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Mumps

Mumps is a topic covered in the 5-Minute Clinical Consult.

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Basics

An acute, 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 occurs 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.
    • Recent (2015 to 2016) U.S. outbreaks in college students Illinois/Iowa:
      • Another U.S. epidemic in 2009 to 2010 in New York/New Jersey: >1,500 cases
  • Mumps is unusual in children <2 years of age; most infants <1 year are immune.
    • Period of maximal communicability is 24 hours before to 72 hours after onset of parotitis.

Incidence
  • 5,833 cases in the United States in 2016
  • Since 1967 (national vaccination program), case rate has dropped from 100/100,000 to 1.8/100,000.
  • Occasional regional epidemic outbreaks
Prevalence
  • 0.0064/100,000 persons in United States
  • 90% of adults are seropositive.

Etiology and Pathophysiology

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: Some nations do not vaccinate for mumps, including most of Africa and Asia.
  • Crowded environments such as dormitories, barracks, or detention facilities increase risk of transmission.
  • Immunity wanes after single-dose vaccination:
    • With two dose schedule, immunity drops from 95% to 86% after 9 years.

General Prevention

  • Vaccination
    • Two doses of live mumps vaccine or measles-mumps-rubella (MMR) vaccine are recommended, first at 12 to 15 months and second at 4 to 6 years.
    • 95% effective in clinical studies; field trials show 68–95% efficacy, which may be below level for herd immunity to prevent spread.
    • Prevention may require 95% 1st dose and >80% second-dose adherence.
    • 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 (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 3rd dose of MMR may decrease the attack rate (3).
  • Vaccine neutralizing antibodies are still effective against variant strains of mumps virus (4).
Pregnancy Considerations
  • Live viral vaccines are typically contraindicated in pregnancy; however, vaccination of children should not be delayed due to a pregnant family member.
  • Immunization of contacts protects against future (but not current) exposures.

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Citation

Stephens, Mark B., et al., editors. "Mumps." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116394/all/Mumps.
Mumps. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116394/all/Mumps. Accessed April 24, 2019.
Mumps. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116394/all/Mumps
Mumps [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116394/all/Mumps.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Mumps ID - 116394 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116394/all/Mumps PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -