Mumps outbreaks have recently been recorded in a number of highly vaccinated populations. We related seroprevalence, epidemiological and vaccination data from 18 European countries participating in The European Sero-Epidemiology Network (ESEN) to their risk of mumps outbreaks in order to inform vaccination strategies. Samples from national population serum banks were collected, tested for mumps IgG antibodies and standardized for international comparisons. A comparative analysis between countries was undertaken using age-specific mumps seroprevalence data and information on reported mumps incidence, vaccine strains, vaccination programmes and vaccine coverage 5-12 years after sera collection. Mean geometric mumps antibody titres were lower in mumps outbreak countries [odds ratio (OR) 0·09, 95% confidence interval (CI) 0·01-0·71)]. MMR1 vaccine coverage ⩾95% remained protective in a multivariable model (P < 0·001), as did an interval of 4-8 years between doses (OR 0·08, 95% CI 0·01-0·85). Preventing outbreaks and controlling mumps probably requires several elements, including high-coverage vaccination programmes with MMR vaccine with 4-8 years between doses.

Center for the Evaluation of Vaccination Vaccine and Infectious Disease Institute University of Antwerp Belgium

Centro Nacional de Microbiología Instituto de Salud Carlos 3 Majadahonda Madrid Spain

European Programme for Intervention Epidemiology Training Stockholm Sweden

Health Protection Agency Health Protection Services Colindale London UK

Health Protection Surveillance Centre Dublin Ireland

Laboratory for Virology NPHI Slovenia

Laboratory of the State Agency Infection Centre Virology Unit Riga Latvia

Mater Dei Hospital Malta

National Centre for Communicable Diseases Surveillance and Control National Institute of Public Health Romania

National Centre for Epidemiology Budapest Hungary

National Institute for Health and Welfare Helsinki Finland

National Institute of Public Health Prague Czech Republic

National Public Health Surveillance Laboratory Vilnius Lithuania

Nicosia Hospital Nicosia Cyprus

Public Health Authority of the Slovak Republic Bratislava Slovak Republic

School of Public Health Sackler Faculty of Medicine Tel Aviv University Israel

Surveillance and Epidemiology of Infectious Diseases Laboratoire National de Santé Luxembourg

Swedish Institute for Infectious Disease Control Stockholm Sweden

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