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Mumps

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Nate Michalak, B.A.

Synonyms and keywords: Epidemic parotitis

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Nate Michalak, B.A.

Overview

Mumps virus (MuV) is an enveloped, non-segmented, negative-sense RNA virus belonging to the Paramyxovirus family that causes mumps. Humans are the only natural host for mumps virus (MuV). MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV infects the upper respiratory tract epithelium and disseminates through the lymphatic system to cause systemic infection. Replication in the parotid gland (or other salivary gland) causes mononuclear cell infiltration, hemorrhage, edema, and necrosis. The average incubation period for MuV is 16-18 days. Nonspecific prodromal symptoms develop and last 3-4 days. Several days after onset of prodrome, one or both of the parotid salivary glands begin to swell (parotitis). One parotid may swell before the other, and in 25% of patients, only one side swells. Complications include: orchitis in post-pubertal males, Oophoritis and/or mastitis in post-pubertal females, transient sensorineural hearing loss, Meningitis, Encephalitis, Pancreatitis, and Spontaneous abortion during the first trimester of pregnancy. Mumps is self-limiting and prognosis is excellent for uncomplicated mumps. The characteristic presentation of mumps is tender, swollen parotid glands. Inflammation of submandibular and sublingual salivary glands is palpable in 10% of patients. Sialoadenitits is usually preceded by a low-grade fever. The jawbone is often not palpable and swelling pushes the angle of the ear out and up. Mumps must be differentiated from other diseases or pathogens that cause upper respiratory infection, prodromal symptoms, swelling of salivary glands (sialadenitis), particularly parotitis. Etiologic agents that cause similar symptoms include: parainfluenza virus, adenovirus, Epstein-Barr virus, coxsackievirus, influenza A, parvovirus B19, human herpesvirus 6. Non-infectious causes include: salivary calculi, tumor, sarcoid, Sjögren’s syndrome, thiazide drug reaction, iodine sensitivity. Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, urine, or serum samples. Serologic testing for IgM antibody or detecting a significant rise in IgG antibody confirms a mumps diagnosis. Antigen detection by polymerase chain reaction (PCR) is an efficient and rapid method to determine mumps as a diagnosis. umps can be prevented with the MMR vaccine. The United States is replacing MMR with the MMRV vaccine, which also protects against chickenpox. A single dose is on average 78% effective at preventing mumps while 2 doses is on average 88% effective. Since the initiation of the MMR vaccination program in the United States in 1967, the incidence of mumps has declined by 99%.

Historical Perspective

Mumps may have first been described by Hippocrates as a disease causing parotitis and orchitis in the 5th century. Prior to the vaccination program, which started in the United States in 1967, approximately 186,000 cases occurred each year. Implementation of the vaccination program resulted in an approximate 99% decrease in incidence rates. Outbreaks in 2006 and 2009 in the United States resulted in 6,584 and over 3,000 affected people, respectively.

Pathophysiology

Humans are the only natural host for mumps virus (MuV). MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV infects the upper respiratory tract epithelium by binding to extracellular sialic acid via the hemagglutinin-neuraminidase (HN) glycoprotein. MuV is able to evade an immune response with small hydrophobic (SH) protein, which blocks TNFα-mediated apoptosis, and with the V proteins, which inhibit IFN production and signaling. MuV disseminates through the lymphatic system to cause systemic infection. Replication in the parotid gland (or other salivary gland) causes mononuclear cell infiltration, hemorrhage, edema, and necrosis.

Causes

Mumps virus (MuV) is an enveloped, non-segmented, negative-sense RNA virus that causes mumps. MuV belongs to the genus Rubulavirus and family Paramyxovirus. Humans are the only natural host of MuV. MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV is able to bind to host epithelial cells via haemagglutinin-neuraminidase (HN) and fusion (F) glycoproteins. Small hydrophobic (SH) protein is presumed to block TNFα-mediated apoptosis. Non-structural proteins NS1 and NS2 (V proteins) inhibit IFN production and signaling.

