Preventing a Mumps Outbreak at Beth Medrash Govoah

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bmg1Over the past few months, there have been a number of cases of mumps in Lakewood, and a few smaller yeshivos were forced to close for short periods of time to prevent an epidemic.

An effort is underway to prevent such a thing from occuring at Beth Medrash Govoha in Lakewood, the largest yeshiva in the country. An outbreak – which is a possibility if proper measures are not taken – could, chas veshalom, cause a rifyon in the yeshiva and possibly prevent anyone who is not immunized from entering the yeshiva. A letter from the Ocean County Board of Health regarding the consequences of an outbreak has been well publicized.

In an effort to prevent any sort of outbreak, it is vital that Beth Medrash Govoha have documentation of the students’ MMR (measles, mumps, rubella) vaccination. MMR vaccination information may be faxed by a doctor to the yeshiva at 732-364-5954.

Every day of delay can be a potential mafriah to the rabim. If one’s doctor is unavailable, one should be aware that camps and yeshivos that one attended before Beth Medrash Govoha often still have immunization records that were sent to them when one applied there. Talmidim of the yeshiva who don’t have other documentation are encouraged to contact them if they have the vaccination documentation on file.

Those who have not yet received the MMR vaccine can help prevent a mumps outbreak in the yeshiva by getting vaccinated. To do so, contact your doctor immediately or call Chemed at 732-364-2144 for an appointment to be vaccinated. Bring the documentation of your vaccination to the Registrar’s Office in the Legion Building or fax it to 732-364-5954.

For those who do not have insurance coverage for a Chemed appointment, the yeshiva has arranged for Chemed to have a vaccination night during which vaccinations will be administered at their cost price. Information will be posted regarding this in the near future.

For more information, or to confirm that the documentation submitted was received correctly, contact the yeshiva office at 732-367-1060 ext. 236.

We will keep you posted here on regarding any further developments.

{Dovid Newscenter}


  1. I learn in mir israel. And it is breaking out now here aswell. As of now aprox 30 bochurim have mumps! May they all have a speedy refuoh sheleimo.

  2. I heard about a yeshiva where a mumps outbreak started with one bochur who hadn’t been immunized. From now on, before accepting a bochur to yeshiva, the adminstration should ask the applicant to produce his immunization record. No immunization – no acceptance. It is not fair to put others at risk.

  3. From what I’ve heard there were many cases where there was documented vaccination, maybe it was just a weak batch. Still, kol hakavod to BMG for making such reasonable hishtadlus. This is a chesed for the entire community.

  4. Please be aware that many, if not most, of the people who came down with the mumps in the recent outbreak were vaccinated in childhood. Is any thought given to the possibily of high-risk populations getting an addition booster now, or at least being tested for antibodies level?

  5. Accoding to the nyc department of health 50% of mumps cases now are in people who have not been properly vaccinated.

    The antibody testing is not completly accurate so the test can come out positive and the immunity is not complete and the person can get the disease. Medicine isn’t foolproof but the risks of the mumps is greater than sideffects of the vaccine. There is no immunogobulin for the mumps so once one person has it there is no way of preventing anyone who has been exposed from getting it. The best defense is getting the proper vaccinations and davening.

  6. See the following article at

    MMR: Major mumps outbreak proves the vaccine doesn’t work

    10 April 2008
    At a time when health officials are quietly admitting that there could be a link between the MMR (measles-mumps-rubella) vaccine and autism, a new study has also discovered that it doesn’t work.

    Researchers investigating a large outbreak of mumps in 2006, when 6,584 cases were reported among college students, have discovered that virtually every sufferer had been vaccinated twice against the disease.

    The Centers for Disease Control (CDC) reveals that at least 84 per cent of young adults aged between 18 and 24 years had received two-dose vaccines against mumps.  And in 2006 – when the outbreak occurred – the national two-dose coverage among adolescents reached 87 per cent, the highest in US history, and just one point below that needed for ‘herd immunity’.
    CDC researchers speculate that the outbreak – primarily among 18- to 24-year-olds – was the result of the ‘wrong type of mumps’.  The vaccine is supposed to protect against A-virus mumps, whereas the outbreak in 2006 was caused by the G-virus strain.

    Despite its limitations, the CDC team reckons that all children need a third dose of MMR – even though the two-dose vaccine was introduced following a 1980 mumps outbreak among children who had received a single vaccine dose. 

    It may be a measure that will be hard to introduce at a time when health officials are accepting that the MMR vaccine can cause autism among children with a ‘mitochondrial disorder’.

    (Source: New England Journal of Medicine, 2008; 358: 1580-9).

    (The full text of The New England Journal of Medicine article can be seen at

    I myself think that this is the big question that needs to be asked here: Almost all of the bachurim in today’s yeshivas have had the full double doses of the Mumps vaccine. So why are so many bachurim now getting the disease? Culd it be that this is further proof that this vaccine does not work???

