The questions around the National Hockey League mumps outbreak that finally found its way to the Penguins this past weekend start with the obvious: Didn’t we eradicate the mumps?
The short answer: Well, we almost did.
Once a common disease with painful and sometimes catastrophic results (sterility in men and miscarriages in pregnant women) mumps is a virus spread through saliva contact from person to person, from something as innocuous as touching the same counter surface as someone with the disease or as obvious as being near someone who sneezes.
But after the creation of the vaccine for mumps in 1967, the federal Centers for Disease Control and Prevention recommendation in 1977 that it be a regular vaccine for toddlers, and the recommendation in 1990 that a second dose of the vaccine be given to children about four years after the first, the number of cases dropped by about 98 percent.
But pockets of resistance to the eradication of the disease have persisted from several different quarters.
There are those who have resisted vaccinating their children, despite the proven success of the mumps vaccine, because of a variety of fears; there are about 10 percent of people who have been vaccinated whose bodies simply don’t respond, so-called “nonresponders” who are still susceptible; and there is some belief that the effectiveness of vaccination may wane over time, requiring that adults get an additional booster shot (the Allegheny County Health Department recommends all adults get a mumps booster).
There also appear to be people apparently along the lines of Penguins star Sidney Crosby who were vaccinated recently and appeared to respond well to the vaccination, but still contracted the disease.
“As physicians, we were caught on our heels by this,” said Matt McCarthy, an infectious disease physician for Weill Cornell Medical Center in New York City. “Why is Sidney Crosby — a young, healthy guy with a good response to the vaccine — getting this disease?
“There’s something that’s not adding up.”
Prior to becoming infected sometime in the past three weeks, presumably from an opponent on one of the other four teams with the infection, Mr. Crosby had a booster shot in February before he left for the Olympic Games in Russia.
Probably as a result, his antibody count — which would show if his body could fight the disease off — was high enough when the Penguins tested him and the rest of the team Dec. 3 that they didn’t think he was even susceptible. Others on the team — including Beau Bennett, who may also have the mumps — and staff did have low antibody counts, though, and 19 of them were given booster shots of the vaccine on Dec. 6.
So what is happening that is leading to this outbreak?
Research following a 2006 outbreak of mumps in the Midwest, primarily on college campuses, found that antibodies were higher in those with a more recent vaccine dose, and that there was no set amount of antibodies in people that appeared to be the safe level that definitively prevented the person from contracting the disease.
“That’s the problem,” said Jennifer Preiss, a family physician in Pittsburgh who works with Allegheny Health Network. “No one knows at what level they’re immune.”
Dr. Preiss said that in her 24 years of practice she has had three patients with the disease, which is why it concerns her that young, healthy men are catching it now.
Some researchers have questioned if the 2006 outbreak, and others over the last three decades, could be the result of the United States’ decision in 1992 to switch the vaccine of choice from one strain to another, in an effort to be more effective.
“It’s possible” the switch in vaccines is part of these outbreaks, Dr. McCarthy said. “I had not considered it until today.”
But it is the small percentage of the population that is not immunizing their children that concerns Michael Green, who works with infectious diseases at Children’s Hospital of Pittsburgh of UPMC.
Prior to 1967, “parents didn’t have to look far to see someone suffering from these diseases we’ve largely eliminated with vaccines” like mumps and polio, he said. “But now, you don’t see a lot of people with mumps or polio, so people think, ‘I don’t have to vaccinate my child.’ We need to push with parents that vaccines are not passe.”
Fortunately, Allegheny County children have high, two-dose mumps vaccination rates, at 91 percent, largely because schools require it before admitting students, said Kristen Mertz, a medical epidemiologist at the Allegheny County Health Department.
There was only one confirmed mumps case in Allegheny County prior to the Penguins’ cases, just two all of last year, and none in 2010, 2011 or 2012, she said.
Dr. Green said Children’s is monitoring the situation to see if the staff has to isolate patients who met Mr. Bennett during a visit there Thursday. He visited with most of the rest of the team, though not Mr. Crosby, to deliver Christmas presents. The Penguins did not know then that Mr. Crosby had the disease or that Mr. Bennett might have it (test results are due back today).
“Of course we’re concerned” that any of the kids at Children’s may have been infected, Penguins spokesman Tom McMillan said Monday. “Kids are such a focus of what we do.”
The team canceled another event set for this Friday in which 17 needy families and kids were going to come to the rink to receive Christmas gifts and meet the team. The gifts will be delivered to their homes, instead, and “we’ll try to visit with them later in the season,” he said.
Sean D. Hamill: shamill@post-gazette.com or 412-263-2579.
