Patterns in the spread and serovirological diagnosis of serous meningitis

The epidemiological and clinico-etiological study of cases of acute serous meningitis with unknown etiology in children was carried out in a large industrial city at the period of a considerable morbidity rise caused by this infection. The maximum morbidity was registered among younger children under school age attending children's institutions. In 26 closed groups of children group morbidity was revealed (4 cases and more), in 5 such groups small local outbreaks were registered. The clinico-instrumental methods of study permitted one to differentiate the groups of children having serous meningitis of supposedly enteroviral etiology, and sero virological studies carried out with the use of a wide range of diagnostic reagents revealed the etiological role of group B Coxsackie virus, mainly type 4, in 20.6% of cases, ECHO virus, serotypes 3 and 11, in 20.7% of cases, and parotitis virus in 5.3% of cases.     

Methods for screening the naturally acquired and vaccine-induced immunity to the mumps virus

Since the introduction of the measles, mumps and rubella (MMR) vaccine in Sweden in 1982, a yearly evaluation of the immunity pattern and seroconversion rate of 12-year-old children has been carried out. To be able to realize large-scale, follow-up studies, techniques have to be used which are not too labour-intensive and time-consuming but are sensitive enough to detect past immunity and post-vaccination titres. We report tests with haemolysis-in-gel (HIG) technique and an enzyme-linked, immunosorbent assay (ELISA) compared with neutralization (NT) for the detection of mumps antibodies. This study comprises 226 paired serum samples obtained between 1985 and 1989. One hundred and forty-one of the paired samples had been selected because they had given negative or borderline readings, using HIG technique. The remaining samples were consecutive pre- and post-vaccination sera obtained in 1989 from 85 vaccinees from one area in Sweden. HIG technique gave both false positive and false negative readings, compared with NT as also the false positive sera were detected. Non-inactivated sera could not be used in the NT test against mumps virus, owing to unspecific NT reactions. No differences between non-inactivated and inactivated sera by NT were seen, as against other paramyxoviruses. Cross-reactivity between mumps and parainfluenzae in NT tests was not demonstrated. The ELISA test proved more reliable and specific than HIG and was more sensitive than NT. Some post-vaccination sera from vaccinees who failed to seroconvert by NT contained high levels of mumps antibody detectable by the ELISA.(ABSTRACT TRUNCATED AT 250 WORDS)     

Serous meningitis

During the second half of the 1950s serous meningitis and other enterovirus-induced diseases played one of the leading roles in human pathology in the world. Since the introduction of oral poliomyelitis vaccine (OPV) into wide medical practice from the beginning of the 1960s and during the subsequent decades the number of epidemics and the morbidity level in enterovirus-induced diseases sharply dropped. This was probably due to the interference of enteroviruses circulating in nature and vaccine polioviruses in the intestine of vaccinated children. At the beginning of the XXI century a tendency towards a growth in the morbidity of serous meningitis of enterovirus etiology was noted. This growth was probably due to a sharp decrease in the level of revaccinations of children with OPV. At the age of 2 to 14 years, most affected by enteroviruses, children were not vaccinated with OPV and they were thus left unprotected. The materials on the epidemiology of serous meningitis and recommendations on etiological diagnosis, as well as on the patients hospitalization and the vaccination of children with OPV as a nonspecific antiepidemic measures based on the phenomenon of virus interference are presented.     

Recent mumps outbreaks in vaccinated populations: no evidence of immune escape

Recently, numerous large-scale mumps outbreaks have occurred in vaccinated populations. Clinical isolates sequenced from these outbreaks have invariably been of genotypes distinct from those of vaccine viruses, raising concern that certain mumps virus strains may escape vaccine-induced immunity. To investigate this concern, sera obtained from children 6 weeks after receipt of measles, mumps, and rubella (MMR) vaccine were tested for the ability to neutralize a carefully selected group of genetically diverse mumps virus strains. Although the geometric mean neutralizing antibody titer of the sera was lower against some virus strains than others, all viruses were readily neutralized, arguing against immune escape.     

