Mumps

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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 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 August 11, 2018, 1,665 cases reported in United States from 47 states and District of Columbia
  • 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: Most of Africa, southern Asia, and Japan do not vaccinate 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.
    • 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
  • Immunoglobulin (Ig) does not prevent mumps.
  • Postexposure vaccination does not protect from recent exposure (1)[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 (2)[A].
  • Vaccine neutralizing antibodies are still effective against variant strains of mumps virus.
  • Live vaccines are contraindicated in immunocompromised such as HIV with CD4 <200, although no reports of disseminated mumps from MMR vaccine in HIV patients.
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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