccinated island population and use of a third dose of measles-mumps-rubella vaccine for outbreak control--Guam 2009 to 2010. Pediatr Infect Dis J. 2013 Apr;32(4):374-80

70 CDC Update: Mumps Outbreak --- New York and New Jersey, June 2009--January 2010. MMWR. Feb. 12, 2010; 59(05);125-129

71 CDC Summary of Notifiable Diseases --- United States, 2009. MMWR May 13, 2011; 58(53);1-100

72 CDC Summary of Notifiable Diseases — United States, 2010. MMWR June 1, 2012; 59(53);1-111

73 CDC Mumps outbreak on a university campus—California, 2011. MMWR. Dec. 7, 2012; 61(48);986-989

74 CDC Mumps Outbreak at a University and Recommendation for a Third Dose of Measles-Mumps-Rubella Vaccine — Illinois, 2015–2016. MMWR July 29, 2016; 65(29);731–734

75 CDC Notes from the Field: Complications of Mumps During a University Outbreak Among Students Who Had Received 2 Doses of Measles-Mumps-Rubella Vaccine — Iowa, July 2015–May 2016. MMWR. Apr. 14, 2017; 66(14);390–391

76 CDC Mumps Cases and Outbreaks. Jun. 27, 2018

77 CDC Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR. Jan. 12, 2018; 67(1);33–38

78 CDC Mumps Cases and Outbreaks. Jan. 10, 2019

79 Ibid

80 Minnesota Department of Health Mumps Clinical Information - Clinical Presentation. Dec. 1, 2017

81 Mayo Clinic. Mumps – Overview. Aug. 12, 2015

82 CDC. Mumps - Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

83 Ibid

84 Vanlioglu B, Chua TC. Presentation of mumps infection as acute pancreatitis without parotitis. Pancreas. 2011 Jan;40(1):167-8

85 Johnstone JA, Ross CAC, Dunn M. Meningitis and Encephalitis Associated with Mumps Infection- A 10-Year Survey. Arch Dis Child. 1972 Aug; 47(254): 647–651.

86 Atkinson RE, Kent S, Fidler K. Mumps encephalitis with brainstem involvement: significant morbidity and diagnostic dilemmas Arch Dis Child. 2011;96:A54-A55.

87 Morrison JC, Givens JR, et al. Mumps oophoritis: a cause of premature menopause. Fertil Steril. 1975 Jul;26(7):655-9.

88 Mizushima N, Murakami Y. Deafness following mumps: the possible pathogenesis and incidence of deafness. Auris Nasus Larynx. 1986;13 Suppl 1:S55-7.

89 Kayan A, Bellman H. Bilateral sensorineural hearing loss due to mumps. Br J Clin Pract. 1990 Dec;44(12):757-9.

90 LEE CM. Primary virus mastitis from mumps. Va Med Mon (1918). 1946 Jul;73:327.

91  Happel JS. Mastitis in the male--a rare complication of mumps. Br Med J. 1965 Oct 30; 2(5469): 1041.

92 Hussain S, Zahid MF, MUMPS MYOCARDITIS: A FORGOTTEN DISEASE? J Ayub Med Coll Abbottabad. 2016 Jan-Mar;28(1):201-3.

93 Arita M, Ueno Y, Masuyama Y, Complete heart block in mumps myocarditis. Br Heart J. 1981 Sep; 46(3): 342–344.

94 Parmar RC, Bavdekar SB, Thyroiditis as a presenting feature of mumps. Pediatr Infect Dis J. 2001 Jun;20(6):637-8.

95 Helin I, Carstensen H. Nephrotic syndrome after mumps virus infection. Am J Dis Child. 1983 Nov;137(11):1126.

96 Lin CY, Chen WP, Chiang H. Mumps associated with nephritis. Child Nephrol Urol. 1990;10(2):68-71.

97 Gordon SC, Lauter CB. Mumps arthritis: a review of the literature. Rev Infect Dis. 1984 May-Jun;6(3):338-44.

98 Bayer AS. Arthritis associated with common viral infections: mumps, coxsackievirus, and adenovirus. Postgrad Med. 1980 Jul;68(1):55-8, 60, 63-4.

99 Reddy CM, Crump EP. Diabetes mellitus following mumps. J Natl Med Assoc. 1976 Nov; 68(6): 459–460.

100Graham DY, Brown CH III, et al. Thrombocytopenia. A complication of mumps. JAMA. 1974 Mar 11;227(10):1162-4.