  7. It is simply not true to say that people are quietly admitting that the mmr causes autism. Any relationship between autism and measles has been disproven beyopnd a reasonable doubt in a recent federal court case. All of the evidencee is available to be reviewed so you can come to your own educated opinion. Just read Autism false prophets by paul offit to learn the facts.

  8. See the following article at

    MMR and Autism: US court says there’s a link, and awards compensation

    06 March 2008
    The MMR (measles, mumps, rubella) vaccine can cause autism, a US court has concluded. 

    In a secret ruling that has only just come to light, the US Court of Federal Claims has conceded that the mercury-based preservative thimerosal, which was in vaccines until 2002, caused autism in the case of one child.

    The ruling is one of 4,900 cases currently being considered for compensation payments, and it is feared by health officials that it could open the floodgates for even more claims.  It also appears to support the controversial findings of Dr Andrew Wakefield, who, in 1998, suggested a link between the vaccine and autism.

    The ruling, made by US Assistant Attorney General Peter Keisler, was made last November, and was one of three test cases into the MMR-autism link that was being considered by a three-member panel, which Keisler chaired.

    In his conclusion, Keisler said that “compensation is appropriate”.  

    The case involved a child who, when she was 18 months old, received nine vaccinations in July 2000, two of which included thimerosal.  Within days, the girl, who had previously been healthy, suddenly exhibited no response to verbal direction, loss of language skills, no eye contact, insomnia, incessant screaming, and arching.

    A diagnosis of autism was confirmed seven months later.

    In its defence, the US government said the girl had a pre-existing mitochondrial disorder that was aggravated by the vaccine.

    (Source: The Huffington Post, February 25, 2008).

    (The full text of the The Huffington Post article can be seen at

  9. See the follwing article at

    Autism caused by vaccination
    A new study has confirmed a definite causal link between the MMR (measles, mumps, rubella) vaccine and autism – and it has used the same data employed by an earlier study that governments have relied on to deny the link.

    The vaccine increases the risk of autism by 850 per cent, or nearly 500 per cent if we allow for greater diagnostic awareness, one of the major arguments put forward for the sudden increase in autism.

    This conclusion contradicts that of the Madsen study carried out in 2002, which found no link, and which governments have gratefully clung to ever since.

    So why the enormous discrepancy between the two trials? Autism is usually diagnosed only at age 5 or older, or it is in Denmark from where the data for both studies has been gleaned. The Madsen study monitored the progress of vaccinated children in Denmark only for four years, so it’s hardly surprising that few, if any, cases of autism were established. Less severe cases, which might have become apparent even later, were certainly not included in the findings.

    The new study, carried out by American paediatrician Dr Fouad Yazbak and Dr G S Goldman, tracks levels of autism in Denmark from 1980 – seven years before the MMR vaccine was introduced in Denmark – until 2002. Prevalence of autism among children aged from 5 to 9 stood at 8.38 cases per 100,000 in the pre-vaccine years of 1980 to 1986, and then rose to 71.43 cases by the year 2000.

    Dr Samy Suissa of McGill University had similar problems with the Madsen study. When he analysed the statistics he discovered that the rate of autism increases to a high of 27.3 cases per 100,000 two years after vaccination compared with just 1.45 cases in non-vaccinated children.

    Sources: Journal of American Physicians and Surgeons, 2004; 3: 70-5; New England Journal of Medicine, 2002; 347: 1477-82

    [The full text of The New England Journal of Medicine article (about the original Madsen study) can be seen at

  10. See the following article at

    Updated September 30, 2004

    by Sue Bennett,

    News concerning the connection between immunizations and autism was provided in People Magazine of all places!  According to an article in the September 27 issue of People Magazine, a report issued to a congressional subcommittee on September 8, 2004 shows thimerosal (a preservative containing mercury that has been widely used in vaccines) triggered autism-like symptoms in a strain of mice genetically susceptible to autoimmune disorders (as are many autistic children).  Researchers at Columbia University found mice exposed to thimerosal displayed damage to their brains similar to autism.  Head researcher, Dr. Mady Hornig said, “Identifying the connection is extremely exciting because it enables us to intervene and limit that exposure in a specific population.”  

    Dr. Hornig and her colleagues studied four strains of mice, including one strain – called SJL/L – in which mercury had previously been shown to stimulate autoimmune disorders. New-born mice of each strain were injected with either thimerosal or a thimerosal-vaccine combination at ages corresponding to those when human infants are typically immunized. The doses of mercury were also comparable to those used in humans.  The three strains of mice with no autoimmune susceptibility showed no effects from either type of inoculation. 

