Of the 2000 students approached, 717 completed the web-based questionnaire (response = 36%);47 of the students frequently working in student bars responded. Sixty-five learn more percent (n = 496) of the respondents were female and

the median age was 22 years (range 17–59). Of the 717 respondents in the main cohort, 38 students reported parotitis (5.0%, CI 4.4–7.8%), suggesting that 2000 (95%CI 1662–2378) parotitis cases may have occurred among all 37,742 KU Leuven students in a period of seven months. Eighty-two percent (n = 31) and 71% (n = 27) of the cases reported pain while swallowing and earache, respectively. Other symptoms frequently reported by the cases included headache (n = 26; 68%), fever (n = 22; 58%) and fatigue (n = 20; 53%). Two (8%) of the male cases reported orchitis and two (4%) cases reported meningitis; 34 (72%)

Fulvestrant cost cases visited a physician and one case was hospitalized. Mumps cases started to occur from October 2012, peaked at the end of December, decreased during the Christmas holidays and exams and re-increased in February 2013 as classes resumed (Fig 3). The median age of cases was 21.5 years (range 18–26) and 53% (n = 25) were male. No significant differences were found between the main cohort and the student bar-cohort. The gender-specific attack rate was 4% for females and 9% for males (RR: 2.1, 95%CI 1.2–3.7). The duration of mumps symptoms ranged from 1 to 20 days (median: 6.5 days) while absences from classes ranged from 1 to 20 days (median: 4.4 days). The risk of mumps was higher among students working Methisazone in student bars (9/47, 19%) than among others (38/717, 5%, RR: 3.6, 95%CI 1.9–7.0). Even after adjustment for documented immunization status the RR differed significantly from one (adjusted RR: 3.4; 95%CI 1.1–11). Of all study participants, 95% (n = 729) reported their vaccination status. Of those, 3% (n = 30) reported that they had not been vaccinated, 37% (n = 290) reported being vaccinated once and 54% (n = 412) reported being vaccinated twice ( Table 1). For 33% (n = 259) of the respondents, documented vaccination

status was available in the medical files of the KU Leuven. Among those with a documented vaccination status, none were unvaccinated, 5% (n = 12) were vaccinated once and 95% (n = 247) twice. The risk of mumps among students who were vaccinated twice (attack rate 5%) was lower than among those who were vaccinated once (attack rate 17%). The two dose vaccine effectiveness, as compared to a single dose, was estimated at 68% (RR: 0.32, 95%CI −24% to 92%). The risk of mumps among those vaccinated with two doses within the last 10 years (attack rate 3%) was lower than among those vaccinated with two doses ≥11 years earlier (attack rate 9%). The difference was not significant (95%CI 0.10–1.02). Between June 2012 and April 2013, the Flemish region of Belgium reported an increased number of mumps cases, mostly among young vaccinated adults and in cities with universities.