101 CDC. Mumps for Healthcare Providers – Mumps during Pregnancy. Feb. 16, 2018

102 CDC. Mumps - Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

103 WHO  Immunization, Vaccines and Biologicals – Mumps. Jan. 25, 2008

104 CDC Current Trends Mumps -- United States, 1985-1988. MMWR. Feb. 24, 1989;  38(7);101-105

105 CDC Mumps – Information for Travelers. May 29, 2015

106 CDC Mumps Cases and Outbreaks Jun. 27, 2018

107 Kasper D, Fauci A, Longo D, et al. Mumps. Harrison’s Principles of Internal Medicine 16th Edition. 2005.

108 Mersch J. Mumps - What are risk factors for contracting mumps? MedicineNet. Jan 31, 2017.

109 CDC Complications of Mumps. July 27, 2016

110 CDC. Mumps for Healthcare Providers – Mumps during Pregnancy. Feb. 16, 2018

111 Roth E. Mumps: Prevention, Symptoms, and Treatment Healthline. Jul. 31, 2017

112 CDC. Mumps Outbreak-Related Questions and Answers for Patients. Nov. 20, 2017

113 Roth E. Mumps: Prevention, Symptoms, and Treatment Healthline. Jul. 31, 2017

114 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

115 FDA PROQUAD. May 16, 2017

116 Ibid

117 Wadman M. Medical research: Cell Division. Nature  Jul. 2013 498, 422–426

118 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

119 Ibid

120 Ibid

121 FDA PROQUAD. May 16, 2017

122 Ibid

123 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

124 FDA PROQUAD. May 16, 2017

125 CDC Vaccine Excipient & Media Summary. (The Pink Book). Mar. 2018

126 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

127 FDA PROQUAD. May 16, 2017

128 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Jun. 14, 2013; 62(RR04);1-34

129 Ibid

130 Ibid

131 Ibid

132 FDA PROQUAD. May 16, 2017

133 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

134 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Jun. 14, 2013; 62(RR04);1-34

135 CDC Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR Jan. 12, 2018; 67(1);33–38

136 CDC. Mumps - Mumps Vaccine Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

137 Ibid

138 CDC Recommendation of the Immunization Practices Advisory Committee Mumps Vaccine MMWR 31(46);617-20,625-7

139 Conniff, R A Forgotten Pioneer of Vaccines. The New York Times. May 6, 2013

140Mumpsvax vaccine product insert advertisement. C.M.A. Journal May 23, 1970; Vol. 102 (1015)

141 Merck Over 100 years of developing vaccines*. May 2017

142 Ibid

143 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

144 FDA PROQUAD. May 16, 2017

145 CDC Recommendations of the Immunization Practices Advisory Committee Mumps Prevention. MMWR Jun 9, 1989. 38(22);388-392,397-400

146 CDC Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR. Dec. 29, 1989; 38(S-9);1-18

147 CDC Measles, Mumps, and Rubella -- Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR. May 22, 1998; 47(RR-8);1-57

148 Ibid

149 Ibid

150 CDC. Mumps Epidemic --- Iowa, 2006. MMWR Apr. 7, 2006; 55(13);366-368

151 CDC Update: Multistate Outbreak of Mumps --- United States, January 1--May 2, 2006. MMWR. May 26, 2006; 55(20);559-563

152 CDC Notice to Readers: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP) for the Control and Elimination of Mumps. MMWR. June 9, 2006; 55(22);629-630

153 Ibid

154 CDC Update: Mumps Outbreak --- New York and New Jersey, June 2009--January 2010 MMWR Feb. 12, 2010; 59(05);125-129

155 CDC Mumps Outbreak --- New York, New Jersey, Quebec, 2009 Nov. 12, 2009; 58;1-4

156 Choi KM. Reemergence of mumps. Korean J Pediatr. 2010 May; 53(5): 623–628.

157 Dayan GH, Quinlisk MP, Parker AA et al. Recent resurgence of mumps in the United States. N Engl J Med. 2008 Apr 10;358(15):1580-9.

158 Koleva G, Merck Whistleblower Suit A Boon to Vaccine Foes Even As It Stresses Importance of Vaccines. Forbes. Jun. 27, 2012.

159 Pierson M. Merck accused of stonewalling in mumps vaccine antitrust lawsuit. Reuters. Jun 4, 2015

160 Mulder JT. Syracuse University mumps outbreak: Whistleblowers say vaccine is flawed. Syracuse.com. Nov. 14, 2017

161 Pierson M. Merck accused of stonewalling in mumps vaccine antitrust lawsuit. Reuters. Jun 4, 2015

162 CDC Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR Jan. 12, 2018;67(1);33–38

163 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

164 CDC Mumps For Healthcare Providers – Vaccination. Feb 16, 2018.

165 Barskey AE, Glasser JW, LeBaron CW. Mumps resurgences in the United States: A historical perspective on unexpected elements. Vaccine. 2009 Oct 19;27(44):6186-95

166 Dayan GH, Quinlisk MP, Parker AA et al. Recent resurgence of mumps in the United States. N Engl J Med. 2008 Apr 10;358(15):1580-9.

