Mumps

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Basics

An acute, self-limited, generalized paramyxovirus infection typically presenting with unilateral or bilateral parotitis

Description

  • Can be asymptomatic in 1/3 of nonimmune individuals and 60% of previously vaccinated cases
  • Painful parotitis in 95% of symptomatic mumps cases
  • Epidemics in late winter and spring; transmission by respiratory secretions
  • Incubation period is 14 to 24 days.
  • System(s) affected: hematologic/lymphatic/immunologic, reproductive, skin, exocrine
  • Synonym(s): epidemic parotitis; infectious parotitis

Epidemiology

  • 85% of mumps cases occur prior to 15 years of age.
  • Adult cases are typically more severe.
  • Predominant sex: male = female
  • Geriatric population: Most adults are immune.
  • Acute epidemic mumps
    • Most cases occur in unvaccinated children 5 to 15 years of age.
    • Multiple recent outbreaks in U.S. college students
  • Mumps is unusual in children <2 years of age.
  • Period of maximal communicability is 24 hours before to 72 hours after onset of parotitis.

Incidence
  • From January 1 to July 19, 2019, 1,799 cases reported in United States from 45 states and District of Columbia
  • Since 1967 (start of national vaccination program), case rate has dropped from 100/100,000 to 1.1/100,000.
  • Occasional regional epidemic outbreaks
Prevalence
  • 0.0064/100,000 persons in United States
  • 90% of adults are seropositive.

Etiology and Pathophysiology

Mumps is an RNA virus (rubulairus) of the Paramyxovirus genus. Mumps virus replicates in glandular epithelium of parotid gland, pancreas, and testes, leading to interstitial edema and inflammation.

  • Interstitial glandular hemorrhage may occur.
  • Pressure caused by testicular edema against the tunica albuginea can lead to necrosis and loss of function.

Risk Factors

  • Foreign travel: Most of Africa, southern Asia, and Japan do not vaccinate for mumps. Only two thirds of all countries vaccinate routinely for mumps.
  • Crowded environments such as dormitories, barracks, or detention facilities increase risk of transmission.
  • Immunity wanes after single-dose vaccination. With 2-dose schedule, immunity drops from 95% to 86% after 9 years.

General Prevention

  • Vaccination
    • 2 doses of live mumps vaccine or mumps, measles, rubella (MMR) vaccine recommended, first at 12 to 15 months and second at 4 to 6 years. Start at 6 months if foreign travel is planned.
    • 95% effective in clinical studies; field trials show 68–95% efficacy, which may be insufficient for herd immunity to prevent spread.
    • Prevention may require 95% first dose and >80% second-dose adherence. Vaccine failure may increase 10–27% each year after vaccination.
    • Adverse effects: fever 8/100,000; seizure 25/100,000; thrombocytopenic purpura 3/100,000
    • No relationship between MMR vaccine and autism, celiac disease, or multiple sclerosis. Recent data show a reduced autism risk in girls after MMR vaccination (aHR 0.79, overall for both genders aHR 0.93) (1).
  • Immunoglobulin (Ig) does not prevent mumps.
  • Postexposure vaccination does not protect from recent exposure (2)[B].
  • Isolate hospitalized patients for 5 days after onset.
  • Isolate nonimmune individuals for 26 days after last case onset (social quarantine).
  • In an epidemic situation, a third dose of MMR is indicated to decrease the attack rate (3)[A].
  • Vaccine neutralizing antibodies are still effective against variant strains of mumps virus.
  • Although there are no reports of disseminated mumps from MMR vaccine in HIV patients, live vaccines (MMR) are contraindicated in immunocompromised patients (e.g., HIV with CD4 <200).

Pregnancy Considerations

  • Live viral vaccines are typically contraindicated in pregnancy; however, vaccination of children should not be delayed if a family member is pregnant.
  • Immunization of contacts protects against future (but not current) exposures.

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Basics

An acute, self-limited, generalized paramyxovirus infection typically presenting with unilateral or bilateral parotitis

Description

  • Can be asymptomatic in 1/3 of nonimmune individuals and 60% of previously vaccinated cases
  • Painful parotitis in 95% of symptomatic mumps cases
  • Epidemics in late winter and spring; transmission by respiratory secretions
  • Incubation period is 14 to 24 days.
  • System(s) affected: hematologic/lymphatic/immunologic, reproductive, skin, exocrine
  • Synonym(s): epidemic parotitis; infectious parotitis

Epidemiology

  • 85% of mumps cases occur prior to 15 years of age.
  • Adult cases are typically more severe.
  • Predominant sex: male = female
  • Geriatric population: Most adults are immune.
  • Acute epidemic mumps
    • Most cases occur in unvaccinated children 5 to 15 years of age.
    • Multiple recent outbreaks in U.S. college students
  • Mumps is unusual in children <2 years of age.
  • Period of maximal communicability is 24 hours before to 72 hours after onset of parotitis.

Incidence
  • From January 1 to July 19, 2019, 1,799 cases reported in United States from 45 states and District of Columbia
  • Since 1967 (start of national vaccination program), case rate has dropped from 100/100,000 to 1.1/100,000.
  • Occasional regional epidemic outbreaks
Prevalence
  • 0.0064/100,000 persons in United States
  • 90% of adults are seropositive.

Etiology and Pathophysiology

Mumps is an RNA virus (rubulairus) of the Paramyxovirus genus. Mumps virus replicates in glandular epithelium of parotid gland, pancreas, and testes, leading to interstitial edema and inflammation.

  • Interstitial glandular hemorrhage may occur.
  • Pressure caused by testicular edema against the tunica albuginea can lead to necrosis and loss of function.

Risk Factors

  • Foreign travel: Most of Africa, southern Asia, and Japan do not vaccinate for mumps. Only two thirds of all countries vaccinate routinely for mumps.
  • Crowded environments such as dormitories, barracks, or detention facilities increase risk of transmission.
  • Immunity wanes after single-dose vaccination. With 2-dose schedule, immunity drops from 95% to 86% after 9 years.

General Prevention

  • Vaccination
    • 2 doses of live mumps vaccine or mumps, measles, rubella (MMR) vaccine recommended, first at 12 to 15 months and second at 4 to 6 years. Start at 6 months if foreign travel is planned.
    • 95% effective in clinical studies; field trials show 68–95% efficacy, which may be insufficient for herd immunity to prevent spread.
    • Prevention may require 95% first dose and >80% second-dose adherence. Vaccine failure may increase 10–27% each year after vaccination.
    • Adverse effects: fever 8/100,000; seizure 25/100,000; thrombocytopenic purpura 3/100,000
    • No relationship between MMR vaccine and autism, celiac disease, or multiple sclerosis. Recent data show a reduced autism risk in girls after MMR vaccination (aHR 0.79, overall for both genders aHR 0.93) (1).
  • Immunoglobulin (Ig) does not prevent mumps.
  • Postexposure vaccination does not protect from recent exposure (2)[B].
  • Isolate hospitalized patients for 5 days after onset.
  • Isolate nonimmune individuals for 26 days after last case onset (social quarantine).
  • In an epidemic situation, a third dose of MMR is indicated to decrease the attack rate (3)[A].
  • Vaccine neutralizing antibodies are still effective against variant strains of mumps virus.
  • Although there are no reports of disseminated mumps from MMR vaccine in HIV patients, live vaccines (MMR) are contraindicated in immunocompromised patients (e.g., HIV with CD4 <200).

Pregnancy Considerations

  • Live viral vaccines are typically contraindicated in pregnancy; however, vaccination of children should not be delayed if a family member is pregnant.
  • Immunization of contacts protects against future (but not current) exposures.

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