Mumps

For the computer language of the same name, see MUMPS.

Mumps or epidemic parotitis is a viral disease of humans. Prior to the development of vaccination, it was a common childhood disease worldwide, and is still a significant threat to health in the third world.

Symptoms of mumps tend to be mild, such as painful swelling of the salivary glands and testicles, rash and fever. In teenagers and adults, the symptoms can be more severe and complications (such as infertility or subfertility -- PMID 8692089, PMID 2368216, PMID 2100952) are relatively common, although still rare in absolute terms. The disease is generally self-limiting, and there is no specific treatment apart from controlling the symptoms with painkillers.

Mumps
Specialty	Infectious diseases, pediatrics

Causes and risks

The mumps are caused by a paramyxovirus, and is spread from person to person by saliva droplets or direct contact with articles that have been contaminated with infected saliva. The parotid glands (the salivary glands between the ear and the jaw) are usually involved. Unvaccinated children between the ages of 2 and 12 are most commonly infected, but the infection can occur in other age groups. Orchitis (swelling of the testes) occurs in 10-20% of infected males, but sterility only rarely ensues; a viral meningitis occurs in about 5% of those infected. In older people, other organs may become involved including the central nervous system, the pancreas, the prostate, the breasts, and other organs.

The incubation period is usually 12 to 24 days. Mumps is generally a mild illness in children in developed countries. After adolescence, mumps tends to affect the ovary, causing oophoritis, and the testis, causing orchitis. The mature testis is particularly susceptible to damage from mumps which can lead to infertility. Adults infected with mumps are more likely to develop severe symptoms and complications. [1] [2]

Symptoms

Symptoms of mumps may include:

• fever
• headache
• sore throat
• painful swelling of one or both parotid glands (in 60%-70% of cases)
• testicular and scrotal pain and swelling(in boys and men)(in 20 to 30% of cases)
• abdominal pain due to ovarian swelling (in girls and women)(in 20 to 30% of cases)
• swelling of the temples or jaw (temporomandibular area)

Signs and tests

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, serology or a saliva test for the virus may be carried out.

Treatment

There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck area, acetaminophen (paracetamol) for pain relief (aspirin is discouraged in children with a viral illness because of the risk of Reye's syndrome). Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms.

Patients are advised to avoid fruit juice or any acidic foods, since these stimulate the salivary glands, which can be painful.

Prognosis

The disease is self-limiting, and general outcome is good, even if other organs are involved. Sterility in men from involvement of the testes is very rare. After the illness, life-long immunity to mumps generally occurs.

Complications

Known complications of mumps include:

• Infection of other organ systems
• Sterility in men (this is quite rare, and mostly occurs in older men)
• Mild forms of meningitis (rare, 40% of cases occur without parotid swelling)
• Encephalitis (very rare, rarely fatal)
• Profound (91 dB or more) but rare sensorineural hearing loss, uni- or bilateral

Prevention

The most common preventative measure against mumps is the MMR immunization (vaccine). This not only protects against mumps, but also protects against measles and rubella. The WHO 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 15 months. The American Academy of Pediatrics recommends the routine administration of MMR vaccine at ages 12-15 months and 4-6 years. [3] The vaccination is repeated in some locations between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. Efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%[4][5].

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. Disagreeing, 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. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.

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 (Atkinson W, Humiston S, Wolfe C, Nelson R Editors. Epidemiology and Prevention of Vaccine-Preventable Diseases, 5th Edition, Centers for Disease Control and prevention.) 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%) (see [6]). 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 152,209 cases of mumps reported in 1968; in 1998 there were only 666 cases reported.

External links

• Original version based on the National Library of Medicine's Medline Plus website. Update Date: 08/15/01. Update date included for cross-reference against newer versions.
• BMJJournals.com - 'Comparative efficacy of three mumps vaccines', Matthias Schlegel, Joseph J Osterwalder, Renato L Galeazzi, Pietro L Vernazza, British Medical Journal, vol 319, p 352 (August 7, 1999)
• NHS.uk - Encylopedia - 'NHS Direct Online Health Encyclopaedia: Mumps', National Health Service (UK)
• WHO.int - "Immunization, Vaccines and Biologicals: Mumps vaccine", World Health Organisation