167 Lewnard JA, Grad, YH Vaccine waning and mumps re-emergence in the United States Sci Transl Med. 2018 Mar 21; 10(433): eaao5945.

168 Peltola H, Kulkarni PS, Kapre SV et al. Mumps outbreaks in Canada and the United States: time for new thinking on mumps vaccines. Clin Infect Dis. 2007 Aug 15;45(4):459-66

169 Lewnard JA, Grad, YH Vaccine waning and mumps re-emergence in the United States Sci Transl Med. 2018 Mar 21; 10(433): eaao5945.

170 Vygen S, Fischer A, Meurice L et al. Waning immunity against mumps in vaccinated young adults, France 2013. Euro Surveill. 2016;21(10):30156.

171 Principi N, Esposito S. Mumps outbreaks: A problem in need of solutions. J Infect. 2018 Jun;76(6):503-506

172 May M, Rieder CA, Rowe RJ Emergent lineages of mumps virus suggest the need for a polyvalent vaccine. Int J Infect Dis. 2018 Jan;66:1-4.

173 Fiebelkorn AP, Coleman LA, Belongia EA et al. Mumps antibody response in young adults after a third dose of measles-mumps-rubella vaccine. Open Forum Infect Dis. 2014 Oct 18;1(3):ofu094

174 Latner DR, Parker Fiebelkorn A, McGrew M et al. Mumps Virus Nucleoprotein and Hemagglutinin-Specific Antibody Response Following a Third Dose of Measles Mumps Rubella Vaccine. Open Forum Infect Dis. 2017 Dec 8;4(4):ofx263

175 Principi N, Esposito S. Mumps outbreaks: A problem in need of solutions. J Infect. 2018 Jun;76(6):503-506

176 Fiebelkorn AP, Coleman LA, Belongia EA et al. Mumps antibody response in young adults after a third dose of measles-mumps-rubella vaccine. Open Forum Infect Dis. 2014 Oct 18;1(3):ofu094

177 Principi N, Esposito S. Mumps outbreaks: A problem in need of solutions. J Infect. 2018 Jun;76(6):503-506

178 Ibid

179 Fields VS, Safi H, Waters C et al. Mumps in a highly vaccinated Marshallese community in Arkansas, USA: an outbreak report. Lancet Infect Dis. 2019 Feb;19(2):185-192

180 L’Huillier AG, Eshaghi A,Racey CS et al. Laboratory testing and phylogenetic analysis during a mumps outbreak in Ontario, Canada Virol J. 2018; 15: 98.

181 Lewnard JA, Grad, YH Vaccine waning and mumps re-emergence in the United States Sci Transl Med. 2018 Mar 21; 10(433): eaao5945.

182 Dayan GH, Rubin S Mumps outbreaks in vaccinated populations: are available mumps vaccines effective enough to prevent outbreaks? Clin. Infect. Dis. 2008; 47: 1458–1467

183 Peltola H, Kulkarni PS, Kapre SV et al. Mumps outbreaks in Canada and the United States: time for new thinking on mumps vaccines. Clin Infect Dis. 2007 Aug 15;45(4):459-66

184 Choi KM. Reemergence of mumps. Korean J Pediatr. 2010 May; 53(5): 623–628.

185 Dayan GH, Quinlisk MP, Parker AA et al. Recent resurgence of mumps in the United States. N Engl J Med. 2008 Apr 10;358(15):1580-9.

186 CDC Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR Jan. 12, 2018; 67(1);33–38

187 Veneti L, Borgen K, Borge KS et al. Large outbreak of mumps virus genotype G among vaccinated students in Norway, 2015 to 2016. Euro Surveill. 2018 Sep;23(38)

188 Gouma S, Ten Hulscher HI, Schurink-van 't Klooster TM et al. Mumps-specific cross-neutralization by MMR vaccine-induced antibodies predicts protection against mumps virus infection. Vaccine. 2016 Jul 29;34(35):4166-4171

189 May M, Rieder CA, Rowe RJ Emergent lineages of mumps virus suggest the need for a polyvalent vaccine. Int J Infect Dis. 2018 Jan;66:1-4.

190 Koleva G, Merck Whistleblower Suit A Boon to Vaccine Foes Even As It Stresses Importance of Vaccines. Forbes. Jun. 27, 2012.

