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Mumps

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For the computer language, see MUMPS.

Mumps or epidemic parotitis is a viral disease of humans. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide, and is still a significant threat to health in the third world.[1]

Painful swelling of the salivary glands (classically the parotid gland) and fever is the most typical presentation.[2] Painful testicular swelling and rash may also occur. While symptoms are generally not severe in children, the symptoms, in teenagers and adults, can be more severe and complications such as infertility or subfertility are relatively common, although still rare in absolute terms.[3],[4],[5] The disease is generally self-limiting, and there is no specific treatment apart from controlling the symptoms with painkillers.

Mumps
SpecialtyInfectious diseases, pediatrics Edit this on Wikidata


Causes and risks

The mumps are caused by a paramyxovirus, and are 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, the central nervous system, the pancreas, the prostate, the breasts, and other organs may be involved.

The incubation period is usually 18 to 21 days, but may range from as few as 12 to as many as 35 days.[2] Mumps is generally a mild illness in children in developed countries. After adolescence, mumps tends to affect the ovary, causing oophoritis, and the testes, 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.

Symptoms

Comparison of a person before and after contracting mumps

The more common symptoms of mumps are:

  • Swelling of the parotid gland (or parotitis) in more than 90% of patients on one side (unilateral) or both sides (bilateral), and pain behind the lower jaw when chewing.
  • Fever
  • Headache
  • Sore throat
  • Orchitis, referring to painful inflammation of the testicle.[6]. Males past puberty who develop mumps have a 15 to 20 percent risk of orchitis.[2]

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, a test of saliva, urine, or blood may be carried out; a newer diagnostic confirmation, using real-time nested polymerase chain reaction (PCR) technology, has also been developed [7]. An estimated 20%-30% of cases are asymptomatic. [8]

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 and by acetaminophen (Tylenol/Paracetamol) for pain relief. Aspirin use is discouraged in young children because of studies showing an increased risk of Reye's syndrome.[9] 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.

Research treatments

  • A University of Tokyo group reported in 1992 that research compound TJ13025 ((6'R)-6'-C-methylneplanocin A) had an antiviral effect on four Mumps virus strains cultured in Vero cells.(see 16526604, tables 1 and 2) Additional research improved the synthesis of a particular isomer, RMNPA, of TJ13025 from the racemic product.[11][12]
  • A 2005 publication in a Russian journal reports that Myramistin has antiviral activity against Mumps virus in Vero cells culture.[13]

Prognosis

Death is very unusual. 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. Mumps can be prevented by getting a vaccination.

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 immunisation with a mumps vaccine. This has been a component of the MMR immunization vaccine which also protects against measles and rubella and is now being supplanted by a combination of the three with Varicella vaccine - MMRV - which adds protection against Chickenpox. 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. Template:PDFlink 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%. [14],[15]

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).[16] 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%).[17] 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; in 1998 there were only 666 cases reported.

Current outbreaks

United Kingdom (2004–2007)

In the United Kingdom over the last two years, a mumps outbreak[18] has involved more than 70,000 patients.[3][19] The cause of the outbreak is low immunity in those too old to have received MMR, but young enough to have not developed natural immunity through exposure. A catch-up programme of immunisation of under twenty five year olds, particularly in university towns such as Exeter was implemented.

In March 2007, there has been an outbreak in Leicestershire.

United States (2005-2006)

Although there may not be a direct link with the mumps outbreak in Ireland, United States CDC Director Dr. Julie Gerberding has been quoted stating that the genotype from the U.S. outbreak, "in the early cases of this outbreak, was the same genotype of virus that was associated with the United Kingdom outbreak." [4] Entrez Gene contains a placeholder database record for a new Mumps gene; the record is dated 23 Feb 2006.[5]

  • 10 May 2006: Mumps appears to be in at least twelve states with at least 3183 confirmed, probable, or suspect cases reported.
  • 31 Jan 2007: 6 404 cases of Mumps in 2006 compared to 314 in 2005. As of today YTD 15 deaths in the United States were reported.[6]


Alaska (2006)

There are several confirmed cases of mumps in Anchorage, Alaska and the number is growing.

Iowa (2005-2006)

In early 2006, for reasons still not fully understood, the state of Iowa experienced a large surge in the number of reported mumps infections.[21] According to the New York Times, college students accounted for about a quarter of the 245 cases [7], while about half of the cases are people aged seventeen to twenty five. Doctors are attributing the rise in mumps case frequency to low vaccination rates in Iowa's youth, coupled with the close quarters in dormitories, classrooms and cafeterias.