    But virtually all of the SJL/L mice developed a variety of problems, including delayed growth, abnormal response to novel environments, decreased exploration of their environments, abnormalities in brain architecture and increased brain size.  All of those were typical of children with autism, Dr Hornig said.   Researchers found lab mice exposed to the mercury-based preservative thimerosal, displayed brain abnormalities, growth delay; reduced locomotion; exaggerated response to novelty; and densely packed, hyperchromic hippocampal neurons with altered glutamate receptors and transporters.   The authors of the study wrote “These findings implicate genetic influences and provide a model for investigating thimerosal-related neurotoxicity”. The study is published in the Journal, Molecular Psychiatry.

    “This is clearly showing that there is an interaction of genes with the environment,” said Dr Daniel H. Geschwind of UCLA, who had been looking for genetic causes of autism and was not involved with the Columbia study. “The strain difference is … quite fascinating. This will clearly rev the debate [about vaccines] up again.”  “I believe this has enormous implications for public health,” said Dr. Julio Licinio of the University of California, Los Angeles, editor of the journal Molecular Psychiatry, where the report was published. “Showing that genetic background impacts on the outcome of thimerosal exposure is a major breakthrough.”  

    Independently, three new studies published in the August 2004 issue of the Journal of American Physicians and Surgeons challenge the validity of a widely sited Danish study in which data was collected from 500,000 Danish children to determine if there was a link between increase in the incidence of autism with the introduction of the MMR (measles, mumps, and rubella) vaccine.  This study reported in its findings that there was no statistical correlation between vaccination and incidence of autism.  However, according to three new studies which re-examine the data, the Danish study was wrongly carried out and gave inaccurate results.  The first new study, by Dr. Samy Suissa, an epidemiologist at McGill University, Montreal, who looked at the same data the Danish doctors used, concludes that children who received the MMR were 45 per cent more likely to develop autism than those who were not given it. A second piece of research by Gary Goldman and Dr Fouad Yazbak shows a 400 per cent rise in autism after the introduction of the MMR vaccine in Denmark, even after taking into account greater awareness of the condition. A third study by Dr. Andrew Wakefield, who first made the link between the MMR vaccine and autism in 1998 and Dr Carol Stott of Cambridge University, shows autism cases in Denmark have increased by 14.8 per cent each year since MMR was introduced.

    Goldman and Yazbak report, “According to the U.S. Department of Education, the number of cases of autism among individuals in schools aged 6 to 21 increased from 12,222 in 1992/93 to 118,602 in 2002-03, for an overall
    increase of 870%. Similar increases have been reported in school-age children in England, Scotland and Canada. These increases are larger than those in Denmark because of the number of vaccinations in those countries
    and the use of thimerosal.”

    While the political and scientific debate concerning immunizations and autism has reignited, we decided to take a poll of Autism Coach customers, asking parents what they believe caused their child’s autism.  For information on the poll, please click here.

    Information about the congressional testimony and immunization studies are as follows: 

    FDA testimony regarding reducing use of Thimerosal in Vaccines – September 8, 2004

    Dr. Mady Hornig’s testimony to congressional subcommittee – September 8, 2004 (at

    New Assessment of Data from Danish Study – Journal of American Physicians and Surgeons, Vol. 9, No. 3, Fall 2004.

  11. See the following article at

    Vaccine update: japan bans mmr
    01 December 1993
    The mumps portion of the measles, mumps, rubella vaccine could bring on mumps, which could be transmitted to other children.

    A two year old Japanese girl developed mumps shortly after being given the MMR vaccine. Nineteen days later, her nine year old sister developed mumps; the strain of the virus isolated in her was found to be identical to that contained in the vaccine. Japanese researchers reporting in The Lancet (7 August 1993) point to numerous other studies showing that the vaccine can bring on mumps.

    This evidence was one reason for the Japanese Ministry of Health and Welfare’s decision last April to discontinue the use of measles, mumps and rubella vaccine.

    (The full text of the The Lancet article can be seen at———————–

  12. See the following article at

    MMR: Vaccine can cause blood disorder
    13 March 2008
    There’s more bad news for advocates of the MMR (measles-mumps-rubella) vaccine with the discovery this week that it can cause a blood disorder.  Researchers have found that it may trigger immune thrombocytopenic purpura (ITP), an immune system malfunction that destroys the body’s own blood platelets.

    The effect seems to last for an average of seven days, during which time the child’s platelet count could fall.

    The risk is relatively low, say researchers, and one case of ITP will be caused per 40,000 vaccinations.  The risk appears to last for up to 42 days after vaccination.

    Researchers from Kaiser Permanente Colorado, Denver analysed the health profiles of more than 1 million children who had been vaccinated.  Of these, 259 developed ITP, and they reckon the vaccine was responsible for 76 per cent of these cases.

    (Source: Pediatrics, 2008; 121: e687-e692).

