Hi Ed,
There are just no good serologic correlates of vaccine-mediated immunity for measles, mumps, or varicella.
More explanation in the attached article, 3rd page in MMR section. False positives and false negatives do occur. For this reason routine post vaccination serologies are not recommended.
Mumps is the least immunogenic moiety in the MMR vaccine. 2 doses is not bullet-proof!
Take care,
Melanie
From: MCOH-EH [mailto:mcoh-eh-bounces+swift.melanie=mayo.edu@mylist.net]
On Behalf Of Galaid Edward I
Sent: Wednesday, February 05, 2020 3:24 PM
To: mcoh-eh@mylist.net
Subject: [EXTERNAL] [MCOH-EH] Rate of waning of mumps immunity
24 year old OR nurse diagnosed with mumps. Initially presented with about 3 days of unilateral parotid pain and swelling.
Documented history of two doses of vaccine; her IgG antibody titer at time of hire about 5 years ago was 39.2 AU/mL (Positive >10.9 by that lab).
At the onset of symptoms she got a curbside from one of the surgeons who she was working with that day, and referred to one of our urgent care centers; mumps confirmed by PCR. Boyfriend had similar illness the week before; was diagnosed
as having salivary duct stone (!).
Once the diagnosis was made, we sent her home for 5 days. Uneventful recovery.
We conferred with the state health department; they felt that the intensity and duration of the exposure was similar to contact in a public place; they did not feel that we had to check on immune status of all the people she had come
in contact with, and a booster dose of vaccine was not indicated. Of note is that we have a college campus outbreak of mumps that’s been going on for a several months.
I’m trying to reconcile the 5 year old IgG titer and having mumps disease. Several factors. Can humeral immunity wane over that relatively short period of time? Or does she have impaired cellular immunity that is not measured. Or was
it a lab error and she was always susceptible, and her luck ran out.
Or it’s just not helpful getting the IgG titer at time of hire, like in this case, because we don’t know what a positive titre actualy represents.
Ed Galaid
Edward I. Galaid, MD, MPH, FACOEM
ABIM, ABPM (OM)
Medical Director, Roper St. Francis Physician Partners Occupational Medicine
Charleston, SC
Member, ACOEM Task Group, Guidance for the Medical Evaluation of Law Enforcement Officers
Special Expert, NFPA Fire Service Occupational Safety & Health (FIX-AAA) Committee
(O) 843-402-5053
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