When you expect five and you get 245, this is pretty serious... We're trying to get ahead of it and get it stopped... It could be that on some of these college campuses, they were not as well vaccinated as we'd like them to be, [but] our law does not allow us to identify entities associated with outbreaks.

— Patricia Quinlisk, state epidemiologist at the Iowa department of public health

Still more cases are being reported from this outbreak, the majority of them in Dubuque County.

According to Canadian media reports [8], there may be something novel about this mumps strain which indicates a standard MMR-series vaccination is not 95% effective, as was thought.

  • 18 April 2006: 815 cases have been reported [10] in Iowa alone, representing a caseload reporting increase of 200 in the last week.
  • 25 April 2006: There are over 1,120 confirmed[11], probable and suspected cases of mumps. Over 1000 of the cases are confirmed.

Georgia (2006)

Illinois (2006)

There have been three confirmed cases of the mumps at Southern Illinois University-Carbondale, and has spread to three other neighboring counties in the Southern Illinois area. There has also been one confirmed case at Knox College, in Galesburg (Western Illinois). Wheaton College has also been affected by 93 cases since early September (as of Jan 9).[14]

  • September 28, 2006: The Illinois Department of Public Health has reported 636 cases of mumps in Illinois between January 1, 2006 and September 28, 2006. [16]

Indiana (2006)

Kansas (2006)

  • 2 May 2006: With 340 mumps cases now reported in Kansas, state health officials have asked the U.S. Centers for Disease Control and Prevention to help.[18]

Kentucky (2006)

  • 4 May 2006: Two cases diagnosed by Doctor Roach in Paducah,KY, a border town to Southern Illinois.[19]

Michigan (2006)

  • 04 May 2006: A case of the mumps is reported in Plymouth-Canton High School, Canton. The three high schools in Canton are requiring students to provide documentation of vaccination.[21]

Minnesota (2006)

  • May 2006: The Minnesota Department of Health has confirmed eleven mumps cases in Minnesota in 2006. Four of the eleven cases may be linked to Iowa. Please continue to check back for updates. [22]

Missouri (2006)

  • 10 May 2006: Missouri reports twenty one confirmed, eighty eight probable, for a total of 109 cases [23]

Nebraska (2006)

  • 10 May 2006: Nebraska reports sixty four confirmed, 193 probable, twenty two suspect, for a total of 279 cases in forty three counties. [24]Officials say many people with mumps in Nebraska had connections to Iowa.

North Carolina (2006)

  • 4 May 2006: An 8-year-old in Mecklenburg County is diagnosed with the mumps, the first case in the county since 2002. [25] NOTE: This case may not be related to the current epidemic in the Midwest.
  • 16 Aug2006: A Duke University student is diagnosed with a highly contagious case of the mumps.

Oregon (2006)

South Dakota (2006)

  • 12 May 2006: SD Department of Health reports thirty three confirmed cases, fifty three probable cases, and six suspect cases for a total of ninety two cases. [28]

Texas (2006)

  • 6 Sep 2006: A man was diagnosed with mumps in Dallas.
  • 24 Nov 2006: A man was diagnosed with mumps in Plano, north of Dallas. According to the physician on duty in the emergency room, this was the fourth such case reported at that hospital in the past week.

Virginia (2006)

  • 25 September 2006: A University of Virginia first-year has been diagnosed with a likely case of mumps. (washingtonpost.com.)
  • 28 September 2006: A second University of Virginia student has been diagnosed with a likely case of mumps. (nbc29.com.)
  • 29 September 2006: A third case of mumps has been diagnosed in a non-student resident of Charlottesville, VA (location of the University of Virginia).
  • 3 October 2006: Up to seven cases are confirmed at the University of Virginia.
  • 5 October 2006: A Virginia Tech student was diagnosed with a probable case of mumps, the university's health center reported. The test however returned negative.
  • 13 October 2006: A student at Wilson Memorial High School in Augusta County, Virginia has been confirmed diagnosed with a case of the mumps.
  • 19 October 2006: Deborah Newell at Washington and Lee University in Lexington, Virginia was diagnosed with a probable case of the mumps, but the blood and culture tests came back negative.
  • 23 October 2006: Four students at the College of William and Mary in Williamsburg, Virginia have been diagnosed with likely cases of the mumps according to an email sent out to students.