  13. See the following article at

    Meruvax I is the trade name for the Mumps vaccine manufactured by Merck & co. The Meruvax I mumps vaccine ingredients include the mumps live virus, the antibiotic neomycin, the chemical Sorbitol and the animal by product hydrolyzed gelatin.

    The Mumps live virus is the active ingredient to the mumps vaccine. My opposition to injecting any virus into the body is you are by passing the first line of defense, the respiratory system, thereby tricking the immune system into fighting the virus. The issue I have with this is the potential of tricking the immune system into fighting similar proteins as well, including those that are a natural part of the body. Vaccines have been used in some countries to fight population growth via sterilization by tricking the body into fighting against pregnancy hormones. You can read my article on vaccines used to sterilize girls.

    The antibiotic neomycin is a very strong antibiotic with allergenic potential to harm those allergic to this family of antibiotics. Neomycin is Nephrotoxic and can damage the kidneys. When ingested in pill form, most of the neomycin is passed through the system and is not absorbed, when injected the intestinal system is by passed therefore the body has no option to pass this potentially toxic antibiotic. Neomycin also has the potential to deplete the body of Vitamin B6 and if the body is too short on B6 it can lead to mental retardation or a form of epilepsy.

    The chemical Sorbitol is a sugar alcohol that is used medically for urinary irrigation. At under the warnings, the first warning is, not for injection. Sorbitol can cause potential side effects of Nausea, gas, diarrhea, stomach cramps or anal irritation, acidosis, diuresis, lack of urination, edema, cardiovascular/pulmonary disorders, convulsions, back ache and more, and can be harmful or fatal to those with fructose, intolerance.

    The animal by product hydrolyzed gelatin is a potential allergenic. Those who have allergies to Jello and other gelatin based food products may suffer anaphylaxsis. Animal by products can also be carriers of additional viral or bacterial hitch hikers.


    Disclaimer: This article, “Meruvax I Mumps Vaccine Ingredients”, is not intended to give medical advice. It is a call to educate yourself about disease and vaccines so that in making a decision where your child is concerned, you should take an active role in learning all you can from medical experts on both sides of the fence, then make an educated decision. We did not make an informed decision until one son got Leukemia and another developed Autism immediately after receiving his MMR vaccine. This has sent us on a quest to inform ourselves and others to seriously question what kind of toxic soups are being injected with the vaccines. Odds are if your child is injured by a vaccine, you have little or no recompense against the industry.

