Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) for Third Dose of Mumps Virus-Containing Vaccine in Persons at Increased Risk for Mumps Disease During an Outbreak

The evidence types supporting critical outcomes for use of third dose of mumps virus-containing vaccine in persons at increased risk for mumps disease because of an outbreak was determined to be 4 for preventing mumps, not determined for preventing mumps complications, and 2 for serious adverse events (Table 5). A third dose of MMR vaccine is effective in preventing mumps and no serious adverse events were reported in more than 14,000 third dose recipients. Together, the benefit of added protection of a third dose of mumps virus-containing vaccine outweighs the low risk for vaccine adverse events. After reviewing the results of the GRADE analysis and other data related to burden of disease, values attributed to benefits and harms from a third dose of MMR vaccine, acceptability, and implementation, the ACIP recommended that persons previously vaccinated with two doses of a mumps virus-containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus-containing vaccine to improve protection against mumps disease and related complications. Although studies evaluated for the GRADE analysis only assessed MMR vaccine, mumps virus-containing vaccine was used in the recommendation to include the measles, mumps, rubella, and varicella (MMRV) vaccine [ProQuad, Merck & Co., Inc] as an option for children aged 12 years or younger when a third dose mumps vaccination is indicated. The full recommendations for the use of mumps virus-containing vaccine in persons at increased risk for mumps because of an outbreak have been published in MMWR.