Wisconsin (2006)

  • 19 April 2006: There are fourteen confirmed cases in Wisconsin, and half of these are at the University of Wisconsin-Milwaukee campus. A vaccination clinic is being held at UWM in response to this as questions rise as about the cause of the outbreak.
  • 10 May 2006: 185 confirmed cases, at least one case in one out of three counties. [22]

References

  1. ^ Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ, Eds. (2004). Harrison's Principles of Internal Medicine (16th ed.). McGraw-Hill Professional. ISBN 0-07-140235-7.{{cite book}}: CS1 maint: multiple names: authors list (link)
  2. ^ a b Enders G (1996). Paramyxoviruses–Mumps virus. In: Barron's Medical Microbiology (Barron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1. {{cite book}}: |edition= has extra text (help)
  3. ^ Preveden T, Jovanovic J, Ristic D (1996). "[Fertility in men after mumps infection without manifestations of orchitis]". Med Pregl. 49 (3–4): 99–102. PMID 8692089.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ^ Shakhov EV, Krupin VN (1990). "[The clinico-statistical characteristics of the testicular generative function in male subfertility following mumps]". Urol Nefrol (Mosk) (2): 46–50. PMID 2368216.
  5. ^ Tsvetkov D (1990). "[Spermatological disorders in patients with postmumps orchitis]". Akush Ginekol (Sofiia). 29 (6): 46–9. PMID 2100952.
  6. ^ Manson AL (1990). "Mumps orchitis". Urology. 36 (4): 355–8. PMID 2219620.
  7. ^ http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16971175
  8. ^ http://jama.ama-assn.org/cgi/reprint/295/20/2348.pdf#search=%22orchitis%20iowa%20health%2030%2020%22
  9. ^ The significance of these studies has been questioned.
  10. ^ Hayashi T, Hayashi K, Maeda M, Kojima I (1996). "Calcium spirulan, an inhibitor of enveloped virus replication, from a blue-green alga Spirulina platensis". J Nat Prod. 59 (1): 83–7. PMID 8984158.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ Shuto S, Obara T, Yaginuma S, Matsuda A (1997). "New neplanocin analogues. IX. A practical preparation of (6'R)-6'-C-methylneplanocin A (RMNPA), a potent antiviral agent, and the determination of its 6'-configuration. Diastereoselective deamination by adenosine deaminase". Chem Pharm Bull (Tokyo). 45 (1): 138–42. PMID 9023976.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ Shuto S, Minakawa N, Niizuma S, Kim HS, Wataya Y, Matsuda A (2002). "New neplanocin analogues. 12. Alternative synthesis and antimalarial effect of (6'R)-6'-C-methylneplanocin A, a potent AdoHcy hydrolase inhibitor". J Med Chem. 45 (3): 748–51. PMID 11806727.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ^ Agafonov AP, Ignat'ev GM, Svistov VV, Smirnov IV, Krivoshein IuS (2005). "[In vitro study of antiviral activity of Myramistin against measles and mumps viruses]". Antibiot Khimioter. 50 (5–6): 17–9. PMID 16526604.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ "Schlegel M, Osterwalder JJ, Galeazzi RL, Vernazza PL" (1999). "Comparative efficacy of three mumps vaccines during disease outbreak in Eastern Switzerland: cohort study". BMJ. 319 (7206): 352. PMID 10435956.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ "Summary". WHO: Mumps vaccine. Retrieved 2006-04-18.
  16. ^ Atkinson W, Humiston S, Wolfe C, Nelson R (Editors). (2006). Epidemiology and Prevention of Vaccine-Preventable Diseases (9th ed.). Centers for Disease Control and prevention. Fulltext. {{cite book}}: |author= has generic name (help)CS1 maint: multiple names: authors list (link)
  17. ^ Kanra G, Isik P, Kara A, Cengiz AB, Secmeer G, Ceyhan M (2004). "Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination". Pediatr Int. 46 (6): 663–8. PMID 15660864.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ^ BMJ Mumps epidemic in UK 2005
  19. ^ CDC (2006). "Mumps epidemic--United kingdom, 2004-2005". MMWR Morb Mortal Wkly Rep. 55 (7): 173–5. PMID 16498380.
  20. ^ ""University of Bath Internal News"". "University of Bath Public Relations". "26 November 2004". {{cite web}}: Check date values in: |date= (help)
  21. ^ CDC (2006). "Exposure to mumps during air travel--United States, April 2006". MMWR Morb Mortal Wkly Rep. 55 (14): 401–2. PMID 16617290.
  22. ^ [1] Wisconsin Immunization Program - Laboratory Confirmed Mumps Cases
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