MUMPS

MUMPS

Current Diagnosis

• Parotitis (swelling of the parotid salivary glands): unilateral or bilateral

•   Fever

•   Headache

•   Malaise

•   Myalgias

•   Anorexia

•   Increased serum amylase

Current Therapy

• Supportive care

•   Warm or cold packs on the parotid

• Analgesics and/or antipyretics (such as acetaminophen [Tylenol] or ibuprofen [Motrin])

• IV fluids or hospitalization for cases of pancreatitis, meningitis, or severe orchitis

Epidemiology

Mumps is an extremely contagious, self-limiting virus that had disease rates of 99% until the vaccine was introduced in 1967. Since that time, the yearly disease rate is less than 1 percent. For the United States and Finland, mumps is almost eradicated. For the rest of the world, mumps is still endemic as a result of a vaccination rate of only 61%.

Pathophysiology

Mumps is a single-stranded RNA virus and a member of the Paramyxovirus genus. It is transmitted through respiratory secretions, saliva, and contact with contaminated fomites.

Prevention

With the high rate of transmission and no antiviral therapy, prevention for mumps relies on community immunity as a result of high vaccine rates. There are two formulations of the mumps vaccine currently available in the United States: the measles-mumps-rubella vaccine (MMR) and the measles-mumps-rubella-varicella vaccine (MMRV, ProQuad). The dosing schedule for children calls for the first dose at age greater than 12 months to 15 months, and the second dose for children greater than 4 years to 6 years of age. For infants aged 6 through 11 months who are traveling internationally, a single MMR vaccine is recommended. These children should be revaccinated with 2 doses of MMR vaccine with the first dose at ages 12 months to 15 months and the second dose at ages 4 years to 6 years. During an epidemic, a single dose for adults born before 1957 is recommended and may be required by some health care professionals. The first dose gives approximately 80% immunity. Persons receiving both doses may still get the mumps virus if there is outbreak or if they travel to an endemic area. To avoid exposure or contraction of the disease during travel, it is suggested that travelers wash hands frequently and use alcohol-based sanitizers to decrease the contraction or spread of disease.

The vaccine is contraindicated for patients who are pregnant or planning to conceive in the 28 days after vaccination. Vaccine administration is also contraindicated for those who have a severe anaphylactic reaction to the vaccine or one of the components, and those individuals who are severely immunocompromised.

Clinical Manifestations

The incubation period for the mumps virus is 16 to 18 days. At the onset of the illness, patients may develop acute viral infection symptoms of fever, headache, and malaise. The parotitis, swelling of the parotid gland, is the diagnostic hallmark of the mumps virus. This is caused by the infection and inflammation of the parotid ductal epithelium. The swelling may last up to 10 days. Close to 30% of persons may not have this symptom and may be only mildly symptomatic.

Diagnosis

Diagnosis is made by the history and the constellation of symptoms and physical findings. It is difficult to use IgM to determine active infection, because the response may be short in duration, delayed, or even absent. PCR testing is available and requires early sampling.

Differential Diagnosis

Viral infections such as parainfluenza (also in the paramyxovirus genus) coxsackievirus, influenza A, Epstein-Barr, adenovirus, HIV, and cytomegalovirus may present with similar symptoms as mumps. There are also noninfectious etiologies of parotitis, which include salivary stones or tumors, sarcoid, Sjögren’s syndrome, and thiazide diuretics.

Therapy (or Treatment)

Treatment for mumps virus is largely supportive. For complicated cases of pancreatitis, meningitis, encephalitis, and orchitis, patient may need to be hospitalized for additional care. The additional care usually includes fever reduction, analgesia, fluid resuscitation, and treatment of secondary bacterial infections.

Monitoring

For persons with active mumps, it is suggested that they be isolated from school or work for 5 days after the onset of symptoms. Shedding of virus usually occurs 4 days prior to the onset of symptoms. For this reason, it is difficult to slow down outbreaks of the disease. The last outbreak in the United States was in 2010.

Complications

Complications from mumps are rare. In children, pancreatitis and hearing loss are the sensorineural complications most often diagnosed. For adolescents and adults the complications are more common and usually more severe. These include aseptic meningitis; orchitis in males, which rarely leads to sterility; oophoritis in females; pancreatitis; and arthritis. Even more uncommon are Guillain– Barré/ascending polyradiculitis, transverse myelitis, facial palsy, interstitial nephritis, and myocardial involvement.

Mumps in pregnancy has been associated with increased fetal loss.

There are no known teratogenic effects.

References

1.     American Academy of Pediatrics. Mumps. In: Pickering L.K., Baker C.J., Kimberlin D.W., Long S.S., eds. Red Book: 2009 Report of the committee on Infectious Diseases. 28th ed Elk Gove Village IL: American Academy of Pediatrics; 2009:468–472.

2.    Centers for Disease Control and Prevention (CDC). Exposure to mumps during air travel—United States, April 2006. MMWR Morb Mortal Wkly Rep. 2006;55(401).

3.     Dayan G.H., Rubin S. Mumps outbreaks in vaccinated population: are available mumps vaccines effective enough to prevent an outbreak? Clin Infect Dis. 2008;47:1458.

4.    Kleiman M.B. Mumps virus. In: Lenette E.H., ed. Laboratory Diagnosis of Viral Infections. ed 2nd New York: Marcel Dekker; 1992 p. 549.

5.     Kutty P.K., Barskey A.E., Gallagher K.M. Mumps. Infectious Diseases Related to Travel. CDC Yellowbook; 2012 (chapter 3).

6.      Wharton M., Cochi S.L.K., William S. Measles, mumps and rubella vaccines. Infect Dis Clin North Am. 1990;4:47 www.cdc.gov/travel/yellowbook.

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