Two clones obtained from Urabe AM9 mumps virus vaccine differ in their replicative efficiency in neuroblastoma cells

A high rate of post-vaccinal aseptic meningitis for Urabe AM9 mumps virus strain is well documented. This strain is composed of two virus variants differing at the nt 1081 (A/G) region in the hemagglutinin-neuraminidase (HN) gene. An association of HN-A(1081) variant with neurovirulence has been proposed. In order to test for neurotropism we isolated the HN-A(1081) and HN-G(1081) virus variants from Urabe AM9 mumps virus vaccine. Sequential passages were performed in monkey kidney Vero cells and human neuroblastoma SH-SY5Y cells. Viral replication was determined by conventional and real-time RT-PCR. The results show that clone HN-A(1081) can replicate efficiently in both cell types. However, a defective replication of clone HN-G(1081), lacking its genetic marker, was observed after the third passage in neuroblastoma cells. Kinetics assays showed that clone HN-A(1081) replicates faster than clone HN-G(1081). Viral clones were also inoculated into the brains of newborn rats. Clone HN-A(1081) replicated 14 times, while clone HN-G(1081) merely duplicated its level over the initial inoculum. These results suggest that there is a selective replication of HN-A(1081) mumps virus variants in cells of nervous origin.     

Cell-mediated immune response to mumps virus infection in man.

The antibody and cell-mediated immune response to mumps virus infection was studied in groups of subjects after natrually acquired mumps virus infection, after parenteral immunization with live attenuated mumps vaccine, and in a population of mumps seronegative subjects. The technique of neutralization of tissue culture infectivity was utilized to study mumps specific antibody. The cell-mediated immunity (CMI) was detected by specific immune release (SIR) of radioactivity by purified lymphocytes after they were reacted with radioactive chromium (51Cr) labeled human conjunctival cell cultures chronically infected with mumps virus. No SIR activity was observed in lymphocytes obtained from cord blood and young individuals seronegative for antibody to mumps virus. Detectable SIR activity was observed in a few older seronegative subjects; however, immunization with mumps vaccine in such antibody negative subjects failed to result in the development of any antibody response in the serum. High SIR activity was observed in the lymphocytes of naturally infected and vaccinated subjects. Although all naturally infected or immunized subjects had varying levels of mumps specific antibody activity in the serum, no correlation existed between the levels of antibody and SIR activity. These observations suggest the development of mumps specific in vitro correlates of CMI after naturally acquired or vaccine-induced mumps virus infection.     

Epidemiologic evaluation of the effectiveness of mass vaccination against mumps

The effectiveness of mass immunization against mumps is evaluated with the use of data on 20 cities in the European part of the RSFSR. The expediency of using the indicator data on morbidity for many years in the preimmunization period for such evaluation is shown. These data permit the evaluation of the effectiveness of immunization for any month in the course of its carrying out. An essential decrease in mumps morbidity has been found to occur if immunization covered not less than 15-30% of children aged 1-14 years.     

Evaluation of live trivalent vaccine of measles AIK-C strain, mumps Hoshino strain and rubella Takahashi strain, by virus-specific interferon-gamma production and antibody response

A trivalent measles-mumps-rubella live virus vaccine, containing measles AIK-C strain, mumps Hoshino strain, and rubella Takahashi strain, was evaluated in 229 children, aged 1 to 5 years. The vaccine induced a high seroconversion rate: 221 (98.7%) out of 224 subjects initially seronegative for measles virus, 167 (93.3%) out of 179 initially seronegative for mumps virus, and 212 (99.1%) out of 214 initially seronegative for rubella virus. It also induced a sufficient cellular immunity against each of the three viruses in over 90% of the subjects, as judged by virus-specific interferon-gamma (IFN-gamma) production. Virus-specific IFN-gamma production was observed 10 days after vaccination by stimulation with measles virus and rubella virus and 14 days after vaccination by stimulation with mumps virus. Mumps-virus-specific IFN-gamma production was observed in 7 out of 12 recipients without seroconversion for mumps virus. And measles-virus-specific IFN-gamma production was demonstrated in one out of three recipients without seroconversion for measles virus. A significant correlation was observed between the serum antibody and IFN-gamma production six weeks after vaccination for measles virus (r = 0.201, P less than 0.01) and for mumps virus (r = 0.174, P less than 0.05) but not for rubella virus (r = -0.045, P less than 0.05). The incidence of febrile reactions of greater than or equal to 37.5 C was quite low, 14.4%, and that of greater than or equal to 39 C occurred in only 1.3% of the recipients. These results suggested that the trivalent vaccine induced sufficient humoral and cellular immunity and yet resulted in no more untoward reaction than observed from the measles vaccine alone.     

Neurovirulence of mumps virus: intraspinal inoculation test in marmosets.

