mumps, or mumps vaccination. The committee heard presentations at its May 1992 public meeting from two parents whose daughters developed IDDM after receiving MMR (see Appendix B). There have been four cases of IDDM reported to VAERS (submitted between November 1990 and July 1992) following receipt of MMR and one or two following receipt of mumps vaccine (both reports might represent the same child, since both were 6-year-old males who developed IDDM following mumps immunization). The ages have ranged from 1 to 27 years, with one case each being reported at ages 1, 7, 18, and 27 years. There was either one or two cases in a child age 6 years, as explained above. The onset of symptoms of IDDM in these patients ranged from 2 days to 2.3 months after immunization, with one case occurring at 2 days, two at 6 weeks, and one at 2.3 months. The intervals in the others were not specified.

In 1975, Sinaniotis and colleagues reported the onset of IDDM 1 month after receipt of mumps vaccine in a 6.5-year-old boy. In 1991, Pawlowski and Gries described an 11-year-old boy who had mumps disease at age 16 months and then received measles-mumps vaccine 5 months before the onset of IDDM. He had severe abdominal pain and fever 1 week after immunization.

In 1984, Otten and colleagues reported three cases of IDDM, with onset in one case 10 days and in two cases 3 weeks after mumps vaccine in children 3, 2, and 16 years of age, respectively. They noted that the two younger children were positive for HLAs DR3 and DR4 and that the older boy was positive for DR4. In 1986, Helmke and colleagues reported seven children who developed IDDM in the second to fourth week following mumps or measles-mumps vaccination. All seven children were positive for DR4, and three were also positive for DR3.

In 1979, Quast and colleagues noted that in the first 2 years after mumps and measles-mumps vaccines were introduced in the former West Germany, two cases of IDDM with onset 7 and 10 days after immunization with measles-mumps and mumps vaccines, respectively, were reported to the manufacturer, Behringwerke AG.

In 1990, Fescharek and colleagues noted that 20 cases of IDDM were reported to the manufacturer, Behringwerke AG, from 1976 through 1989, a period during which about 5 million doses of mumps vaccine were distributed in the former West Germany, giving a rate of 1 for every 250,000 doses distributed. The two cases of IDDM identified by Quast et al. (1979) are probably part of the more extensive study from the records of Behringwerke AG (Fescharek et al., 1990). For 19 of 20 patients, the interval between immunization and the onset of symptoms was reported, and this ranged from 3 days to 7 months. Twelve cases began within 30 days of immunization. The annual number of new cases of IDDM was assumed to be about



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