191 Krahling S, Wlochowski, Plaintiffs, vs Merck. U.S. District Court for the Eastern District of Pennsylvania. Aug. 27, 2010. 

192 CDC Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR Jan. 12, 2018; 67(1);33–38

193 CDC MMR (Measles, Mumps, & Rubella) VIS Feb. 12, 2018

194 CDC MMRV (Measles, Mumps, Rubella & Varicella) VIS Feb. 12, 2018

195 CDC Use of Combination Measles, Mumps, Rubella, and Varicella Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. May 7, 2010; 59(RR03);1-12

196 CDC MMR (Measles, Mumps, & Rubella) VIS Feb. 12, 2018

197 CDC MMRV (Measles, Mumps, Rubella & Varicella) VIS Feb. 12, 2018

198 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

199 FDA PROQUAD. May 16, 2017

200 MacDonald SE, Dover DC, Simmonds KA, et al. Risk of febrile seizures after first dose of measles–mumps–rubella–varicella vaccine: a population-basd cohort study. CMAJ. 2014 Aug 5; 186(11): 824–829.

201 Ma SJ, Xiong YQ, Jiang LN et al. Risk of febrile seizure after measles-mumps-rubella-varicella vaccine: A systematic review and meta-analysis. Vaccine. 2015 Jul 17;33(31):3636-49

202 Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Effects of Vaccines: Evidence and Causality. (Evaluating Biological Mechanisms for Adverse Events: Increased Susceptibility). Washington, DC: The National Academies Press. 2012

203 Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Effects of Vaccines: Evidence and Causality. (Evaluating Biological Mechanisms for Adverse Events: Increased Susceptibility). Washington, DC: The National Academies Press. 2012. Chap. 4 (103-238)

204 Ibid

205 Ibid

206 Ibid

207 Demicheli V, Rivetti A, et al. (Intervention Review) Vaccines for Measles, Mumps and Rubella in Children. The Cochrane Library 2012, Issue 2. Online.

208 Ibid

209 Lakshman R. MMR Vaccine and Allergy. Arch Dis Child 2000;82:93-95.

210 Bogdanovic, J, Halsey NA, Wood RA, et al. Bovine and Porcine Gelatin Sensitivity in Milk and Meat-Sensitized Children J Allergy Clin Immunol. 2009 Nov; 124(5): 1108–1110.

211 Fisher BL. The Emerging Risks of Live Virus and Virus Vectored Vaccines: Vaccine Strain Virus Infection, Shedding and Transmission. NVIC November 2014.

212 Alrasheuskaya AV, Neverov AA, Rubin S, et al Horizontal transmission of the Leningrad-3 live attenuated mumps vaccine virus. Vaccine 2006; 24(1): 1530-1536.

213 Kaic B, Gjenero-Margan I, Aleraj S et al. Transmission of the L-Zagreb Mumps Vaccine Virus, Croatia, 2005-2008. Euro Surveil 2008 13(16).

214 FDA PROQUAD. May 16, 2017

215 Sigiura A, Yamada A. Aseptic meningitis as a complication of mumps vaccination. Pediatr Infect Dis J 1991; 10(3): 209-213.

216 Dourado I, Cunha S, da Gloria Teixeira et al. Outbreak of Aseptic Meningitis associated with Mass Vaccination with a Urabe-containing Measles-Mumps-Rubella Vaccine. Am J Epidemiol 2000; 151(5):524-530.

217 Bonnet MC, Dulta A, Weinberger C, et al. Mumps vaccine virus strains and aseptic meningitis. Vaccine 2006; 24(49-50): 7037-7045.

218 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

219 FDA PROQUAD. May 16, 2017

220 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.

221 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.

222 Braun M. Vaccine adverse event reporting system (VAERS): usefulness and limitations. Johns Hopkins Bloomberg School of Public Health

223 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.

224 AHRQ Electronic Support for Public Health–Vaccine Adverse Event Reporting System (ESP:VAERS) Dec 1, 2007-Sep. 30, 2010

225 HRSA National Vaccine Injury Compensation Program Data Report – August 31, 2018. Aug 31, 2018

226 MCTlawyers.com $101 Million Dollar Vaccine Injury Award for Encephalopathy from MMR Vaccine. Press Release. Jul. 17, 2018

227 Ibid

228 Office of Special Masters. United States Court of Federal Claims. RAYMOND ROACH, on behalf of O.G.R., a minor child V. Secretary of Health and Human Services. Nov. 20, 2017

229 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

230 FDA PROQUAD. May 16, 2017

231 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

232 FDA Varivax Feb. 17, 2017

233 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

234 Ibid

235 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. June 14, 2013; 62(RR04);1-34

236 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

237 FDA PROQUAD. May 16, 2017


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