mumps

Definition

Mumps is a relatively mild, short-term viral infection of the salivary glands that usually occurs during childhood. Typically, mumps is characterized by a painful swelling of both cheek areas, although the person could have swelling on one side or no perceivable swelling at all. The salivary glands are also called the parotid glands, therefore, mumps is sometimes referred to as an inflammation of the parotid glands (epidemic parotitis). The word mumps comes from an old English dialect, meaning lumps or bumps within the cheeks.

Description

Mumps is a very contagious infection that spreads easily in highly populated areas, such as schools. Although not as contagious as measles or chickenpox, mumps was once quite common. Prior to the release of a mumps vaccine in the United States in 1967, approximately 92% of all children had been exposed to mumps by the age of 15. In these pre-vaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 1941 when approximately 250 cases were reported for every 100,000 people. In 1968, the year after the live mumps vaccine was released, only 76 cases were reported for every 100,000 people. By 1985, less than 3,000 cases of mumps were reported throughout the entire United States, which works out to about 1 case per 100,000 people. The reason for the decline in mumps was the increased usage of the mumps vaccine. However, 1987 noted a five-fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws. Since then, state-enforced school entry requirements have achieved student immunization rates of nearly 100% in kindergarten and first grade. In 1996, the Centers for Disease Control and Prevention (CDC) reported only 751 cases of mumps nationwide, or, in other words, about one case for every five million people.

— Ron Gasbarro, PharmD

[Perhaps from pl. of dialectal mump, grimace.]

For more information on mumps, visit Britannica.com.

An acute contagious viral disease, characterized chiefly by enlargement of the parotid glands (parotitis).

Besides fever, the chief signs and symptoms are the direct mechanical effect of swelling on glands or organs where the virus localizes. One or both parotids may swell rapidly, producing severe pain when the mouth is opened. In orchitis, the testicle is inflamed but is enclosed by an inelastic membrane and cannot swell; pressure necrosis produces atrophy, and if both testicles are affected, sterility may result. The ovary may enlarge, without sequelae.

An attenuated live virus vaccine can induce immunity without parotitis. It is recommended particularly for adults exposed to infected children, for students in boarding schools and colleges, and for military troops.

(parotitis), a contagious parotitis caused by the mumps virus (paramyxovirus) and characterized by swelling of the parotid gland and sometimes swelling of the pancreas, ovaries, and testicles. The incubation period is 12 to 20 days; transmission is by droplet spread and direct contact; communicability begins about 2 days before the appearance of symptoms and lasts until swelling of the glands has abated. See also parotitis.

Mumps. (Zitelli/Davis, 2002, courtesy of GDW McKendrick)

Definition

Mumps is a relatively mild short-term viral infection of the salivary glands that usually occurs during childhood. Typically, mumps is characterized by a painful swelling of both cheek areas, although the person could have swelling on one side or no perceivable swelling at all. The salivary glands are also called the parotid glands; therefore, mumps is sometimes referred to as an inflammation of the parotid glands (epidemic parotitis). The word mumps comes from an old English dialect word that means lumps or bumps within the cheeks.

Description

Mumps is a very contagious infection that spreads easily in such highly populated areas as day care centers and schools. Although not as contagious as measles or chickenpox, mumps was once quite common. Prior to the release of a mumps vaccine in the United States in 1967, approximately 92% of all children had been exposed to mumps by the age of 15. In these pre-vaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 1941 when approximately 250 cases were reported for every 100,000 people. In 1968, the year after the live mumps vaccine was released, only 76 cases were reported for every 100,000 people. By 1985, less than 3,000 cases of mumps were reported throughout the entire United States, which works out to about 1 case per 100,000 people. The reason for the decline in mumps was the increased usage of the mumps vaccine. However, 1987 noted a five-fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws. Since then, state-enforced school entry requirements have achieved student immunization rates of nearly 100% in kindergarten and first grade. In 1996, the Centers for disease Control and Prevention (CDC) reported only 751 cases of mumps nationwide, or, in other words, about one case for every five million people.

