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Centers for Disease Control and Prevention (CDC) clinical case definition for mumps: illness with acute onset of unilateral or bilateral, tender, self-limited swelling of the parotid or other salivary gland, lasting ≥2 days, without other apparent cause
- In the prevaccine era, 90% of all children contracted mumps virus infection by 14 years of age.
- Incidence of this once very common disease has declined dramatically since the advent of universal childhood immunization.
- Outbreaks, however, continue to occur.
- 200–300 cases per year reported in the United States since 2001
- In early 2006, a large epidemic broke out in Iowa and neighboring states:
- 11 states reported >2,500 cases.
- Largest epidemic since 1988
- Median age of patient was 21 years (mostly college students)
- Led CDC and American College Health Association to recommend 2 doses of MMR vaccine to be a requirement for college entry
- In 2006, 81–100% of children entering United States schools had received 2 doses of mumps vaccine.
- In 2009–2010, an outbreak of mumps occurred in a highly vaccinated population in the northeastern United States. Intense exposure facilitated transmission. Previous vaccination appeared to limit the severity of disease.
- Seroprevalence of antibody to mumps virus in the United States population (1999–2004) is estimated at 90%.
- 2 combination mumps vaccine are used:
- MMR: Measles, mumps, rubella
- MMRV: Measles, mumps, rubella, varicella
- A single 0.5-mL SC injection of live mumps vaccine (MMR or MMRV) is recommended at 12–15 months.
- A second vaccination is recommended between 4 and 6 years of age.
- The efficacy of 2 doses of vaccines is estimated at approximately 80–90%.
- Primary vaccine failure and waning vaccine-induced immunity have been reported.
- Some have suggested the need for a 3rd vaccination to mitigate waning immunity. Preliminary studies indicate no increase in adverse effects after a 3rd vaccination.
- The 1st dose of MMR vaccine sometimes causes fever and rash:
- These symptoms occur 7–12 days after immunization.
- Measles component is usually the culprit.
- Both MMRV and MMR vaccines, but not varicella vaccine alone, are associated with increased outpatient fever visits and seizures 5–12 days after vaccination in 12- to 23-month-olds, with MMRV vaccine increasing fever and seizure twice as much as the MMR + varicella vaccine.
- Vaccine should not be administered to children who are immunocompromised by disease or pharmacotherapy, as well as to pregnant women.
- If a child has recently received immune globulin, administration of MMR vaccine should be delayed (for 3–11 months depending on the dose of IG).
- Children with HIV infection who are not severely immunocompromised should be immunized with the MMR vaccine.
- 1 attack of mumps (clinical or subclinical) usually confers lifelong immunity.
- Links of the MMR vaccine to autism by Andrew Wakefield MB, BS in a 1998 Lancet publication have now been exposed as fraudulent.
- The virus is spread by contact with respiratory secretions.
- The mumps virus enters via the respiratory tract, and a viremia ultimately ensues.
- The virus spreads to many organs, including the salivary glands, gonads, pancreas, and meninges.
- Period of communicability: 7 days before to 9 days after onset of parotid swelling
- Most communicable period: 2–3 days before to 5 days after onset of parotid swelling
- Incubation period: 12–25 days after exposure
- Humans are the only known host for mumps.
- Epidemic parotitis is caused by mumps, an RNA virus in the Paramyxoviridae family.
- Other viral causes of parotitis include Epstein-Barr virus, cytomegaloviruses, influenza, parainfluenza, and enteroviruses
- Parotid enlargement can be an initial sign in HIV-infected children.
- Bacterial cases are usually secondary to Staphylococcus aureus (suppurative parotitis).
- Streptococci, gram-negative bacilli, and anaerobic infections are also possible.
- Rare childhood cases may be secondary to an obstructing calculus, foreign body (sesame seed), tumors, sarcoid, Sjögren syndrome, or various drugs (antihistamines, phenothiazines, iodine-containing drugs/contrast media).
Commonly Associated Conditions
- Salivary adenitis
- Most common manifestation of mumps
- 1/3 of cases occur subclinically
- Up to 35% of adolescent mumps cases are complicated by orchitis.
- Orchitis develops within 4–10 days of the onset of the parotid swelling.
- Sterility is uncommon.
- Aseptic meningitis
- Mild inflammation is common.
- Serious involvement is rare.