Differential Diagnosis

Mumps must be differentiated from other diseases or pathogens that cause upper respiratory infection, prodromal symptoms, swelling of salivary glands (sialadenitis), particularly parotitis. Etiologic agents that cause similar symptoms include: parainfluenza virus, adenovirus, Epstein-Barr virus, coxsackievirus, influenza A, parvovirus B19, human herpesvirus 6. Non-infectious causes include: salivary calculi, tumor, sarcoid, Sjögren’s syndrome, thiazide drug reaction, iodine sensitivity.

Epidemiology and Demographics

Since the initiation of the MMR vaccination program in the United States, the incidence of mumps has declined by 99%. Currently, the number of cases per year ranges from a couple hundred to a couple thousand. Mumps predominantly occurs in school-age children (5-14 years) but outbreaks have occurred in adolescents and adults. There is currently no significant difference in mumps incidence between sexes and races. Mumps is uncommon in the United States and other developed countries. However sporadic outbreaks have occurred, predominantly in environments that involve close contact or high level of social interaction. Only 57% of countries belonging to the World Health Organization use a mumps vaccine. Most of these countries are developing and mumps remains endemic in these regions.

Risk Factors

Risk factors for mumps include: unvaccinated individuals who do not have evidence of immunity, belonging to the age group 2-12 years, international travel, especially to countries without mumps vaccination programs, working or living in close proximity to individual(s) infected with Rubulavirus, and being in states of immunodeficiency.

Natural History, Complications and Prognosis

The average incubation period for mumps virus is 16-18 days. Nonspecific prodromal symptoms develop and last 3-4 days. Several days after onset of prodrome, one or both of the parotid salivary glands begin to swell (parotitis). One parotid may swell before the other, and in 25% of patients, only one side swells. Other salivary glands (submandibular and sublingual) under the floor of the mouth also may swell but do so less frequently (10%). Parotitis, lasts at least 2 days, but may persist longer than 10 days. Complications include: orchitis in post-pubertal males, Oophoritis and/or mastitis in post-pubertal females, transient sensorineural hearing loss, Meningitis, Encephalitis, Pancreatitis, and Spontaneous abortion during the first trimester of pregnancy. Mumps is self-limiting and prognosis is excellent for uncomplicated mumps. Adolescents and adults are more likely than children to develop complications but these are rare, and prognosis is still favorable.

Diagnosis

Diagnostic Criteria

Suspected mumps involves parotitis, orchitis, or oophoritis unexplained by another diagnosis OR a positive lab result with no mumps clinical symptoms. Probable mumps involves parotitis or other salivary gland swelling lasting at least 2 days, or orchitis or oophoritis unexplained by another more likely diagnosis, in a person with a positive test for serum anti-mumps immunoglobulin M (IgM) antibody OR person with epidemiologic linkage to another probable or confirmed case or linkage to a group/community defined by public health during an outbreak of mumps. Confirmed mumps involves positive mumps laboratory confirmation for mumps virus with reverse transcription polymerase chain reaction (RT-PCR) or culture in a patient any of the following symptoms: acute parotitis or other salivary gland swelling, lasting at least 2 days, aseptic meningitis, encephalitis, hearing loss, orchitis, oophoritis, mastitis, pancreatitis.

History and Symptoms

The most common symptoms of mumps are a prodrome with low grade fever, myalgia, anorexia, malaise, and headache, followed by painful, bilateral parotitis. Less common symptoms include orchitis in post-pubertal males, oophoritis or mastitis in post-pubertal females, encephalitis, and transient sensorineural hearing loss. Approximately 15-20% of patients may be asymptomatic.

Physical Examination

The characteristic presentation of mumps is tender, swollen parotid glands. Inflammation of submandibular and sublingual salivary glands is palpable in 10% of patients. Sialoadenitits is usually preceded by a low-grade fever. The jawbone is often not palpable and swelling pushes the angle of the ear out and up. 25% of patients present with unilateral swelling. Stensen’s duct orifice may be inflamed and erythematous. Lymph node swelling can be differentiated by the well-defined borders of the lymph nodes, location behind the angle of the jawbone, and lack of the ear protrusion or obscuring of the jaw angle.

Laboratory Findings

Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, urine, or serum samples. Serologic testing for IgM antibody or detecting a significant rise in IgG antibody confirms a mumps diagnosis. However, there are many important caveats to be aware of when interpreting the results. Antigen detection by polymerase chain reaction (PCR) is an efficient and rapid method to determine mumps as a diagnosis. It may be necessary to test for antibodies for other infections causing parotitis including: Epstein-Barr Virus, parainfluenza virus, parvovirus B19, adenovirus, and enterovirus.