An intraspinal inoculation test of mumps virus using marmosets was performed in order to develop a neurovirulence test of mumps vaccines. In the group inoculated with non-neurovirulent Jeryl Lynn vaccine strain at 10(2.0) pfu/dose, there were only minimal histopathological changes in 3 of the 5 marmosets. In contrast, all marmosets inoculated with neurovirulent Urabe and NK-M46 vaccine strains developed extensive encephalitis and meningitis. Thus, this marmoset model, which can distinguish between non-neurovirulent and neurovirulent vaccine strains, is useful for evaluating neurovirulence of vaccine strains and elucidating the molecular pathogenesis of mumps.     

The V protein of mumps virus plays a critical role in pathogenesis

Mumps virus (MuV) causes an acute infection in humans characterized by a wide array of symptoms ranging from relatively mild manifestations, such as parotitis, to more-severe complications, such as meningitis and encephalitis. Widespread mumps vaccination has reduced mumps incidence dramatically; however, outbreaks still occur in vaccinated populations. The V protein of MuV, when expressed in cell culture, blocks interferon (IFN) expression and signaling and interleukin-6 (IL-6) signaling. In this work, we generated a recombinant MuV incapable of expressing the V protein (rMuVΔV). The rescued MuV was derived from a clinical wild-type isolate from a recent outbreak in the United States (MuV(Iowa/US/06), G genotype). Analysis of the virus confirmed the roles of V protein in blocking IFN expression and signaling and IL-6 signaling. We also found that the rMuV(Iowa/US/06)ΔV virus induced high levels of IL-6 expression in vitro, suggesting that V plays a role in reducing IL-6 expression. In vivo, the rMuV(Iowa/US/06)ΔV virus was highly attenuated, indicating that the V protein plays an essential role in viral virulence.     

Changes in mumps virus gene sequence associated with variability in neurovirulent phenotype

Mumps virus is highly neurotropic and, prior to widespread vaccination programs, was the major cause of viral meningitis in the United States. Nonetheless, the genetic basis of mumps virus neurotropism and neurovirulence was until recently not understood, largely due to the lack of an animal model. Here, nonneurovirulent (Jeryl Lynn vaccine) and highly neurovirulent (88-1961 wild type) mumps virus strains were passaged in human neural cells or in chicken fibroblast cells with the goal of neuroadapting or neuroattenuating the viruses, respectively. When tested in our rat neurovirulence assay against the respective parental strains, a Jeryl Lynn virus variant with an enhanced propensity for replication (neurotropism) and damage (neurovirulence) in the brain and an 88-1961 wild-type virus variant with decreased neurotropic and neurovirulent properties were recovered. To determine the molecular basis for the observed differences in neurovirulence and neuroattenuation, the complete genomes of the parental strains and their variants were fully sequenced. A comparison at the nucleotide level associated three amino acid changes with enhanced neurovirulence of the neuroadapted vaccine strain: one each in the nucleoprotein, matrix protein, and polymerase and three amino acid changes with reduced neurovirulence of the neuroattenuated wild-type strain: one each in the fusion protein, hemagglutinin-neuraminidase protein, and polymerase. The potential role of these amino acid changes in neurotropism, neurovirulence, and neuroattenuation is discussed.     

Clonal analysis of HLA-restricted virus-specific cytotoxic T lymphocytes from cerebrospinal fluid in mumps meningitis

T lymphocytes were cloned directly from the cerebrospinal fluid of a patient with mumps meningitis by limiting dilution in the presence of irradiated feeder cells and T cell growth factor. Of 84 colonies analyzed, 41 were cytotoxic, as shown by their ability to exert phytohemagglutinin-dependent killing. Of these, 39 showed specificity for the autologous mumps-virus infected target cells. The cytotoxic T cell colonies showed the same pattern of HLA restriction as bulk cultures of CSF lymphocytes. This study shows that it is possible to perform functional assays on inflammatory exudate cells at the clonal level. The data also suggest that recruitment of effector cells from the peripheral compartment into the meningeal spaces in mumps meningitis is highly antigen-specific.     

The F gene of rodent brain-adapted mumps virus is a major determinant of neurovirulence