  14. It is with trepidation and concern that I write to the Hanhala of Beth Medresh Govoa and attempt to clarify issues regarding the Mumps outbreak. It is clear that over 175 cases have been reported to the health department and that of these 16% resulted in Mumps orchitis which is a significant risk for long term male infertility. In addition, only 25% of cases have been reported. What’s more, there appears to be a controversy in the community regarding the proper course in obtaining vaccinations going to school unvaccinated, and the effectiveness of two immunizations. Over 1000 cases have been reported in the tri-state area.
    I write as the data are perfectly clear and should be made available to members of the community.
    There is at least a 12% chance that prior mumps vaccine will wear off and leave a person unprotected to mumps infection even after two immunizations, i.e., a primary shot and a booster. A single shot leaves the risk of mumps is at least 36%.
    Mumps,Measels and Rubella vaccines have repeatedly been demonstrated as safe and the risks of any side effects are far outweighed by the risk of mumps orchitis and rubella infection in pregnancy. In my own clinical experience treating previously vaccinated Kallahs, I see 3 to 4 % without immunity who are at risk for infection, Has V’ Shalom, and who need booster injections. I am seeing this both for mumps and for measles and also am now checking for Chicken pox where I also find lack of immunization. These data are reiterated below and demonstrate the need to screen children who might be at risk for exposure and are critical proof that vaccination can make a difference in child and infant health.
    There are NO DATA to support claims that vaccinations are unsafe and should be avoided. Quite to the contrary, they SAFELY provide protection that is critical to school age children
    Finally, Rabbis Shmuel Fuerst, REisman, and Sorcher, in response to a question from R. Kanarek answered that children CAN be kept out of school if they are not immunized.
    Please address with your Kehillahs the following information and address these concerns. You can save lives, prevent infection and infertility and stop the spread of viral infection.
    Sincerely yours, Douglas S. Rabin, MD
    Notice to Readers: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP) for the Control and Elimination of Mumps
    On June 1, this notice was posted as an MMWR Early Release on the MMWR website (
    On May 17, 2006, the Advisory Committee on Immunization Practices (ACIP) updated criteria for mumps immunity and mumps vaccination recommendations. According to the 1998 ACIP recommendations for measles, mumps, and rubella (MMR) vaccine, for routine vaccination, a first dose of MMR vaccine is recommended at ages 12–15 months and a second dose at ages 4–6 years. Two doses of MMR vaccine also are recommended for students attending colleges and other post–high school institutions (1). However, documentation of mumps immunity through vaccination has consisted of only 1 dose of mumps-containing vaccine for all designated groups, including health-care workers.
    Live mumps virus vaccines (i.e., mumps and MMR vaccines) produced in the United States are derived from the Jeryl Lynn mumps vaccine strain. Postlicensure studies in the United States demonstrated that 1 dose of mumps vaccine was 78%–91% effective in preventing clinical mumps with parotitis (2). However, in the late 1980s and early 1990s, mumps outbreaks were observed in schools with extremely high (>95%) vaccination coverage (3,4), suggesting that 1 dose of mumps vaccine or MMR vaccine was not sufficient to prevent mumps outbreaks in school settings.
    In response to the resurgence of measles that began in 1989 and continued through 1991 (1), a second dose of MMR vaccine for school-aged (i.e., grades K–12) and college students was recommended in 1989. Since implementation of the 2-dose MMR vaccination requirement, the incidence of mumps disease has decreased, and studies of vaccine effectiveness during outbreaks suggest substantially higher levels of protection with a second dose of MMR. For example, during a mumps outbreak at a Kansas high school during the 1988–89 school year, students who had received only 1 dose of MMR had five times the risk of contracting mumps compared with students who had received 2 doses (3). A study from the United Kingdom, which uses MMR vaccines that contain either the Jeryl Lynn mumps vaccine strain or the RIT 4385 strain (derived from the Jeryl Lynn strain) (2), indicated a vaccine effectiveness of 88% for 2 doses of MMR vaccine compared with 64% for a single dose (5). In addition, elimination of mumps was declared in Finland through high and sustained coverage with 2 doses of MMR vaccine (6).
    Infection-control failures resulting in nosocomial transmission have occurred during mumps outbreaks involving hospitals and long-term–care facilities that housed adolescent and young adult patients (7). Exposures to mumps in health-care settings also can result in added economic costs associated with furlough or reassignment of staff members from patient-care duties or closure of wards.
    During January 1–May 2, 2006, the current outbreak in the United States has resulted in reports of 2,597 cases of mumps in 11 states (8). The outbreak has underscored certain limitations in the 1998 recommendations relating to prevention of mumps transmission in health-care and other settings with high risk for mumps transmission. After reviewing data from the current outbreak and previous evidence on mumps vaccine effectiveness and transmission, ACIP issued updated recommendations for mumps vaccination (Box).
    Acceptable Presumptive Evidence of Immunity to Mumps
    Acceptable presumptive evidence of immunity to mumps includes one of the following: 1) documentation of adequate vaccination, 2) laboratory evidence of immunity, 3) birth before 1957, or 4) documentation of physician-diagnosed mumps. Evidence of immunity through documentation of adequate vaccination is now defined as 1 dose of a live mumps virus vaccine for preschool-aged children and adults not at high risk and 2 doses for school-aged children (i.e., grades K–12) and for adults at high risk (i.e., health-care workers,* international travelers, and students at post–high school educational institutions).†
    Routine Vaccination for Health-Care Workers
    All persons who work in health-care facilities should be immune to mumps. Adequate mumps vaccination for health-care workers born during or after 1957 consists of 2 doses of a live mumps virus vaccine. Health-care workers with no history of mumps vaccination and no other evidence of immunity should receive 2 doses (at a minimum interval of 28 days between doses). Health-care workers who have received only 1 dose previously should receive a second dose. Because birth before 1957 is only presumptive evidence of immunity, health-care facilities should consider recommending 1 dose of a live mumps virus vaccine for unvaccinated workers born before 1957 who do not have a history of physician-diagnosed mumps or laboratory evidence of mumps immunity.
    Mumps Outbreak Control
    Depending on the epidemiology of the outbreak (e.g., the age groups and/or institutions involved), a second dose of mumps vaccine should be considered for children aged 1–4 years and adults who have received 1 dose. In health-care settings, an effective routine MMR vaccination program for health-care workers is the best approach to prevent nosocomial transmission. During an outbreak, health-care facilities should strongly consider recommending 2 doses of a live mumps virus vaccine to unvaccinated workers born before 1957 who do not have evidence of mumps immunity.
    These new recommendations for health-care workers are intended to offer increased protection during a recognized outbreak of mumps. However, reviewing health-care worker immune status for mumps and providing vaccine during an outbreak might be impractical or inefficient. Therefore, facilities might consider reviewing the immune status of health-care workers routinely and providing appropriate vaccinations, including a second dose of mumps vaccine, in conjunction with routine annual disease-prevention measures such as influenza vaccination or tuberculin testing.
    1. CDC. Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1998;47(No. RR-8).
    2. Plotkin SA, Orenstein WA, eds. Vaccines. 4th ed. Philadelphia, PA: Elsevier Inc.; 2003:441–5.
    3. Hersh BS, Fine PE, Kent WK, et al. Mumps outbreak in a highly vaccinated population. J Pediatr 1991;119:187–93.
    4. Briss PA, Fehrs LJ, Parker RA, et al. Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity. J Infect Dis 1994;169:77–82.
    5. Harling R, White JM, Ramsay ME, Macsween KF, van den Bosch C. The effectiveness of the mumps component of the MMR vaccine: a case control study. Vaccine 2005;23:4070–4.
    6. Peltola H, Heinonen OP, Valle M, et al. The elimination of indigenous measles, mumps, and rubella from Finland by a 12-year, two-dose vaccination program. N Engl J Med 1994;331:1397–402.
    7. Wharton M, Cochi SL, Hutcheson RH, Schaffner W. Mumps transmission in hospitals. Arch Intern Med 1990;150:47–9.
    8. CDC. Update: multistate outbreak of mumps—United States, January 1–May 2, 2006. MMWR 2006;55:1–5.
    * Health-care workers include persons who provide health care to patients or work in institutions that provide patient care (e.g., physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, hospital volunteers, or administrative and support staff in health-care institutions).
    † The first dose of mumps-containing vaccine should be administered on or after the first birthday; the second dose should be administered no earlier than 1 month (i.e., at a minimum of 28 days) after the first dose. MMR vaccine generally should be used whenever any of its component vaccines are indicated. For children aged 12 months–12 years, combined measles, mumps, rubella, and varicella (MMRV) vaccine can be considered if varicella vaccination is also indicated.