CT

Mumps is a clinical diagnosis. Imaging studies do not play a role in the initial diagnosis of mumps. However, imaging studies, such as a CT scan, may be helpful in patients with secondary complications.

Ultrasound

Mumps is a clinical diagnosis. Imaging studies do not play a role in the initial diagnosis of mumps. However, imaging studies, such as an ultrasound, may be helpful in patients with secondary complications.

Other Diagnostic Studies

Mumps is a clinical diagnosis. Further testing may be required in patients with secondary complications.

Treatment

Medical Therapy

No antiviral agent currently exists and therefore supportive care is indicated for patients with mumps. Supportive care includes prescribing analgesics, application of warm or cold packs to swollen areas, warm salt water gargles, and fluid intake. Patients should avoid acidic foods or juices. Patients should be isolated for at least 5 days after onset of symptoms.

Primary Prevention

Mumps can be prevented with the MMR vaccine. The United States is replacing MMR with the MMRV vaccine, which also protects against chickenpox. A single dose is on average 78% effective at preventing mumps while 2 doses is on average 88% effective. In general all age groups should receive 2 doses of MMR or MMRV vaccine unless an individual has evidence of immunity. The vaccine is contraindicated in pregnant women, individuals with egg or neomycin allergies and immune-compromised or severely immune-suppressed individuals.

References


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Historical Perspective

Historical Perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nate Michalak, B.A.

Overview

Mumps may have first been described by Hippocrates as a disease causing parotitis and orchitis in the 5th century. Prior to the vaccination program, which started in the United States in 1967, approximately 186,000 cases occurred each year. Implementation of the vaccination program resulted in an approximate 99% decrease in incidence rates. Outbreaks in 2006 and 2009 in the United States resulted in 6,584 and over 3,000 affected people, respectively.

Historical Perspective

  • Mumps was first been described by Hippocrates as a disease causing parotitis and orchitis in the 5th century.[1]
  • Johnson and Goodpasture first identified the etiologic agent, paramyxovirus, in 1930.[2]
  • Vaccination for mumps in the United States began in 1967.
  • Prior to the vaccination program, approximately 186,000 cases were reported each year.
  • Since the start of the program, there has been an approximate 99% decrease in incidence rates.
  • In 2006, an outbreak occurred affecting 6,584 people in the United States, predominately on college campuses.
  • In 2009, another outbreak occurred in the Northeast of the United States among religious communities, affecting over 3,000 people.[3]

References

  1. ↑ Atkinson, William (May 2012). Mumps Epidemiology and Prevention of Vaccine-Preventable Diseases (12 ed.). Public Health Foundation. pp. Chapter 14. ISBN 9780983263135.
  2. ↑ Rubin S, Eckhaus M, Rennick LJ, Bamford CG, Duprex WP (2015). “Molecular biology, pathogenesis and pathology of mumps virus”. J Pathol. 235 (2): 242–52. doi:10.1002/path.4445. PMC 4268314. PMID 25229387.
  3. ↑ Mumps. Centers for Disease Control and Prevention (May 29, 2015). http://www.cdc.gov/mumps/hcp.html Accessed March 07, 2016.


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Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Nate Michalak, B.A.

Overview

Humans are the only natural host for mumps virus (MuV). MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV infects the upper respiratory tract epithelium by binding to extracellular sialic acid via the hemagglutinin-neuraminidase (HN) glycoprotein. MuV is able to evade an immune response with small hydrophobic (SH) protein, which blocks TNFα-mediated apoptosis, and with the V proteins, which inhibit IFN production and signaling. MuV disseminates through the lymphatic system to cause systemic infection. Replication in the parotid gland (or other salivary gland) causes mononuclear cell infiltration, hemorrhage, edema, and necrosis.

Pathophysiology

Transmission

  • Humans are the only natural host for mumps virus (MuV).
  • MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV.
  • Mumps is contagious several days prior and up to 5 days after onset of parotitis.