Causes & Symptoms

The paramyxovirus that causes mumps is harbored in the saliva and is spread through sneezing, coughing, and other direct contact with another person's infected saliva. Once the person is exposed to the virus, symptoms generally become noticeable in 14–24 days. Initial symptoms include chills, headache, loss of appetite, and a lack of energy. However, an infected person may not experience these initial symptoms. Swelling of the salivary glands in the face (parotitis) generally occurs within 12–24 hours of the above symptoms. Accompanying the swollen glands is pain on chewing or swallowing, especially with acidic beverages, such as lemonade. A fever as high as 104°F (40°C) is also common. Swelling of the glands reaches a maximum on about the second day and usually disappears by the seventh day. Once a person has contracted mumps, he or she becomes immune to the disease, despite how mild or severe symptoms may have been.

While the majority of cases of mumps are uncomplicated and pass without incident, some complications can occur. Complications are, however, more noticeable in adults who get the infection. In 15% of cases, the covering of the brain and spinal cord becomes inflamed (meningitis). Symptoms of meningitis usually develop within four or five days after the first signs of mumps. These symptoms include a stiff neck, headache, vomiting, pain with bending or flexing the head, and a lack of energy. Mumps meningitis is usually resolved within seven days, and damage to the brain is exceedingly rare.

Mumps infection can spread into the brain causing inflammation of the brain (encephalitis). Symptoms of mumps encephalitis include the inability to feel pain, seizures, and high fever. Encephalitis can occur during the parotitis stage or one to two weeks later. Recovery from mumps encephalitis is usually complete, although complications, such as seizure disorders, have been noted. Only about 1 in 100 patients with mumps encephalitis dies from the complication.

About one-quarter of all post-pubertal males who contract mumps can develop a swelling of the scrotum (orchitis) about seven days after the parotitis stage. Symptoms include marked swelling of one or both testicles, severe pain, fever, nausea, and headache. Pain and swelling usually subside after 5–7 days, although the testicles can remain tender for weeks.

Girls occasionally suffer an inflammation of the ovaries, or oophoritis, as a complication of mumps, but this condition is far less painful than orchitis in boys.

As of late 2002, some researchers in Europe are studying the possibility that mumps increases a person's risk of developing inflammatory bowel disease (IBD) in later life. This hypothesis will require further research, as present findings are inconclusive.

Diagnosis

When mumps reaches epidemic proportions, diagnosis is relatively easy on the basis of the physical symptoms. The doctor will take the child's temperature, gently palpate (touch) the skin over the parotid glands, and look inside the child's mouth. If the child has mumps, the openings to the ducts inside the mouth will be slightly inflamed and have a "pouty" appearance. With so many people vaccinated today, a case of mumps must be properly diagnosed in the event the salivary glands are swollen for reasons other than viral infection. For example, in persons with poor oral hygiene, the salivary glands can be infected with bacteria. In these cases, antibiotics are necessary. Also in rare cases, the salivary glands can become blocked, develop tumors, or swell due to the use of certain drugs, such as iodine. A test can be performed to determine whether the person with swelling of the salivary glands actually has the mumps virus.

As of late 2002, researchers in London have reported the development of a bioassay for measuring mumps-specific IgG. This test would allow a doctor to check whether an individual patient is immune to mumps, and allow researchers to measure the susceptibility of a local population to mumps in areas with low rates of vaccination.

Treatment

Nutritional Therapy

Nutritional therapy may alleviate pain and aid healing. A nutritionist or naturopath may recommend the following:

• drinking lots of fluids to replace fluid loss
• eating only such easy-to-digest foods as soups, broth or bland foods
• taking multivitamin/mineral supplement to help boost the immune function

Homeopathy

A number of homeopathic remedies can be used in the treatment of mumps. For example, belladonna may be useful for flushing, redness, and swelling. Bryonia (wild hops) may be useful for irritability, lack of energy, or thirst. Phytolacca (poke root) may be prescribed for extremely swollen glands. A homeopathic physician should always be consulted for appropriate doses for children, and remedies that do not work within one day should be stopped. A homeopathic preparation of the mumps virus can also be used prophylactically or as a treatment for the disease.

Herbal Therapy

Several herbal remedies may be useful in helping the body recover from the infection or may help alleviate the discomfort associated with the disease. Echinacea (Echinacea spp.) can be used to boost the immune system and help the body fight the infection. Other herbs taken internally, such as cleavers (Galium aparine), calendula (Calendula officinalis), and phytolacca (poke root), target the lymphatic system and may help to enhance the activity of the body's internal filtration system. Since phytolacca can be toxic, it should only be used by patients under the care of a skilled practitioner. Topical applications are also useful in relieving the discomfort of mumps. A cloth dipped in a heated mixture of vinegar and cayenne (Capsicum frutescens) can be wrapped around the neck several times a day. Cleavers or calendula can also be combined with vinegar, heated, and applied in a similar manner.