    **Questions or messages regarding errors in formatting should be addressed to
    Date last reviewed: 6/7/2006
    Measles, Mumps, and Rubella (MMR) Vaccine
    The measles, mumps, and rubella (MMR) vaccine is a combination vaccine that was licensed in 1971 to protect against measles, mumps, and rubella. These diseases are serious and can be potentially deadly. Each year in the United Statess, nearly 10 million doses of the vaccine are distributed. CDC continues to
    MMR Vaccine Safety
    • Measles, Mumps, and Rubella (MMR) Vaccine
    • Frequently Asked Questions about Thimerosal
    • MMR and Idiopathic thrombocytopenia Purpura (ITP)
    • VSD Chart of Autism Studies–Updated 08-20-2009 (PDF–30.03 KB)
    Scientific Articles
    Barlow WE, Davis RL, Glasser JW, Rhodes PH, Thompson RS, Mullooly JP, Black SB, Shinefield HR, Ward JI, Marcy SM, DeStefano F, Chen RT, Immanuel V, Pearson JA, Vadheim CM, Rebolledo V, Christakis D, Benson PJ, Lewis N. The risk of seizures after receipt of whole-cell pertussis or measles, mumps, and rubella vaccine. New England Journal of Medicine 2001;345(9):656–661.
    Black S, Shinefield H, Ray P, Lewis E, Chen R, Glasser J, Hadler S, Hardy J, Rhodes P, Swint E, Davis R, Thompson R, Mullooly J, Marcy M, Vadheim C, Ward J, Rastogi S, Wise R. Risk of hospitalization because of aseptic meningitis after measles-mumps-rubella vaccination in one- to two-year-old children: an analysis of the Vaccine Safety Datalink (VSD) Project. Pediatric Infectious Disease Journal 1997;16(5):500–503.
    Davis RL, Kramarz P, Bohlke K, Thompson RS, Mullooly J, Black S, Shinefield H, Ward J, Marcy M, Eriksen E, Lewis N, DeStefano F, Chen R. Measles-Mumps-Rubella and Other Measles-Containing Vaccines Do Not Increase the Risk for Inflammatory Bowel Disease: A Case-Control Study from the Vaccine Safety Datalink Project. Archives of Pediatrics and Adolescent Medicine 2001;155(3):354–359.
    DeStefano F, Chen RT. Negative association between MMR and autism. [Commentary] Lancet 1999;353(9169):1987–1988.
    MMWR Articles about the MMR Vaccine

  15. re mumps and the risk for infertility see the folowing
    Mumps orchitis
    M Masarani H Wazait M Dinneen

    Department of Urology, Imperial College of London, Chelsea & Westminster Hospital, London SW10 9NH, UK

    Correspondence to: M Masarani E-mail:


    Although the incidence of mumps orchitis has dramatically declined since the introduction of the childhood vaccination programme, a sharp increase in reported cases of both mumps and mumps orchitis has been seen recently in the UK. There are great concerns about mumps outbreaks and the associated risk of infertility; it remains an important clinical condition. Immunization is the best policy to avoid this viral disease.


    The incidence of mumps orchitis has declined dramatically since the introduction of the childhood vaccination programme. Over the last few years mumps orchitis has rarely been seen in our institution: however, more recently, 11 patients with mumps orchitis were admitted to our unit between March and September 2005.

