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Transmission of the L-Zagreb mumps vaccine virus, Croatia, 2005-2008

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Abstract

We report on three cases of symptomatic transmission of the L-Zagreb mumps vaccine virus from three vaccinated children to five adult contacts. The five contact cases were parents of the vaccinated children and presented with parotitis and in one case also with aseptic meningitis. The etiology of the contacts' illness was determined by viral culture, genomic sequencing, serology and epidemiological linking. Two of the vaccinated children developed vaccine associated parotitis as an adverse event three weeks following immunization. Symptoms in contact cases developed five to seven weeks after the vaccination of the children. The five contact cases, as well as the three children with adverse events recovered completely. The children had been vaccinated with MMR vaccine produced by the Institute of Immunology Zagreb, each of them with a different lot. One of the possible explanations for these adverse events is that the very low levels of wild mumps virus circulation in the last decade, combined with waning immunity in those who received one dose of vaccine or suffered from mumps in childhood, resulted in susceptible young adults and that this unique epidemiological situation allows us to detect horizontal transmission of mumps vaccine virus.
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... In very rare cases, the risk can be associated with the residual pathogenic potential of the vaccine virus which has been observed for some mumps vaccine strains and OPV. Symptomatic horizontal transmission of the vaccine virus has been recorded among previously healthy household members of the vaccinees after vaccination with L-Zagreb mumps vaccine strain (Atrasheuskaya et al. 2006(Atrasheuskaya et al. , 2012Kaic et al. 2008;Tesović et al. 2008). The use of the Sabin live attenuated OPV decreased the number of poliovirus infections by > 99%. ...
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Inactivated and live attenuated vaccines have improved human life and significantly reduced morbidity and mortality of several human infectious diseases. However, these vaccines have faults, such as reactivity or suboptimal efficacy and expensive and time-consuming development and production. Additionally, despite the enormous efforts to develop vaccines against some infectious diseases, the traditional technologies have not been successful in achieving this. At the same time, the concerns about emerging and re-emerging diseases urge the need to develop technologies that can be rapidly applied to combat the new challenges. Within the last two decades, the research of vaccine technologies has taken several directions to achieve safe, efficient, and economic platforms or technologies for novel vaccines. This review will give a brief overview of the current state of the novel vaccine technologies, new vaccine candidates in clinical trial phases 1–3 (listed by European Medicines Agency (EMA) and Food and Drug Administration (FDA)), and vaccines based on the novel technologies which have already been commercially available (approved by EMA and FDA) with the special reference to pandemic COVID-19 vaccines. Key points • Vaccines of the new generation follow the minimalist strategy. • Some infectious diseases remain a challenge for the vaccine development. • The number of new vaccine candidates in the late phase clinical trials remains low.
... Despite a better antibody response to L-Zagreb, the vaccination with this strain had some side effects and complications. There were cases of post-vaccination encephalitis caused by the L-Zagreb strain, and some cases of horizontal transmission of the vaccine virus were reported (3,4). The Rubini strain was officially not recommended by scientific authorities due to a weakened antibody response in comparison with the other vaccine strains, and its effectiveness of 33% was deemed to be inadequate (5). ...
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Background: The incidence of mumps has decreased in many countries since the introduction of vaccination programmes, however, in the past decade a rapid increase in the disease occurrence has been reported worldwide. The reason for this situation is still not clear. We present the results of a serological survey carried out in the Eastern Bohemia Region of the Czech Republic during the years 2008-2012. Methods: In total, 2,536 samples of 2,034 patients were examined during the study period. The study cohort was divided into two groups, one consisted of individuals born before the introduction of mandatory vaccination and the other one comprised individuals born after mandatory vaccination started. For the serology analyses the ELISA kits RIDASCREEN Mumpsvirus IgM and IgG (R-Biopharm®, Germany) were used. Results: Out of 2,536 samples (including paired sera), 23.9% (n=606) were positive and 12% (n=304) had equivocal results. Most of the positive samples were obtained from patients aged 17-20 years. Significantly more (p<0.05) positive patients were born after the start of the national vaccination programme (patient group 2) (22.8%) compared to those born before its start (patient group 1) (13.7%). Interestingly, the analysis of data showed that 75.3% of patients falling into group 1 had anti-mumps IgG antibodies, which means that they had contracted mumps, whilst 23.5% of patients of group 2 had undetectable IgG antibodies, even though they should have been vaccinated. Conclusion: The data from our study, with a low number of positive samples in the first years of the study and an increase in the last two years, could suggest the occurrence of outbreaks every 4-6 years.
... Mumps is preventable by vaccination with live mumps viruses (MuV) that have been attenuated by passage in various cell substrates [2][3][4][5][6]. MuV vaccine strains vary in protective efficacy, degree of attenuation [7] and adverse event profiles [8][9][10][11]. A correlate of protection in terms of neutralising antibody has not been established [12] and an animal model which mimics human disease has yet to be identified [13][14][15][16]. ...
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Chapter
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Adverse Events Following vaccination in Croatia in 2005 [in Croatian Available from
  • B Kaic
  • Ed
Kaic B. Ed. Adverse Events Following vaccination in Croatia in 2005 [in Croatian]. Zagreb: Croatian Institute of Public Health, 2006; 5. Available from: http://www.hzjz.hr/epidemiologija/nuspojave2005.pdf
Mumps outbreak in young adults following a festival in Austria Available from: http://www Citation style for this article Transmission of the L-Zagreb mumps vaccine virus
  • D Schmid
  • H Holzmann
  • C Alfery
  • H Wallenko
  • Th
  • Allerberger
Schmid D, Holzmann H, Alfery C, Wallenko H, Popow-Kraupp Th, Allerberger F. Mumps outbreak in young adults following a festival in Austria, 2006. Euro Surveill 2008;13(7). Available from: http://www.eurosurveillance.org/edition/ v13n07/080214_6.asp This article was published on 17 April 2008. Citation style for this article: Kaic B, Gjenero-Margan I, Aleraj B, Ljubin-Sternak S, Vilibic-Cavlek T, Kilvain S, Pavic I, Stojanovic D, Ilic A. Transmission of the L-Zagreb mumps vaccine virus, Croatia, 2005-2008. Euro Surveill. 2008;13(16):pii=18843. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18843
Adverse Events Following vaccination in Croatia in
  • B Kaic
  • Ed
Kaic B. Ed. Adverse Events Following vaccination in Croatia in 2005 [in Croatian]. Zagreb: Croatian Institute of Public Health, 2006; 5. Available from: http://www.hzjz.hr/epidemiologija/nuspojave2005.pdf