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Letter From Helsinki |

Mumps and Rubella Eliminated From Finland

Heikki Peltola, MD; Irja Davidkin, PhD; Mikko Paunio, MD; Martti Valle, MD; Pauli Leinikki, MD; Olli P. Heinonen, MD
JAMA. 2000;284(20):2643-2647. doi:10.1001/jama.284.20.2643.
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Many countries use trivalent measles-mumps-rubella (MMR) vaccine for their mumps and rubella immunization programs.

In Finland, a national 2-dose MMR vaccination program for children, free of charge and on a voluntary basis, was launched in 1982. Serological confirmation of all suspected cases of mumps and rubella has been required since 1987. Despite intensive surveillance, no persistent sequelae or deaths attributable to vaccination have been detected. Indigenous mumps and rubella were eliminated in 1996, but 4 imported cases of mumps and 2 of rubella occurred from 1997 to 1999. Lack of secondary cases indicates sufficient immunity in the community. Compared with an epidemic year, up to thousands of cases of mumps meningoencephalitis and orchitis and around 50 cases of congenital rubella syndrome are now avoided annually.

A 2-dose vaccine regimen in children during the last 17 years (1983-1999) has interrupted circulation of the target viruses entirely. Finland is the first country documented to be free of indigenous mumps and rubella (measles was eliminated in 1996). Despite the ongoing possibility of imported disease, major outbreaks probably can be avoided by maintaining high vaccination coverage and the 2-dose policy.

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Figure 1. Indigenous Mumps in Finland in 1960-1999: Reported Cases Until 1986, Serological Confirmation Since 1987
Graphic Jump Location
Unshaded area indicates number of cases through 1986 based on reported cases; shaded area, number of cases after 1986 based on serological confirmation.
*Inactivated mumps vaccine was used for recruits of the defense forces in 1960-1986.
†Component of measles-mumps-rubella vaccine.
‡Two cases of mumps imported from Russia.
§One case imported from Estonia.
∥One case imported from Africa.
Figure 2. Indigenous Rubella in Finland in 1960-1999: Reported Cases Until 1986, Serological Confirmation Since 1987
Graphic Jump Location
Unshaded area indicates number of cases through 1986 based on reported cases; shaded area, number of cases after 1986 based on serological confirmation.
*Cendehill strain was given to schoolgirls and mothers who had recently delivered in 1975-1983 but was replaced by Wistar RA 27/3 for 1983-1988 (this strain is a component of measles-mumps-rubella vaccine).
†Component of measles-mumps-rubella vaccine.
‡One case imported from Russia.
§One case imported from Estonia.

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