    This sharp increase was also noticed elsewhere in the UK; 25 cases of mumps orchitis were reported by the Urology Department of the Royal Liverpool University Hospital between September 2004 and April 2005.1


    We conducted a MEDLINE/PubMed search (search terms ‘mumps, orchitis, infertility’) and review of the literature with emphasis on management.

    Natural history
    Mumps is a contagious viral disease that often results in painful swelling of the parotid gland. About 30%-40% of patients with mumps do not develop parotitis. The virus is an RNA virus of the genus paramyxovirus which is spread from human reservoir by direct contact, airborne droplets, fomites contaminated by saliva and possibly by urine.

    The microbiological diagnosis is by serology or virus culture. Enzyme immunoassay for mumps immunoglobulin antibodies are most commonly used for diagnosis. IgM antibodies are detectable in the first few days of the illness and are considered diagnostic. In addition, seroconversion or a fourfold increase in IgG titre are also diagnostic.2

    The measles, mumps and rubella (MMR) vaccine was introduced in the UK in1988. In 1996, a second dose of the vaccine was routinely introduced to all children born in 1991 onwards. A large increase in both notifications and laboratory confirmed cases were observed in 2003 which has continued into 2004 and 2005 (Table 1).3

    View this table:
    [in this window]
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    Table 1. All laboratory confirmed cases of mumps (England and Wales 1996-2005). Source: Communicable Disease Surveillance Centre

    Ninety per cent of confirmed cases in 2004-2005 were among people aged 15 years and over. This age group had either never received any MMR vaccine because they were too old when it was introduced, or had only received a single dose. Uptake of MMR vaccination in the UK has fallen from a peak of 92% in early 1995 to a national level of 82% in 2003 (at the age of 2). In London, uptake is now less than 75%—much less in some areas—which is leading to significant risk of outbreaks.3

    Mumps orchitis is now rarely seen in children under 10.4 Orchitis is the most common complication of mumps in post-pubertal men, affecting about 20%-30% of cases:5 10%-30% are bilateral.2 Orchitis usually occurs 1-2 weeks after parotitis.

    Of affected testicles, 30%-50 % show a degree of testicular atrophy.2 Within the first few days of infection the virus attacks the testicular glands, leading to parenchymal inflammation, separation of seminiferous tubules and perivascular interstitial lymphocyte infiltration. The tunica albugenia forms a barrier against oedema, and the subsequent rise in intratesticular pressure leads to pressure-induced testicular atrophy.5

    Adamopoulos et al.6 studied the effects of mumps orchitis on Leydig cell function and found low testosterone levels, elevated leuteinizing hormone levels and an exaggerated pituitary response to leuteinizing hormone-releasing hormone (LHRH) stimulation in the acute phase. Whilst basal testosterone concentrations returned to normal after several months, mean basal follicle stimulating hormone and leuteinizing hormone concentrations remained significantly increased at 10 and 12 months after the acute phase.

    The causal link between mumps orchitis and anti-sperm antibodies has been unclear. Although the antibodies were suspected to impair fertility, Kalaydjiev et al.7 demonstrated that both the incidence and the level of serum anti-sperm antibodies among mumps orchitis patients were low, and did not support the hypothesis of an enhanced humoral immunity against spermatozoa.

    Mumps orchitis rarely leads to sterility but it may contribute to subfertility. It can also can lead to oligospermia, azoospermia, and asthenospermia (defects in sperm movement). Unilateral disease can significantly, but only transiently, diminish the sperm count, mobility, and morphology. Impairment of fertility is estimated to occur in about 13% of patients,2 while 30%-87% of patients with bilateral mumps orchitis experience infertility.8


    Treatment is supportive (bed rest, scrotal support, and the use of nonsteroidal anti-inflammatory agents). We have found two studies which supported prescribing broadspectrum antibiotics.8,9 They claimed that bacterial infection of the oedematous testicular tissues cannot always be ruled out.

    Steroid administration helps in diminishing pain and oedema, but it does not alter the clinical course of the disease or prevent future complications. The benefits must be weighed against the self-limiting nature of mumps orchitis and the potential side effects of steroid treatment. Adamopoulos et al.6 found that corticosteroids may reduce pain and oedema, but it caused the testosterone levels to decrease and follicle stimulating hormone and leuteinizing hormone levels to increase. Smith and Bishir10 described the use of high doses of steroids in reducing pain, but they had little effect on local findings and subsequent clinical course of the disease. Bertschat et al.11 in his small series found that patients on corticosteroids showed better semen analysis parameters at follow up examinations, although it was not significant.

