Mumps facts

Mumps is a highly contagious viral infection with an incubation period of 14-18 days from exposure to onset of symptoms. The duration of the disease is approximately 10 days. The initial symptoms of mumps infection are nonspecific (low-grade fever, malaise, headache, muscle aches, and loss of appetite). The classic finding of parotid gland tenderness and swelling generally develops the third day of illness. The diagnosis is generally made without the need for laboratory tests. Serious complications of mumps include meningitis, encephalitis, deafness, and orchitis. The MMR vaccine provides 80% effective immunity against mumps following a twodosage schedule (12-15 months with booster at 4-6 years of age). No specific therapy exists for mumps. Warm or cold packs for the parotid gland tenderness and swelling is helpful. Pain relievers (acetaminophen [Tylenol] and ibuprofen [Advil]) are also helpful.

What is mumps?
Mumps is a viral infection transmitted by and affecting only humans. While the salivary glands (especially the parotid gland) are well known to be involved during a mumps infection, many other organ systems may also experience viral effects. There is no cure for mumps, but the illness is of short duration (seven to 10 days) and resolves spontaneously. Prior to the introduction of mumps vaccination, the highest rate of new cases of mumps was reported in the late winter to early spring.

What causes mumps? How is mumps transmitted?

Mumps virus is a single strand of RNA housed inside a two-layered envelope that provides the virus its characteristic immune signature. Only one type of mumps virus has been demonstrated to exist (in contrast to multiple virus types which may cause the common cold). Mumps is highly contagious and has a rapid spread among members living in close quarters. The virus most commonly is spread directly from one person to another via respiratory droplets. Less frequently, the respiratory droplets may land on fomites (sheets, pillows, clothing) and then be transmitted via hand-to-mouth contact after touching such items. The incubation period from exposure to the virus and onset of symptoms is approximately 14-18 days. Viral shedding is short lived and a patient should be isolated from other susceptible individuals for the first five days following the onset of swelling of the salivary (parotid) glands.

What are the signs and symptoms of mumps in children and adults?
Nonspecific symptoms of low-grade fever, headache, muscle aches (myalgia), reduced appetite, and malaise occur during the first 48 hours of mumps infection. Parotid gland swelling characteristically is present on day three of illness. (The parotid gland is a salivary gland located anterior to the ear and above the angle of the jaw -- imagine a large set of sideburns.) The parotid gland is swollen and tender to touch, and referred pain to the ear may also occur. Parotid gland swelling may last up to 10 days, and adults generally experience worse symptoms than children.

Approximately 95% of individuals who develop symptoms of mumps will experience tender inflammation of their parotid glands. Interestingly about 15%-20% of mumps cases have no clinical evidence of infection, and 50% of patients will have only nonspecific respiratory symptoms and not the characteristic description above. Adults are more likely to experience such a subclinical or respiratory-only constellation of symptoms while children between 2-9 years of age are more likely to experience the classic presentation of mumps with parotid gland swelling.

How is mumps diagnosed?

The diagnosis of mumps is primarily one of clinical acumen. Supportive laboratory studies are generally done to support the clinical impression. The purpose of these laboratory studies is to exclude other viruses that may give a similar clinical presentation as well as exclude very infrequent similarly presenting illnesses (for example, salivary gland cancer, Sjogren's syndrome, side effects of thiazide diuretics, etc.).

What is the treatment for mumps in adults and in children?

The mainstay of therapy (regardless of age range) is to provide comfort for this self-limited disease. Taking analgesics (acetaminophen, ibuprofen) and applying warm or cold packs to the swollen and inflamed salivary gland region may be helpful.

What are complications of mumps?

There are four serious complications of mumps: meningitis (infection of the spinal fluid which surrounds the brain and spinal cord), encephalitis (infection of the brain substance), deafness, and orchitis (infection of the testicle/testicles). All three complications may occur without the patient experiencing the classic involvement of the parotid gland. 1. Meningitis: More than 50% of patients with mumps will have meningitis, which may occur during any period of the disease. Generally patients make a full recovery without permanent side effects.

2. Encephalitis: Until the 1960s mumps was the primary cause of confirmed viral encephalitis in the United States. Since the successful introduction of a vaccination program, the incidence of mumps encephalitis has fallen to 0.5%. Fortunately, most patients recover completely without permanent side effects.

3. Deafness: Preceding the mumps vaccination program, permanent nerve damage resulting in deafness was not unusual. While occasionally bilateral, more commonly only one ear was affected.

4. Orchitis: This complication was the most common side effect (40%) to postpubertal males who contracted mumps. Severe pain (often requiring hospitalization for pain management) was one-sided in 90% of cases. Between 30%-50% of affected testes atrophied (decreased in size), and 13% demonstrated impaired fertility. The "common knowledge" of sterility was actually rare. Previous concerns regarding mumps orchitis and later testicular cancer have not been proven. (Ovarian involvement occurred in approximately 7% of postpubertal girls.) Less frequent complications of mumps infection include arthritis, infection of the pancreas, infection of the myocardium (heart muscle), and neurological conditions (for example, facial palsy, Guillain-Barr syndrome, etc.).

Can mumps be prevented? Is there a vaccine for mumps?

Prior the introduction of the mumps vaccine in 1948, epidemics during the winter/spring would commonly affect young schoolchildren with secondary spread to other family members not yet immune. Until an effective vaccine program was introduced, isolation of the infected individual was the only public-health control option. The current MMR strain used in the United States and other developed countries was licensed in 1967. Another strain is more commonly used in developing countries. Both strains provide approximately 80% immunity following the twovaccination schedule detailed below. The Centers for Disease Control and Prevention (CDC) recommends a combination vaccine (MMR) to children at 12 to 15 months of age with a booster dose at 4 to 6 years of age. During periods of possible epidemics, the booster dose may be administered after a minimum of 28 days following the initial vaccination. The MMR vaccination is designed to prevent measles, mumps, and rubella (German measles). Adults born after 1956 should receive at least one MMR vaccination. Those born prior to 1956 are generally found to have acquired natural immunity and no vaccination is necessary. More common side effects of the MMR vaccine include stinging/burning at the injection site, mild temperature, and mild skin rash. The temperature and skin rash most commonly develop five to 12 days postvaccination and occur more commonly after the first vaccination. Some recipients of the vaccine will note mild enlargement and tenderness of local (for example, neck) lymph nodes. It should be noted that these relatively common side effects are considerably less severe than acquiring any of the three illnesses the MMR vaccine is designed to prevent. In extremely rare situations, more severe reactions affecting the nervous system, gastrointestinal system, and digestive organs, the skin, and others may occur. A very small population should not receive the MMR vaccine. These include those with a compromised immune system (HIV/AIDS, cancer, those receiving more than two continuous weeks of steroids) or who are allergic to any component of the vaccine, including gelatin or neomycin. MMR vaccines are very unlikely to produce a severe reaction to those who are egg white allergic. Daily use of inhaled steroids (such as those used to control certain pulmonary diseases such as asthma, COPD, etc.) is not a contraindication to the MMR vaccine. Patients with a mild illness (for example, the common cold) may safely receive the MMR vaccine. Conception should be avoided until at least 28 days following vaccination.

Multiple international studies have not demonstrated any causative relationship between administration of the MMR vaccine and the development of autism.

What is the prognosis of a mumps infection?

Mumps is generally a benign self-limited disease that produces lifelong immunity. Severe side effects are extremely rare; more common complications (though still relatively rare) are listed above. Nonimmune women who contract mumps during the first trimester of their pregnancy have an increased rate of miscarriage, but infants carried to term have no higher risk for congenital malformations.