Child with mumps
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|eMedicine||emerg/324 emerg/391 ped/1503|
Mumps (epidemic parotitis) is a highly infectious, self-limited viral disease caused by the mumps virus. Fever, painful swelling of the parotid glands, muscle pain, headache and feeling tired are common initial symptoms. Up to 48 hours later, painful swelling of the salivary glands – classically the parotid gland – usually occurs and is the most typical presentation found in up to 95% of cases. Painful testicular swelling which can cause sterility and rash may also occur. Symptoms in adults are often more severe than in children.
Mumps is highly contagious and is able to spread rapidly among people living in close quarters. The virus is transmitted by respiratory droplets, direct contact, or contaminated objects. Symptoms typically occur usually 14 to 18 days after exposure and patients are infectious a few days before the onset of symptoms. 
The disease is generally self-limiting, running its course before receding, with no specific treatment apart from controlling the symptoms with pain medication and medications to reduce fevers such as acetaminophen. Hospitalization may be required if meningitis or pancreatitis develops. After the illness, lifelong immunity to mumps generally occurs; reinfection is possible but tends to be mild and atypical.
Mumps is preventable by vaccination, and since its use cases in the United States have declined by 96%. Before the development of vaccination and the introduction of a vaccine, mumps was a common childhood disease worldwide. It is still common in developing countries and outbreaks occur occasionally in developed countries.
Signs and symptoms
Mumps is usually preceded by a set of prodromal symptoms including low-grade fever, headache, and malaise. This is followed by progressive swelling of one or both parotid glands. Parotid gland swelling usually lasts about one week. Other symptoms of mumps can include dry mouth, sore face and/or ears and some patients find it difficult to talk.
- Painful testicular inflammation develops in 15-40% of men who have completed puberty and contract the mumps virus. This testicular inflammation is generally one-sided (both testes are swollen in 15-30% of mumps orchitis cases) and typically occurs about 10 days after the parotid gland. Testicular swelling has been documented as late as six weeks after parotid gland swelling. Subfertility is an uncommon consequence of testicular inflammation from mumps and infertility is rare.
- Studies have reached differing conclusions regarding whether or not infection with the mumps virus during pregnancy leads to an increased rate of spontaneous abortion.
- Meningitis occurs in up to 10% of cases (40% of cases occur without parotid swelling)
- Ovarian inflammation occurs in about 5% of adolescent and adult females, but fertility is affected in almost half of these 5%.
- Acute pancreatic inflammation in about 4% of cases, manifesting as abdominal pain and vomiting
- Encephalitis (very rare, and fatal in about 1% of the cases when it occurs)
- Profound (91 dB or more) but rare sensorineural hearing loss, uni- or bilateral. Acute unilateral deafness occurs in about 0.005% of cases.
The mumps virus is an enveloped single-stranded, linear negative-sense RNA virus of the Rubulavirus genus and Paramyxovirus family. The genome consists of 15,384 bases encoding nine proteins. Proteins involved in viral replication are the nucleoprotein, phosphoprotein, and polymerase protein while the genomic RNA forms the ribonucleocapsid.   Humans are the only natural host for the virus.
Mumps is spread from person to person through contact with respiratory secretions, such as saliva from an infected person. When an infected person coughs or sneezes, the droplets aerosolize and can enter the eyes, nose, or mouth of another person. Mumps can also be spread by sharing food and drinks. The virus can also survive on surfaces and then be spread after contact in a similar manner. A person infected with mumps is contagious from approximately 7 days before the onset of symptoms until about 8 days after symptoms start. The incubation period (time until symptoms begin) can be from 12–25 days, but is typically 16–18 days. 20-40% of persons infected with the mumps virus do not show symptoms, so it is possible to be infected and spread the virus without knowing it.
During an outbreak, a diagnosis can be made by determining recent exposure and parotitis. However when the disease incidence is low, other infectious causes of parotitis should be considered such as HIV, coxsackievirus and influenza. Some viruses such as enteroviruses may cause aseptic meningitis that is very clinically similar to mumps. 
A physical examination confirms the presence of the swollen glands. Usually, the disease is diagnosed on clinical grounds, and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, a test of saliva or blood may be carried out; a newer diagnostic confirmation, using real-time nested polymerase chain reaction (PCR) technology, has also been developed. As with any inflammation of the salivary glands, the serum level of the enzyme amylase is often elevated.
The most common preventative measure against mumps is a vaccination with a mumps vaccine, invented by American microbiologist Maurice Hilleman at Merck. The vaccine may be given separately or as part of the MMR immunization vaccine that also protects against measles and rubella. In the US, MMR is now being supplanted by MMRV, which adds protection against chickenpox (varicella, HHV3). The WHO (World Health Organization) recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 13 months with a booster at 3–5 years (preschool) This confers lifelong immunity. The American Academy of Pediatrics recommends the routine administration of MMR vaccine at ages 12–15 months and at 4–6 years. In some locations, the vaccine is given again between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. The efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%. The Jeryl Lynn strain is most commonly used in developed countries but has been shown to have reduced efficacy in epidemic situations. The Leningrad-Zagreb strain commonly used in developing countries appears to have superior efficacy in epidemic situations.
Because of the outbreaks within college and university settings, many governments have established vaccination programs to prevent large-scale outbreaks. In Canada, provincial governments and the Public Health Agency of Canada have all participated in awareness campaigns to encourage students ranging from grade 1 to college and university to get vaccinated.
Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. There is no evidence whatsoever to support the claim that the wild disease is beneficial, or that the MMR vaccine is harmful. Claims have been made that the MMR vaccine is linked to autism and inflammatory bowel disease, including one study by Andrew Wakefield (the paper was discredited and retracted in 2010 and Wakefield was later stripped of his license after his work was found to be an "elaborate fraud" ) that indicated a link between gastrointestinal disease, autism, and the MMR vaccine. Also, subsequent studies indicate no link between vaccination with the MMR and autism. Since the dangers of the disease are well known, and the dangers of the vaccine are quite minimal, most doctors recommend vaccination.
The WHO, the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the British Medical Association and the Royal Pharmaceutical Society of Great Britain currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987.
Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000). In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%). The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968. From 2001 to 2008, the case average was only 265 per year, excluding an outbreak of >6000 cases in 2006 attributed largely to university contagion in young adults.
There is no available cure for mumps and treatment is supportive. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck/testicular area and by acetaminophen for pain relief. Warm saltwater gargles, soft foods, and extra fluids may also help relieve symptoms. Acetylsalicylic acid (aspirin) is not used to treat children due to the risk of Reye's syndrome.
Mumps is considered most contagious in the five days after the onset of symptoms, and isolation is recommended during this period. In someone who has been admitted to hospital, standard and droplet precautions are needed. People who work in healthcare cannot work for five days.
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|Wikimedia Commons has media related to Mumps.|
- NHS.uk – Encyclopedia – 'NHS Direct Online Health Encyclopaedia: Mumps', National Health Service (UK)
- WHO.int – "Immunization, Vaccines and Biologicals: Mumps vaccine", World Health Organisation
- MicrobiologyBytes: Paramyxoviruses"
- cdc.gov – Collection of information from the CDC concerning mumps
- Public Health Agency of Canada – Public Health Agency of Canada Vaccination Campaigns