Mumps

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Mumps is a viral illness. It is often recognised by swelling and tenderness of one or more parotid (salivary) glands although some people with mumps have no symptoms and others may only have symptoms in other organs e.g., meningitis or one or both testicles inflamed.

A brief history

Mumps was first recognised in the fifth century BC by Hippocrates. Mumps was described as an illness accompanied by swelling of the ear and painful enlargement of the testes, either unilaterally or bilaterally. It was not recognised as an infectious disease until the 19th century. The first safe and immunogenic attenuated mumps virus vaccine became available in 1967. The origin of the word mumps is obscure but may be related to the old English verb, which means ‘grimace, grin, or mumble.’

In the years before the introduction of mumps vaccine the disease was most commonly reported among young school-age children.

NZ Situation

The last mumps epidemic was in 1994, when there were 188 hospitalisations. However, mumps cases are still occurring in New Zealand.

Symptoms

Most children under two years of age have no symptoms when they get mumps. Those who get mumps as adults are more likely to experience severe disease.

When symptoms are present they usually include fever, headache, malaise, muscle aches, poor appetite, swelling, and tenderness of one or more salivary glands (just below the ear lobe).

However, some people may have no involvement of salivary glands and have symptoms from other organ involvement.

On average fever usually lasts 1-6 days, but salivary gland swelling can last for 10 days or longer.

It usually takes between 6-18 days from exposure to the first symptom but could also range from 12-25 days.

How do you get it?

Mumps is spread by infected droplets in the air from breathing, coughing and sneezing, and also by direct contact with infected saliva.

A person with mumps may be infectious from seven days before the salivary glands swell until nine days after. The most infectious period is between two days before illness and four days afterwards. People without symptoms are also infectious.

What are the risks?

Adults are more likely to experience severe mumps disease.

Viral meningitis occurs in up to 15% of mumps cases (almost always without long term consequences),
Temporary deafness to high frequency sounds is more common, occurring in 4 in 100 cases.
Orchitis (inflamed testicle), usually one sided, occurs in 20-25% of post-pubertal males. Oophoritis (inflamed ovary) occurs in 5% of post-pubertal females. Sterility occurs rarely.
Encephalitis (brain inflammation) occurs in 1 in 6,000 cases, and 1 in 100 of those with encephalitis die.
Profound and permanent deafness, usually on one side, occurs in 1 in 15,000 cases.
Overall the case fatality rate from mumps is about 1.8 per 10,000 cases.
Pancreatitis, neuritis, arthritis, mastitis, nephritis, thyroiditis and pericarditis may also occur.
Mumps in the first trimester of pregnancy may increase the rate of miscarriage, but there is no evidence that it causes fetal abnormalities.

Who is the most at risk?

Unvaccinated adolescents and adults are most at risk.

Pregnant women who get mumps during the first 3 months of pregnancy have an increased risk of miscarriage.

Treating the symptoms

There is no treatment for the mumps infection. Treatment of symptoms is aimed at improving comfort.

Preventing the disease from spreading

Immunisation given on time is the best method of preventing mumps. The measles, mumps, rubella vaccine (MMR) is given as part of the standard immunisation schedule at 15 months and 4-5 years of age. In New Zealand there is no single mumps vaccine available.

People with mumps are excluded from early childhood education, school and work until nine days after the appearance of swollen salivary glands.
Contacts of mumps cases, who are not immune to mumps e.g., those who are unimmunised, are excluded from early childhood education, school and work until 26 days after the appearance of swollen glands in the last case they were in contact with.

Risk of disease vs. vaccine side effects
Mumps Effects of disease Side effects of vaccine

A highly contagious viral infection spread by droplets in the air and saliva. It is typically recognised by fever and swollen, tender salivary glands.

  • Adults are more likely to experience severe mumps disease.
  • Fever, headache, and swelling and tenderness of one or more parotid (salivary) glands.
  • Viral meningitis: Up to 15 in 100, usually followed by full recovery.
  • Temporary deafness to high frequency sounds is more common, occurring in 4 in 100 cases.
  • Orchitis (inflammation of the testicle): 20-25 in 100 post pubertal males, usually only one testicle is affected. Sterility occurs rarely.
  • Oophoritis (inflammation of the ovaries): 5 in 100 post pubertal females.
  • Encephalitis: 1 in 6000, and 1 in 100 of those with encephalitis die.
  • Profound and permanent deafness, usually on one side, occurs in 1 in 15,000 cases.
  • Overall case fatality rate of 1.8 in 100,000.
  • Pancreatitis, neuritis, arthritis, mastitis, nephritis, thyroiditis and pericarditis may also occur.
  • Mumps contracted during the first trimester of pregnancy increases the risk of miscarriage. There is no evidence it causes fetal abnormalities.
Common side effects
  • Measles component:
  • Fever over 39.5˚C and/or rash 6–12 days after immunisation.
  • Mumps component:
  • Parotid and/or submaxillary swelling 10–14 days after immunisation.
  • Rubella component:
  • Mild rash, fever and/or lymphadenopathy between two and four weeks after immunisation.
  • Joint symptoms may occur after the vaccine, the incidence of which is age related. More adult women than children get joint symptoms about two to four weeks after immunisation.
Uncommon side effects
Rare/very rare side effects
  • Anaphylaxis.
  • Temporary thrombocytopenia.
  • Encephalitis occurs once in one million doses. There may be some long-term effects from this.
  • Aseptic mumps meningitis.
  • Convulsion associated with fever.

Mumps is a viral illness. It is often recognised by swelling and tenderness of one or more parotid (salivary) glands although some people with mumps have no symptoms and others may only have symptoms in other organs e.g., meningitis or one or both testicles inflamed.

Causative organism

Mumps virus is a member of the genus Rubulavirus in the family Paramyxoviridae.

Humans are the only known natural hosts.

Clinical signs, symptoms and complications

The diagnosis of mumps is usually made on the presence parotitis. However, infection from other viruses e.g., coxsackieviruses and Epstein–Barr virus, can infrequently cause parotitis.

Method of transmission

Mumps is spread by infected droplets in the air from breathing, coughing and sneezing, and also by direct contact with infected saliva. Viraemia leads to organ involvement including the kidneys, meninges, joints and particularly the parotid (salivary) glands or respiratory tract involvement.

Public health significance

Mumps is notifiable to the Medical Officer of Health immediately on suspicion of the disease.

New Zealand epidemiology

The last mumps epidemic was in 1994, when there were 188 hospitalisations. However, mumps cases are still occurring in New Zealand. In 2010 41 cases of mumps were notified and of these 16 were laboratory confirmed. Most cases occurred in children aged 15 months-3 years and those over 20 years. One person was hospitalised and no one died.

Prevention

Some infants may have passive immunity from transplacental transfer of maternal mumps antibodies during the later weeks of pregnancy. This passive protection dependent on maternal immunity to mumps and wanes by 6-12 months of age in most infants.

Treatment

There is no treatment for the mumps infection. Treatment is symptomatic and aimed at improving comfort.

M-M-R® II

MMR

M-M-R® II is used for primary vaccination and revaccination of children and adults to protect against measles, mumps and rubella.

Listed below are the available videos for this disease