Pathogenesis

  • MuV enters the body through inhalation or oral contact and infects the upper respiratory tract epithelium.[1]
  • MuV is able to attach to extracellular sialic acid via the hemagglutinin-neuraminidase (HN) glycoprotein.
  • HN and the fusion (F) glycoprotein mediate cell membrane fusion, allowing viral material to enter respiratory epithelial cells.
  • HN and F, in conjunction with matrix (M) protein, are also involved in localizing viral material after replication and inducing virion budding.
  • MuV is able to inhibit an immune response to infection with the following virulence factors:
  • Small hydrophobic (SH) protein is presumed to block TNFα-mediated apoptosis.[2]
  • Non-structural proteins NS1 and NS2 (V proteins) inhibit IFN production and signaling.[3]

Virulence Factors

  • Small hydrophobic (SH) protein: blocks TNFα-mediated apoptosis
  • Non-structural proteins NS1 and NS2 (V proteins): inhibit IFN production and signaling
  • Haemagglutinin-neuraminidase (HN) glycoprotein: binds with extracellular host cell sialic acid

Resources

References

  1. ↑ Rubin S, Eckhaus M, Rennick LJ, Bamford CG, Duprex WP (2015). “Molecular biology, pathogenesis and pathology of mumps virus”. J Pathol. 235 (2): 242–52. doi:10.1002/path.4445. PMC 4268314. PMID 25229387.
  2. ↑ He B, Lin GY, Durbin JE, Durbin RK, Lamb RA (2001). “The SH integral membrane protein of the paramyxovirus simian virus 5 is required to block apoptosis in MDBK cells”. J Virol. 75 (9): 4068–79. doi:10.1128/JVI.75.9.4068-4079.2001. PMC 114152. PMID 11287556.
  3. ↑ Andrejeva J, Childs KS, Young DF, Carlos TS, Stock N, Goodbourn S; et al. (2004). “The V proteins of paramyxoviruses bind the IFN-inducible RNA helicase, mda-5, and inhibit its activation of the IFN-beta promoter”. Proc Natl Acad Sci U S A. 101 (49): 17264–9. doi:10.1073/pnas.0407639101. PMC 535396. PMID 15563593.


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Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Nate Michalak, B.A.

Overview

Mumps virus (MuV) is an enveloped, non-segmented, negative-sense RNA virus that causes mumps. MuV belongs to the genus Rubulavirus and family Paramyxovirus. Humans are the only natural host of MuV. MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV is able to bind to host epithelial cells via haemagglutinin-neuraminidase (HN) and fusion (F) glycoproteins. Small hydrophobic (SH) protein is presumed to block TNFα-mediated apoptosis. Non-structural proteins NS1 and NS2 (V proteins) inhibit IFN production and signaling.

Organism

Morphology

  • The spherical virion is approximately 200nm is diameter and its genome consists of a single RNA strand of 15,384 nucleotides.[2]
  • The RNA is encapsidated by nucleoprotein (N protein) forming the ribonucleoprotein (RNP) complex.

Replication Cycle

  • MuV binds to host cell sialic acid via haemagglutinin-neuraminidase (HN) and fusion (F) glycoproteins and cause virus-to-cell membrane fusion.
  • Replication and transcription is mediated by an RNA polymerase complex composed of large (L) and phospho- (P) proteins.
  • Budding is initiated after HN and F glycoproteins are transported through the endoplasmic reticulum and Golgi body to the cell surface.
  • Matrix (M) protein localizes the RNP to the area of the host cell expressing HN and F.

Human Pathogen

  • Humans are the only natural host of MuV.
  • MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV.
  • MuV is able to evade an immune response to infection with the following virulence factors:
  • Small hydrophobic (SH) protein is presumed to block TNFα-mediated apoptosis.[3]
  • Non-structural proteins NS1 and NS2 (V proteins) inhibit IFN production and signaling.[4]

