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Mumps ˈməm(p)s

(Epidemic Parotitis)

by Mary T. Caserta, MD

Mumps (epidemic parotitis) is a contagious viral infection that causes painful enlargement of the salivary glands. The infection may also affect the testes, brain, and pancreas, especially in adults.

  • Mumps is caused by a virus.

  • Symptoms include chills, headache, poor appetite, fever, and a feeling of illness, followed by swelling of the salivary glands.

  • The diagnosis is based on typical symptoms.

  • Most children recover with no problems; however, infection can lead to meningitis or encephalitis.

  • Routine vaccination can prevent the infection.

  • Treatment aims to relieve symptoms.

Children become infected with mumps by breathing in small airborne droplets of moisture coughed out by an infected person or by having direct contact with objects contaminated by infected saliva. Mumps is less contagious than measles or chickenpox. In heavily populated areas, it occurs year-round but is most frequent in late winter and early spring.

Epidemics may occur when people without immunity are crowded together. However, small outbreaks have occurred among people who have been vaccinated, probably because some people (about 10 to 12%) do not develop immunity after vaccination and, in some others, immunity may decrease over time. Although the infection may occur at any age, most cases occur in children 5 to 10 years old.

In 1967, before children were routinely vaccinated against mumps, there were 186,000 cases of mumps in the United States. Since vaccination began, the number of cases has decreased significantly. However, mumps still occurs. A 2006 mumps outbreak in the midwestern United States caused more than 6,584 cases. Young adults had the highest infection rates, which highlighted the need for continued use of vaccination. Two smaller outbreaks occurred in 2009 and 2010, one with 3,000 cases, mainly among high school–age students in a religious community in New York City. In the first half of 2014, 871 cases have occurred, many in outbreaks at four universities in the United States. The infection does not usually occur in children younger than 2 years, particularly those younger than 1 year. One infection with the mumps virus usually provides lifelong immunity.

Like measles, mumps may be imported by travelers or immigrants, who then transmit the infection, especially in places where many people group together (such as college campuses) or in closed communities (such as traditional-observant Jewish communities).

Symptoms of Mumps

Mumps symptoms begin 12 to 24 days after infection. However, about one quarter of people do not develop symptoms. Most children develop chills, headache, poor appetite, a general feeling of illness (malaise), and a low to moderate fever. These symptoms are followed in 12 to 24 hours by swelling of the salivary glands, which is most prominent on the second day and lasts 5 to 7 days.

Some children simply have swelling of the salivary glands without the other symptoms. The swelling results in pain when chewing or swallowing, particularly when swallowing acidic liquids, such as citrus fruit juices. The glands are tender when touched. At this stage, the temperature usually rises to 103 or 104° F (about 39.5 or 40° C) and lasts 1 to 3 days.

Complications of mumps

Mumps may affect organs other than the salivary glands.

About 30% of men who become infected after puberty develop inflammation of one or both testes ( orchitis). Inflammation of the testes causes swelling and severe pain. Once healed, the affected testis may be smaller, but testosterone production and fertility are usually unaffected. In women, inflammation of the ovaries (oophoritis) is less commonly recognized, is less painful, and does not impair fertility.

Mumps leads to inflammation of the layers of tissue covering the brain ( meningitis) in 1 to 10% of people. Meningitis causes headache, vomiting, and a stiff neck. Mumps also causes inflammation of the brain ( encephalitis) in 1 out of 1,000 to 5,000 people. Encephalitis causes drowsiness, coma, or seizures. Most people recover completely, but some have permanent nerve or brain damage, such as deafness or paralysis of the facial muscles, usually affecting only one side of the body.

Inflammation of the pancreas ( pancreatitis) may occur toward the end of the first week of infection. This disorder causes abdominal pain, severe nausea, and vomiting. These symptoms disappear in about a week, and the person recovers completely.

Other complications, such as swelling of the liver, kidneys, or heart muscle, are extremely rare.

Diagnosis of Mumps

  • A doctor's evaluation

Doctors diagnose mumps based on the typical symptoms, particularly when they occur during an outbreak of mumps. Laboratory tests can identify the mumps virus and its antibodies. Such tests can be used to confirm the diagnosis and are usually done to document outbreaks for public health purposes. A spinal tap is done for people who have signs of meningitis or encephalitis.

Prognosis

Almost all children with mumps recover fully without problems, but in rare cases symptoms may worsen again after about 2 weeks.

Prevention of Mumps

  • Mumps vaccine

The first dose of the mumps vaccine, one of the routine immunizations of childhood, is given between 12 months and 15 months of age. The second dose is given between 4 years and 6 years of age. The vaccine that is used is a combined vaccine. The combination contains measles, mumps, and rubella vaccine, and sometimes also varicella (chickenpox) vaccine. There is no separate vaccine just for mumps.

Adults born during or after 1957 should have one dose, unless they have had mumps diagnosed by a health care practitioner. Pregnant women and people with an impaired immune system should not be given live mumps virus vaccine.

Treatment of Mumps

  • Acetaminophen or ibuprofen for discomfort

Once the infection has started, it just has to run its course. To minimize discomfort, children should eat a soft diet and avoid foods that require much chewing or are acidic. Analgesics, such as acetaminophen and ibuprofen, may be used for headache and discomfort.

Boys or men with inflammation of the testes need bed rest. The scrotum may be supported with an athletic supporter or by an adhesive-tape bridge connected between the thighs. Ice packs may be applied to relieve pain.

If pancreatitis causes severe nausea and vomiting, fluids may be given by vein (intravenously), and intake by mouth should be avoided for a few days. Children with meningitis or encephalitis may need intravenous fluids and acetaminophen or ibuprofen for fever or headache. If seizures develop, anticonvulsant drugs may be needed.

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  • DELATESTRYL
  • ADVIL, MOTRIN IB
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