    As interferon inhibits transcriptase-induced viral replication, it would be expected that systemic interferon treatment could prevent the development of testicular atrophy and infertility. Erpenbach et al.12 claimed in 1991 to have prevented testicular damage and infertility in four patients who had bilateral mumps orchitis by using systemic interferon-{alpha} 2B for seven days. Those cases with severe subfertility before treatment improved to normospermia and remained fertile during the 12-20 month follow-up period. Ku et al.13 studied the effect of interferon-{alpha} 2B on 13 patients with mumps orchitis in comparison to eight infected patients who did not receive therapy. No patient in the treatment group developed testicular atrophy as opposed to three in the control group. The sperm count was improved in all patients treated with interferon, but low sperm count persisted in four from the control group. Abnormal sperm morphology persisted in both patient groups. Yeniyol et al.14 studied the effects of interferon-{alpha} 2B on 18 patients with mumps orchitis. Patients were evaluated by testicular biopsy after a year of treatment. The biopsies showed total atrophy of the seminiferous tubules in 39%, 10% atrophy in 16%, and no apparent histological alterations, except an arrest in spermatogenesis, in 45%. They concluded that systemic treatment with interferon is not completely effective in preventing atrophy after mumps orchitis.

    In the past, surgical management with early incision of the tunica albuginea was tried, but failed to prevent development of testicular atrophy.15 Mumps outbreaks are now seen only sporadically. Therefore, evaluation of any treatment is difficult as it is not possible to recruit adequate number of patients for controlled studies.

    When azoospermia occurs as a consequence of mumps orchitis, it does not necessarily cause complete absence of spermatozoa in the testes. Testicular biopsy often yields occasional spermatozoa. The development of intracytoplasmic sperm injection has significantly changed the treatment of male subfertility. Fertilization and pregnancy can be achieved after retrieving a few spermatozoa.


    Small mumps outbreaks and their complications continue to be identified, and it remains an important clinical condition. There are great concerns about subsequent infertility in these patients. Immunization is the best policy to avoid mumps-related complications. Treatment remains conservative.


    Competing interests None declared.


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    2. Berhrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics, 17th edn. Philadelphia: Saunders,2004

    3. Health protection agency. Mumps Notifications, By Age 1996-2005 [] Accessed 27 March 2006

    4. Bertschat FL, Alexander M. Infertility after mumps orchitis. Munch Med Wchnschr1981; 123:606 -8

    5. Bartak V. Sperm count, morphology, and motility after unilateral mumps orchitis. J Reprod Fertil1973; 32:491 -3[Abstract/Free Full Text]

    6. Adamopoulos DA, Lawrence DM, Vassilopoulos P, Contoyiannis PA, Swyer GI. Pituitary-testicular interrelationships in mumps orchitis and other infections. BMJ1978; i:1177 -80

    7. Kalaydjiev S, Dimitrova P, Tsvetkova D. Serum sperm antibodies unrelated to mumps orchitis. Andrologia2001; 33:69 -70[Medline]

    8. Casella R, Leibundgut B, Lehmann K, Gasser TC. Mumps orchitis: report of a mini-epidemic. J Urol1997; 158:2158 -61[Medline]

    9. Scholz M, Graf N, Steffens J, et al. mumps-orchitis im jugend-und erwachsenenalter: ein vergessenes krankheitsbild. Dt Arztbl 1996;93:2087

    10. Smith IM, Bishir JE. Treatment of mumps orchitis with ACTH and cortisone. N Engl J Med1958; 258:120 -4[Medline]

    11. Steinberger E. The etiology and pathophysiology of testicular dysfunction in man. Fertil Steril1978; 29:481 -91[Medline]

    12. Erpenbach K. Systemic treatment with interferon-alpha 2B: an effective method to prevent sterility after bilateral mumps orchitis. J Urol1991; 146:54 -6[Medline]

    13. Ku JH, Kim YS, Lee NK. The preventive effect of systemic treatment with interferon-alpha 2B for infertility from mumps orchitis. BJU Int 1999;84:839 -42[Medline]

    14. Yeniyol CO, Sorguc S, Minareci S, Ayder AR. Role of interferon-alpha 2B in prevention of testicular atrophy with unilateral mumps orchitis. Adult Urol2000; 55:931 -3

    15. Nixon N, Lewis DB. Mumps orchitis: surgical treatment. J Urol 1946; 56:554 -60

  16. One last point, the fact the at least 12% of twice immunized men will NOT HAVE IMMUNITY means they need blood testing to document their protection against mumps. This is a reasonably inexpensive test and can be done with a single blood draw and results return in a week. PLEASE EMPHASIZE ITs IMPORTANCE

  17. What is clear from these posts is that it is of the utmost importance to receive the most updated medical advice and care to prevent as many cases as possible. We wish a refuah shleima to all.
    What is missing is the usual tirade against the medical profession and the foolish claim that our Torah learning provides immunity from disease. Maybe the yeshivishe velt is finally admitting that its’ dogmatic obscurantist approach is fallacious.


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