References

  1. ↑ Rubin S, Eckhaus M, Rennick LJ, Bamford CG, Duprex WP (2015). “Molecular biology, pathogenesis and pathology of mumps virus”. J Pathol. 235 (2): 242–52. doi:10.1002/path.4445. PMC 4268314. PMID 25229387.
  2. ↑ Hviid A, Rubin S, Mühlemann K (March 2008). “Mumps”. The Lancet. 371 (9616): 932–44. doi:10.1016/S0140-6736(08)60419-5. PMID 18342688.
  3. ↑ He B, Lin GY, Durbin JE, Durbin RK, Lamb RA (2001). “The SH integral membrane protein of the paramyxovirus simian virus 5 is required to block apoptosis in MDBK cells”. J Virol. 75 (9): 4068–79. doi:10.1128/JVI.75.9.4068-4079.2001. PMC 114152. PMID 11287556.
  4. ↑ Andrejeva J, Childs KS, Young DF, Carlos TS, Stock N, Goodbourn S; et al. (2004). “The V proteins of paramyxoviruses bind the IFN-inducible RNA helicase, mda-5, and inhibit its activation of the IFN-beta promoter”. Proc Natl Acad Sci U S A. 101 (49): 17264–9. doi:10.1073/pnas.0407639101. PMC 535396. PMID 15563593.


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Differentiating Mumps from other Diseases

Differentiating Mumps from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nate Michalak, B.A.

Overview

Mumps must be differentiated from other diseases or pathogens that cause upper respiratory infection, prodromal symptoms, swelling of salivary glands (sialadenitis), particularly parotitis. Etiologic agents that cause similar symptoms include: parainfluenza virus, adenovirus, Epstein-Barr virus, coxsackievirus, influenza A, parvovirus B19, human herpesvirus 6. Non-infectious causes include: salivary calculi, tumor, sarcoid, Sjögren’s syndrome, thiazide drug reaction, iodine sensitivity.

Differentiating mumps from other diseases

Mumps must be differentiated from other diseases or pathogens that cause upper respiratory infection, prodromal symptoms, swelling of salivary glands (sialadenitis), particularly parotitis.[1][2][3]

Infectious etiologies

Non-infectious causes

Differential diagnosis of Mumps Symptoms Signs Diagnosis Additional Findings
Fever Rash Diarrhea Abdominal pain Weight loss Painful lymphadenopathy Hepatosplenomegaly Arthritis Lab Findings
Brucellosis ✔ ✔ ✘ ✔ ✔ ✔ ✔ ✔ Relative lymphocytosis Night sweats, often with characteristic smell, likened to wet hay
Typhoid fever ✔ ✔ ✘ ✔ ✘ ✘ ✔ ✔ Decreased hemoglobin Incremental increase in temperature initially and than sustained fever as high as 40°C (104°F)
Malaria ✔ ✘ ✔ ✔ ✘ ✘ ✔ ✔ Microcytosis,

elevated LDH

“Tertian” fever: paroxysms occur every second day
Tuberculosis ✔ ✔ ✘ ✔ ✔ ✔ ✘ ✔ Mild normocytic anemia, hyponatremia, and

hypercalcemia

Night sweats, constant fatigue
Lymphoma ✔ ✘ ✘ ✔ ✔ ✘ ✔ ✘ Increase ESR, increased LDH Night sweats, constant fatigue
Mumps ✔ ✘ ✘ ✘ ✘ ✔ ✘ ✘ Relative lymphocytosis, serum amylaseelevated Parotidswelling/tenderness
Rheumatoid arthritis ✘ ✔ ✘ ✘ ✘ ✘ ✘ ✔ ESR and CRP elevated, positive rheumatoid factor Morning stiffness
SLE ✘ ✔ ✘ ✔ ✔ ✘ ✘ ✔ ESR and CRP elevated, positive ANA Fatigue
HIV ✘ ✘ ✘ ✔ ✔ ✔ ✘ ✔ Constant fatigue

References

  1. ↑ Davidkin, Irja; Jokinen, Sari; Paananen, Anja; Leinikki, Pauli; Peltola, Heikki (2005). “Etiology of Mumps‐Like Illnesses in Children and Adolescents Vaccinated for Measles, Mumps, and Rubella”. The Journal of Infectious Diseases. 191 (5): 719–723. doi:10.1086/427338. ISSN 0022-1899.
  2. ↑ Gupta, R. K (2005). “Mumps and the UK epidemic 2005”. BMJ. 330 (7500): 1132–1135. doi:10.1136/bmj.330.7500.1132. ISSN 0959-8138.
  3. ↑ Mumps. Centers for Disease Control and Prevention (May 29, 2015). http://www.cdc.gov/mumps/index.html Accessed March 08, 2016.