Prior to the introduction of live-attenuated vaccines, mumps virus (MuV) was the leading cause of virus-induced meningitis. Although vaccination has been effective at controlling the disease, the use of insufficiently attenuated strains has been associated with high rates of aseptic meningitis in vaccinees. The molecular basis of MuV attenuation is poorly understood, and no reliable molecular markers of virulence have been identified. In this study, reverse genetics has been used to identify molecular determinants of MuV neuropathogenesis. Recombinant viruses, containing the envelope-associated genes from the Kilham (MuV(KH)) rodent brain-adapted strain of MuV, were generated in the Jeryl Lynn 5 (MuV(JL5)) vaccine strain background. The syncytium phenotypes of the recombinant viruses on Vero cells differed depending on the source of the fusion (F) and hemagglutinin-neuraminidase (HN) glycoproteins, with heterologous combinations showing either an increase or a decrease in the level of cell fusion compared to that of the homologous parental combinations. This was confirmed by transiently cotransfecting eukaryotic F and HN glycoprotein expression constructs. A Lewis rat model that discriminates between neurovirulent and nonneurovirulent MuV strains based on the extent of hydrocephalus induced in the rat brain after intracerebral inoculation was used to assess the phenotype of the recombinant viruses. Expression of the matrix (M), small hydrophobic (SH), or HN gene in isolation did not confer a neurovirulent phenotype. Expression of the F gene of the neurovirulent strain alone was sufficient to induce significant levels of hydrocephalus. Coexpression of the homologous HN gene led to a marginal increase in the level of hydrocephalus.     

Critical factors for the replication of mumps virus in primary chicken embryo fibroblasts defined by the use of design of experiments (DoE)

Live attenuated vaccines against mumps virus (MuV) have been traditionally produced by passaging the virus in the embryonated chicken eggs or primary chicken embryo fibroblasts (CEFs). Virus propagation on these cell substrates enables successful virus attenuation and retains it sufficiently antigenic to induce lasting protective immunity in humans. The aim of this study was to identify critical factors for MuV replication in primary CEFs grown on a small-scale level in order to explore possibilities for improvements in the virus replication and yield. The effect of differently prepared cells, culturing conditions, and infection conditions on virus yield was estimated by employing statistical design of experiments (DoE) methodology. Our results show that the preparation of primary CEFs and the way of their infection substantially impact virus yield and are critical for efficient MuV replication. These process parameters should be considered in further process optimization. We also demonstrate the applicability of DoE in optimization of virus replication as a crucial step in obtaining high virus yields.     

Gene-specific contributions to mumps virus neurovirulence and neuroattenuation

Mumps virus (MuV) is highly neurotropic and was the leading cause of aseptic meningitis in the Western Hemisphere prior to widespread use of live attenuated MuV vaccines. Due to the absence of markers of virus neuroattenuation and neurovirulence, ensuring mumps vaccine safety has proven problematic, as demonstrated by the occurrence of aseptic meningitis in recipients of certain vaccine strains. Here we examined the genetic basis of MuV neuroattenuation and neurovirulence by generating a series of recombinant viruses consisting of combinations of genes derived from a cDNA clone of the neurovirulent wild-type 88-1961 strain (r88) and from a cDNA clone of the highly attenuated Jeryl Lynn vaccine strain (rJL). Testing of these viruses in rats demonstrated the ability of several individual rJL genes and gene combinations to significantly neuroattenuate r88, with the greatest effect imparted by the rJL nucleoprotein/matrix protein combination. Interestingly, no tested combination of r88 genes, including the nucleoprotein/matrix protein combination, was able to convert rJL into a highly neurovirulent virus, highlighting mechanistic differences between processes involved in neuroattenuation and neurovirulence.     

An assessment of mumps vaccine effectiveness by dose during an outbreak in Canada

Background

This investigation was done to assess vaccine effectiveness of one and two doses of the measles, mumps and rubella (MMR) vaccine during an outbreak of mumps in Ontario. The level of coverage required to reach herd immunity and interrupt community transmission of mumps was also estimated.

Methods

Information on confirmed cases of mumps was retrieved from Ontario’s integrated Public Health Information System. Cases that occurred between Sept. 1, 2009, and June 10, 2010, were included. Selected health units supplied coverage data from the Ontario Immunization Record Information System. Vaccine effectiveness by dose was calculated using the screening method. The basic reproductive number (R₀) represents the average number of new infections per case in a fully susceptile population, and R₀ values of between 4 and 10 were considered for varying levels of vaccine effectiveness.

Results

A total of 134 confirmed cases of mumps were identified. Information on receipt of MMR vaccine was available for 114 (85.1%) cases, of whom 63 (55.3%) reported having received only one dose of vaccine; 32 (28.1%) reported having received two doses. Vaccine effectiveness of one dose of the MMR vaccine ranged from 49.2% to 81.6%, whereas vaccine effectiveness of two doses ranged from 66.3% to 88.0%. If we assume vaccine effectiveness of 85% for two doses of the vaccine, vaccine coverage of 88.2% and 98.0% would be needed to interrupt community transmission of mumps if the corresponding reproductive values were four and six.

