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To the Editor: Italian military recruits have received mandatory mumps vaccination by Urabe Am9 strain since 1998. A previous study1 found that, in 1999, 37 episodes of mumps-like disease were found in recipients of the vaccine, and that 35 of these occurred within 1 month of immunization. To assess whether these cases were due to some expected residual virulence of the live attenuated Urabe Am9 mumps strain, we analyzed saliva samples from recruits who developed mumps-like disease within 1 month of vaccination.
After informed consent, saliva samples were collected from 20 military recruits who had developed mumps-like disease and from 14 randomly selected asymptomatic recruits 1 month following vaccination. For positive amplification control a commercial Jeryl Linn vaccine strain was used (M-M-R-II, Aventis Pasteur MSD, Lyon, France). Viral RNA was extracted according to the manufacturer's instructions (Machery-Nagel, Duren, Germany), retrotranscribed with avian myeloblastosis virus enzyme (Roche, Basel, Switzerland) and amplified by nested polymerase chain reaction.2 Amplified fragments were first purified, then sequenced using a BigDye Terminator kit in a 377ABI sequencer (Applied Biosystems, Foster City, Calif). The obtained sequences, together with the consensus sequence of Urabe Am9,3 have been aligned by the CLUSTALW tool (available at: http://www2.ebi.ac.uk/clustalw/).
Fifteen of the 20 saliva samples from vaccinated subjects with mumps-like disease were positive for mumps RNA, whereas all saliva samples from asymptomatic controls were negative. The positive samples were sequenced and all of them completely overlapped the reference consensus sequence of Urabe Am9.
Wild mumps virus genotypes A and C are predominant in Europe, whereas genotype B is nearly absent.4 This information, together with the results of our study, confirms that Urabe Am9 vaccine (a B genotype strain) can be associated with early mumps-like disease, which, therefore, may be considered as a possible vaccine-induced adverse effect. This finding is not unexpected and is shared by all mumps live-attenuated vaccines.5
In light of these molecular data, our previous conclusion1 that Urabe Am9 is 70% effective may actually be too low, as the efficacy of the Urabe Am9 vaccine against wild-virus infections could be underestimated if vaccine-associated cases are included. However, Cohen et al,2 using a different vaccine strain, found that natural mumps disease can occur 16 days after vaccination. Thus, for subjects for whom molecular data are not available, the possibility of a coincidental infection with wild-type mumps virus cannot be completely ruled out.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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