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Epidemiology and Demographics

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Since the initiation of the MMR vaccination program in the United States, the incidence of mumps has declined by 99%. Currently, the number of cases per year ranges from a couple hundred to a couple thousand. Mumps predominantly occurs in school-age children (5-14 years) but outbreaks have occurred in adolescents and adults. There is currently no significant difference in mumps incidence between sexes and races. Mumps is uncommon in the United States and other developed countries. However sporadic outbreaks have occurred, predominantly in environments that involve close contact or high level of social interaction. Only 57% of countries belonging to the World Health Organization use a mumps vaccine. Most of these countries are developing and mumps remains endemic in these regions.

Epidemiology and Demographics

Incidence

  • According to the Centers for Disease Control and Prevention (CDC), approximately 212,000 mumps case occurred in 1964, in contrast to 229 in 2012 in the United States.
  • Since the initiation of the MMR vaccination program in the United States, the incidence of mumps has declined by 99%.
  • Currently, the number of cases per year ranges from a couple hundred to a couple thousand.[1]

Age

  • Mumps predominantly occurs in school-age children (5-14 years).
  • Sporadic outbreaks have occurred in adolescents and adults.

Gender

  • Males and females are equally affected by mumps.

Race

  • Between 1988 ad 1993, there was a higher incidence of mumps in African Americans and Hispanics.
  • Currently there is no significant difference in mumps rates between races.

Developed Countries

  • Mumps is uncommon in the United States and other developed countries. However sporadic outbreaks have occurred, predominantly in environments that involve close contact or high level of social interaction.[1]

Developing Countries

  • According to the World Health Organization (WHO) reports, only 57% of countries belonging to the organization use a mumps vaccine. Therefore mumps still remains endemic in many developing (and developed) countries.[2]

Recent Mumps Outbreaks

I. United States: 2009 – 2010

  • Between June 2009 and June 2010, an outbreak occurred in Orthodox Jewish communities in New York and New Jersey affecting 3,405 individuals, 78% of whom were adolescents (13-17 years).
  • The index case occurred in a 11-year-old boy who returned from a trip to the United Kingdom, where an outbreak was also occurring.[3][4]
  • The 2-dose MMR vaccine coverage for adolescents in New York and New Jersey was greater than 90% in 2008 and 2009.[5]

II. United States: 2006

  • In 2006, there were 6,584 mumps cases reported in the United States.
  • The outbreak is presumed to have started at colleges in Iowa and spread to other Midwestern states including Illinois, Kansas, Minnesota, Missouri, Nebraska, South Dakota, and Wisconsin. These states accounted for 5,586 of the 6,584 reported cases (85%).
  • The age group with the highest incidence was 18-24 years, majority of whom were attending college in the Midwest United States.
  • Majority of patients had received 2 doses of the MMR vaccine.[6]

III. United Kingdom: 2004 – 2005

  • Between 2004 to 2005, the United Kingdom experienced an epidemic when 56,390 cases of mumps were reported.
  • Majority of cases occurred in individuals between ages 15-24 years.
  • Majority of patients did not have 2 doses of the MMR vaccine and only 30.1% of patients in 2004 had received 1 dose.[7]