Interpretation

Our estimates of vaccine effectiveness of one and two doses of mumps-containing vaccine were consistent with the estimates that have been reported in other outbreaks. Outbreaks occurring in Ontario and elsewhere serve as a warning against complacency over vaccination programs.Between September 2009 and June 2010, there was an outbreak of mumps in Ontario, Canada. Outbreaks of mumps were also taking place in the United States (New York and New Jersey) and in Israel during the same period.^1,2 These outbreaks shared several features, including the age distribution of the cases, the predominance of male cases and the occurrence of the disease among people who had received vaccinations against mumps.^1,2 This latter issue can lead to questions from the public and health care providers regarding the effectiveness of the vaccine. Rapid assessment of vaccine effectiveness is, therefore, an important component of outbreak management for vaccine-preventable diseases, and knowledge of the history of the vaccination program is necessary for interpreting the results.A live attenuated mumps vaccine was licensed in Canada in 1969 and introduced in Ontario shortly thereafter. In 1975, a single dose of the combined vaccine for measles, mumps and rubella (MMR) was implemented. A single-dose program continued until 1996, when a second dose of the MMR vaccine was introduced as part of a plan to eradicate measles. The first dose of the MMR vaccine is routinely given at 12 months of age; until 2007, the second dose was recommended for children between four and six years of age. The recommended age for the second dose is now 18 months.Two MMR vaccines are available for use in Ontario. A single dose of monovalent measles vaccine was offered to all students aged 4–18 years in 1996 as part of a measles catch-up campaign. Because mumps-containing vaccine was not used, a cohort of individuals born before 1992 who had only received one dose of mumps-containing vaccine were therefore potentially susceptible to the virus.Epidemiologic data show that the mumps virus circulated relatively widely throughout Ontario until approximately 1980 (M.A. Simpson, Ontario Ministry of Health and Long-Term Care, Toronto, Ont.: personal communication, 2011 Feb. 1), which would have resulted in the natural boosting of the population’s immunity to the disease. The combination of changes in the policy governing vaccination against mumps and the circulation of the disease thus resulted in a susceptible cohort of individuals born between approximately 1980 and 1992 (i.e., people currently between 19 and 31 years of age).A person’s susceptibility to mumps is also influenced by the effectiveness of the vaccine he or she received. Clinical trials have reported vaccine efficacy of approximately 95% after one dose of mumps vaccine under controlled conditions, although estimates of vaccine effectiveness that were conducted in the field (as opposed to clinical trials) have been much lower (i.e., 62%–85%).³ There is less information available about vaccine effectiveness after two doses, but estimates have ranged from 76% to 95%,^3–5 with accumulating evidence of waning immunity.^2–6The objectives of this investigation were to assess the vaccine effectiveness of MMR vaccine by dose and by birth cohort during the outbreak, and to estimate the level of vaccine coverage required to reach herd immunity and interrupt community transmission of mumps.     

Identification and development of a promising novel mumps vaccine candidate strain

Mumps epidemics are usually caused by airborne transmission of mumps virus (MuV) and have high morbidity in non-immunized children. Epidemiological studies in many regions of China show that the genotype F viral strain is the most prevalent. However, the genotype A strain is currently used to prepare vaccines. Regional epidemiological MuV data suggest a significant application for the development of live attenuated mumps vaccines targeting specific genotypes. This article reports the isolation and culture of a genotype F MuV candidate strain that could be used to prepare a live attenuated mumps vaccine. This strain is shown to have good immunological efficacy and stability in neurovirulence evaluations. This work should facilitate the implementation of mumps vaccination in mainland China by targeting the most prevalent MuV genotype, genotype F.     

Synthesis of mumps virus nucleocapsid protein in yeast Pichia pastoris

The expression of mumps virus nucleocapsid protein in yeast Pichia pastoris was investigated. Viral nucleocapsid proteins usually elicit a strong long-term humoral immune response in patients and experimental animals. Therefore, the detection of antibodies specific to mumps virus nucleoprotein can play an important role in immunoassays for mumps diagnosis. For producing a high-level of recombinant mumps virus nucleoprotein the expression system of yeast P. pastoris was employed. The recombinant nucleocapsid protein was purified by cesium chloride ultracentrifugation of yeast lysates. Electron microscopy of the purified recombinant nucleocapsid protein revealed a herring-bone structure similar to the one discovered in mammalian cells infected with mumps virus. The yield of purified nucleocapsid-like particles from P. pastoris constituted 2.1 mg per 1 g of wet biomass and was considerably higher in comparison to the other expression systems.