Mumps outbreak in Vancouver

It's déjà vu all over again.

The first chapter in Arthur Allen's book "Vaccine" describes the history of smallpox vaccination in the United States. In 1721, in Boston, the prevailing belief was that to get vaccinated was to intervene with "divine providence." If you tried to protect yourself, it meant that you lacked faith in God. Today, I read that a mumps outbreak is happening in Vancouver, Canada. So far 116 cases have been confirmed. Why is mumps, a preventable and serious disease, causing problems in Canada?

photo of a child with mumps by by Barbara Rice, from the Public Health Image Library

Quoting from CBCnews.ca:

Two people from Alberta carried the mumps to a religious community near Agassiz that has a low rate of vaccinations, said Dr. Elizabeth Brodkin of the Fraser Health Authority. "My understanding is their interpretation of scripture is that to immunize would be to show a lack of faith in God's ability to protect them, and therefore they choose not to do that," said Brodkin.

It's seems odd that anyone would consider it appropriate to test their faith by risking the lives of others. Still, as Orac has written so eloquently, there is a small group of parents in U.S. who are also willing risk the lives of their kids and members of the community. This group contributed to a large outbreak of mumps in 2006 where 6584 cases were found and 85 people, hospitalized (1). What is mumps? What does it do? and why is it a problem? Mumps is the name of a virus and the disease caused by the mumps virus. The most notable symptom is that it causes the salivary glands to swell, as you can see in the picture. When you get mumps, to quote Gisela Enders' chapter from Medical Microbiology:

meningitis is common; and pancreatitis, encephalitis, and hearing loss may occur. In young adults, orchitis or oophoritis is not uncommon

In English, meningitis is an inflammation of the meninges, the tissues surrounding the brain. Pancreatitis refers to an inflamed pancreas. Hearing loss, is clear enough. Orchitis means that if you're male, your testicles can be inflamed. Oophoritis is an inflammation of the ovaries. The CDC mumps page adds that mumps can make you feel achy, lose your appetite, and feel tired (myalgia, anorexia, malaise, headache, and low-grade fever). Mumps is an RNA virus, composed of 15,384 nucleotides. Its genome is a single strand of RNA. If we look at the mumps genome at the NCBI, we can see that it codes for eight proteins. If we follow the link to the proteins, we can see something about each one. The names aren't very informative, though. We have to select the GeneID to get more useful information and even then, we may have to read an abstract or a paper to see more about the function of the protein. This is one of my favorite ways to learn about something new. I go to the genome map and look around to see what kinds of genes are there. It's interesting to see that the mumps virus has a gene that acts as a hemagglutinin and neuraminidase. In influenza, it takes two proteins to provide those functions. Hemagglutinin helps the virus stick to cells with certain sugars on the surface and neuraminidase helps the virus escape after new particles are made. What happens to people who get the mumps/ Learn more about the consequences here. References:

1. Dayan, G. et. al. 2008. Recent Resurgence of Mumps in the United States. NEJM Volume 358:1580-1589.