Resources

CDC: Mumps Outbreaks

References

  1. ↑ 1.0 1.1 Mumps. Centers for Disease Control and Prevention (May 29, 2015). http://www.cdc.gov/mumps/index.html Accessed March 09, 2016.
  2. ↑ “Global status of mumps immunization and surveillance”. Relevé Épidémiologique Hebdomadaire / Section D’hygiène Du Secrétariat De La Société Des Nations = Weekly Epidemiological Record / Health Section of the Secretariat of the League of Nations. 80 (48): 418–24. 2005. PMID 16350930. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  3. ↑ Barskey, Albert E.; Schulte, Cynthia; Rosen, Jennifer B.; Handschur, Elizabeth F.; Rausch-Phung, Elizabeth; Doll, Margaret K.; Cummings, Kisha P.; Alleyne, E. Oscar; High, Patricia; Lawler, Jacqueline; Apostolou, Andria; Blog, Debra; Zimmerman, Christopher M.; Montana, Barbara; Harpaz, Rafael; Hickman, Carole J.; Rota, Paul A.; Rota, Jennifer S.; Bellini, William J.; Gallagher, Kathleen M. (2012). “Mumps Outbreak in Orthodox Jewish Communities in the United States”. New England Journal of Medicine. 367 (18): 1704–1713. doi:10.1056/NEJMoa1202865. ISSN 0028-4793.
  4. ↑ Centers for Disease Control and Prevention (CDC) (2010). “Update: mumps outbreak – New York and New Jersey, June 2009-January 2010”. MMWR Morb Mortal Wkly Rep. 59 (5): 125–9. PMID 20150887.
  5. ↑ Kutty, Preeta Krishnan; Lawler, Jacqueline; Rausch-Phung, Elizabeth; Ortega-Sanchez, Ismael R; Goodell, Stephen; Schulte, Cynthia; Pollock, Lynn; Valure, Barbara; Hudson, Jean; Gallagher, Kathleen; Blog, Debra (2014). “Epidemiology and the economic assessment of a mumps outbreak in a highly vaccinated population, Orange County, New York, 2009–2010”. Human Vaccines & Immunotherapeutics. 10 (5): 1373–1381. doi:10.4161/hv.28389. ISSN 2164-5515.
  6. ↑ Dayan, Gustavo H.; Quinlisk, M. Patricia; Parker, Amy A.; Barskey, Albert E.; Harris, Meghan L.; Schwartz, Jennifer M. Hill; Hunt, Kae; Finley, Carol G.; Leschinsky, Dennis P.; O’Keefe, Anne L.; Clayton, Joshua; Kightlinger, Lon K.; Dietle, Eden G.; Berg, Jeffrey; Kenyon, Cynthia L.; Goldstein, Susan T.; Stokley, Shannon K.; Redd, Susan B.; Rota, Paul A.; Rota, Jennifer; Bi, Daoling; Roush, Sandra W.; Bridges, Carolyn B.; Santibanez, Tammy A.; Parashar, Umesh; Bellini, William J.; Seward, Jane F. (2008). “Recent Resurgence of Mumps in the United States”. New England Journal of Medicine. 358 (15): 1580–1589. doi:10.1056/NEJMoa0706589. ISSN 0028-4793.
  7. ↑ Centers for Disease Control and Prevention (CDC) (2006). “Mumps epidemic–United kingdom, 2004-2005”. MMWR Morb Mortal Wkly Rep. 55 (7): 173–5. PMID 16498380.


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Risk Factors

Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Nate Michalak, B.A.

Overview

Risk factors for mumps include: unvaccinated individuals who do not have evidence of immunity, belonging to the age group 2-12 years, international travel, especially to countries without mumps vaccination programs, working or living in close proximity to individual(s) infected with Rubulavirus, and being in states of immunodeficiency.

Risk Factors

  • Unvaccinated individuals who do not have evidence of immunity.
  • Acceptable presumptive evidence of immunity to mumps includes: documented administration of two doses of live mumps virus vaccine at least 28 days apart, on or after the first birthday; laboratory evidence of immunity; birth before 1957; or documentation of physician-diagnosed mumps.
  • Individuals with only 1 dose of the MMR or MMRV vaccine are at higher risk than those with 2 doses.
  • Individuals with 2 doses of the MMR or MMRV vaccine are still at risk since the vaccines are not 100% effective at preventing mumps.
  • Children between 2 and 12 years old are at the highest risk for contracting mumps.
  • International travel, especially to countries without mumps vaccination programs.[1]
  • Working or living in close proximity to individual(s) infected with Rubulavirus (e.g. classrooms, college dormatories).
  • Individuals in states of immunodeficiency.[2]

References

  1. ↑ Galazka AM, Robertson SE, Kraigher A (1999). “Mumps and mumps vaccine: a global review”. Bull World Health Organ. 77 (1): 3–14. PMC 2557572. PMID 10063655.
  2. ↑ Mumps. Centers for Disease Control and Prevention (May 29, 2015). http://www.cdc.gov/mumps/index.html Accessed March 09, 2016.


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Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Nate Michalak, B.A.

