1723. Mumps attack rates following administration of a third dose of MMR vaccine to school-aged children, Arkansas, 2016 – 2017
Session: Oral Abstract Session: Public Health: Epidemiology and Outbreaks
Saturday, October 6, 2018: 9:30 AM
Room: S 157

During the 2016-17 school year, the largest mumps outbreak in the US since 2006 occurred in Arkansas with nearly 3,000 cases. As part of outbreak response, a third dose of measles-mumps-rubella vaccine (MMR3) was offered at 27 schools with mumps attack rates ≥5 cases/1000 students. We compared attack rates after vaccination clinics among students who received MMR3 and students with two MMR vaccine doses.


We obtained information on school enrollment and student immunization status from school registries, and mumps case status from Arkansas’s National Electronic Disease Surveillance System database. We included students aged 6–21 years who had previously received ≥2 doses of MMR vaccine. We used Arkansas's Immunization Information System to identify students who received MMR3.

We included schools with at least one mumps case after their vaccination clinic. We calculated mumps attack rates by 2- and 3-dose MMR vaccine recipients. Observation time started 14 days after each clinic to allow for development of an immune response to MMR3, and continued to the end of the 2016-17 school year. Observation time varied by school as schools held clinics on different dates.


A total of 18 schools (10 elementary, 8 middle/junior high) with 10,275 students who had previously received ≥2 doses of MMR (85% of total enrolled) met inclusion criteria. Median number of students per school was 553. Median student age was 11 years (range, 6-18) and 1,525 students received MMR3. MMR3 uptake varied by school (median, 12%; range, 2-33%; interquartile range, 7-22%).

A total of 12 mumps cases occurred among MMR3 recipients and 122 cases among 2-dose recipients. School-specific attack rates ranged from 0 to 23 cases/1000 students among 3-dose recipients, and 2 to 41 cases/1000 students among 2-dose recipients.

Mumps attack rates within each school were lower for 3-dose recipients vs 2-dose recipients in all but one school (p<.05). The differences in attack rates between 2- and 3-dose recipients ranged from -5 to 23 cases/1000 students (median, 5/1000).


Mumps attack rates were lower in 3-dose vs 2-dose MMR vaccine recipients after MMR3 vaccination clinics, supporting a benefit of MMR3 for persons in outbreak settings. Further analysis is needed to determine impact of MMR3 on duration and size of mumps outbreaks.

Angela Guo, MPH1, Tracy Ayers, PhD, MS1,2, Jessica Leung, MPH1, Virgie Fields, MS, CPH3,4,5, Puthiery Va, DO, MSc2,6, Haytham Safi, MD, MPH4, Catherine Waters, RN, BSN4, J. Gary Wheeler, MD4, Mona Marin, MD1, Manisha Patel, MD, MS1, Janell Routh, MD, MHS1 and Dirk Haselow, MD, PhD4, (1)Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, (2)Epidemic Intelligence Service, Atlanta, GA, (3)Virginia Department of Health, Richmond, VA, (4)Arkansas Department of Health, Little Rock, AR, (5)Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Atlanta, GA, (6)Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA


A. Guo, None

T. Ayers, None

J. Leung, None

V. Fields, None

P. Va, None

H. Safi, None

C. Waters, None

J. G. Wheeler, None

M. Marin, None

M. Patel, None

J. Routh, None

D. Haselow, None

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