Overview

The average incubation period for mumps virus is 16-18 days. Nonspecific prodromal symptoms develop and last 3-4 days. Several days after onset of prodrome, one or both of the parotid salivary glands begin to swell (parotitis). One parotid may swell before the other, and in 25% of patients, only one side swells. Other salivary glands (submandibular and sublingual) under the floor of the mouth also may swell but do so less frequently (10%). Parotitis, lasts at least 2 days, but may persist longer than 10 days. Complications include: orchitis in post-pubertal males, Oophoritis and/or mastitis in post-pubertal females, transient sensorineural hearing loss, Meningitis, Encephalitis, Pancreatitis, and Spontaneous abortion during the first trimester of pregnancy. Mumps is self-limiting and prognosis is excellent for uncomplicated mumps. Adolescents and adults are more likely than children to develop complications but these are rare, and prognosis is still favorable.

Natural History

  • The average incubation period for mumps virus is 16-18 days a range of 12-25 days.
  • Nonspecific prodromal symptoms develop including low-grade fever which may last 3 to 4 days, myalgia, anorexia, malaise, and headache.
  • Several days after onset of prodrome, one or both of the parotid salivary glands begin to swell (parotitis).
  • Swelling is first visible in front of the lower part of the ear. It then extends downward and forward as fluid builds up in the skin and soft tissue of the face and neck.
  • Inflammation usually peaks in 1 to 3 days and then subsides during the next week.
  • Swollen tissue pushes the angle of the ear up and out. As swelling worsens, the angle of the jawbone below the ear is no longer visible.
  • One parotid may swell before the other, and in 25% of patients, only one side swells.
  • Other salivary glands (submandibular and sublingual) under the floor of the mouth also may swell but do so less frequently (10%).
  • Parotitis, lasts at least 2 days, but may persist longer than 10 days.
  • Mumps infection may present only with nonspecific or primarily respiratory symptoms, or may be asymptomatic.[1]

Complications

  • Symptoms in teenagers and adults may be more severe.
  • Complications are relatively rare but may occur in asymptomatic patients and are more common in people who have reached puberty.
  • The most common complication is orchitis in post-pubertal males.[1]
  • Other complications of mumps include:[5][6]

Prognosis

The disease is self-limiting, and the prognosis is generally good, even if other organs are involved. After the illness, life-long immunity to mumps generally occurs. Sterility in men secondary to testicular involvement and death are very rare occurrences.

Resources

CDC: Mumps Complications

References

  1. ↑ 1.0 1.1 Mumps. Centers for Disease Control and Prevention (May 29, 2015). http://www.cdc.gov/mumps/index.html Accessed March 09, 2016.
  2. ↑ Preveden T, Jovanovic J, Ristic D (1996). “Fertility in men after mumps infection without manifestations of orchitis”. Med Pregl. 49 (3–4): 99–102. PMID 8692089.
  3. ↑ Shakhov EV, Krupin VN (1990). “The clinico-statistical characteristics of the testicular generative function in male subfertility following mumps”. Urol Nefrol (Mosk) (2): 46–50. PMID 2368216.
  4. ↑ Tsvetkov D (1990). “Spermatological disorders in patients with postmumps orchitis”. Akush Ginekol (Sofiia). 29 (6): 46–9. PMID 2100952.
  5. ↑ Galazka AM, Robertson SE, Kraigher A (1999). “Mumps and mumps vaccine: a global review”. Bull World Health Organ. 77 (1): 3–14. PMC 2557572. PMID 10063655.
  6. ↑ Gupta, R. K (2005). “Mumps and the UK epidemic 2005”. BMJ. 330 (7500): 1132–1135. doi:10.1136/bmj.330.7500.1132. ISSN 0959-8138.
  7. ↑ Hashimoto H, Fujioka M, Kinumaki H, Kinki Ambulatory Pediatrics Study Group (2009). “An office-based prospective study of deafness in mumps”. Pediatr Infect Dis J. 28 (3): 173–5. doi:10.1097/INF.0b013e31818a8ca8. PMID 19209100.
  8. ↑ Nussinovitch M, Volovitz B, Varsano I (1995). “Complications of mumps requiring hospitalization in children”. Eur J Pediatr. 154 (9): 732–4. PMID 8582424.


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Diagnosis

Diagnosis

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Treatment

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