Acupressure

Acupressure can be used effectively to relieve pain caused by swollen glands. The patient can, by using the middle fingers, gently press the area between the jawbone and the ear for two minutes while breathing deeply.

Allopathic Treatment

When mumps occurs, the illness is usually allowed to run its course. The symptoms, however, are treatable. Because of difficulty swallowing, the most important challenge is to keep the patient fed and hydrated. The individual should be provided a soft diet, consisting of cooked cereals, mashed potatoes, broth-based soups, prepared baby foods, or foods put through a home food processor. Aspirin, acetaminophen, or ibuprofen can relieve some of the pain due to swelling, headache, and fever. Avoiding fruit juices and other acidic foods or beverages that can irritate the salivary glands is recommended, as is avoiding dairy products that can be hard to digest. In the event of complications, a physician should be contacted at once. For example, if orchitis occurs, a physician should be called. Also, supporting the scrotum in a cotton bed on an adhesive-tape bridge between the thighs can minimize tension. Ice packs are also helpful.

Expected Results

When mumps is uncomplicated, the prognosis for full recovery is excellent. In rare cases, however, a relapse occurs after about two weeks. Complications can also delay complete recovery.

Prevention

A vaccine exists to protect against mumps. The vaccine preparation (MMR) is usually given as part of a combination injection that helps protect against measles, mumps, and rubella. MMR is a live vaccine administered in one dose between the ages of 12-15 months, 4-6 years, or 11-12 years. Persons who are unsure of their mumps history and/or mumps vaccination history should be vaccinated. Susceptible health care workers, especially those who work in hospitals, should be vaccinated. Because mumps is still prevalent throughout the world, susceptible persons over age one who are traveling abroad would benefit from receiving the mumps vaccine.

The mumps vaccine is extremely effective, and virtually everyone should be vaccinated against this disease. There are, however, a few reasons why people should not be vaccinated against mumps:

• Pregnant women who contract mumps during pregnancy have an increased rate of miscarriage, but not birth defects. As a result, pregnant women should not receive the mumps vaccine because of the possibility of damage to the fetus. Women who have had the vaccine should postpone becoming pregnant for three months following vaccination.
• Unvaccinated persons who have been exposed to mumps should not get the vaccine, as it may not provide protection. The person should, however, be vaccinated if no symptoms result from exposure to mumps.
• Persons with minor fever-producing illnesses, such as an upper respiratory infection, should not get the vaccine until the illness has subsided.
• Because mumps vaccine is produced using eggs, individuals who develop hives, swelling of the mouth or throat, dizziness, or breathing difficulties after eating eggs should not receive the mumps vaccine.
• Persons with immune deficiency diseases and/or those whose immunity has been suppressed with anti-cancer drugs, corticosteroids, or radiation should not receive the vaccine. Family members of immunocompromised people, however, should get vaccinated to reduce the risk of mumps.
• The CDC recommends that all children infected with human immunodeficiency disease (HIV) who are asymptomatic should receive an MMR vaccine at 15 months of age.

The mumps vaccine has been controversial in recent years because of concern that its use was linked to a rise in the rate of childhood autism. The negative publicity given to the vaccine in the mass media led some parents to refuse to immunize their children with the MMR vaccine. One result has been an increase in the number of mumps outbreaks in several European countries, including Italy and the United Kingdom.

In the fall of 2002, the New England Journal of Medicine published a major Danish study disproving the hypothesis of a connection between the MMR vaccine and autism. A second study in Finland showed that the vaccine is not associated with aseptic meningitis or encephalitis as well as autism. Since these studies were published, American primary care physicians have once again reminded parents of the importance of immunizing their children against mumps and other childhood diseases.

Resources

Books

"Viral Infections: Mumps." Section 19, Chapter 265 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Zand, Janet, Allan N. Spreen, and James B. LaValle. "Mumps." Smart Medicine for Healthier Living. Garden City Park, NY: Avery Publishing Group, 1998.

Periodicals

Gabutti, G., M. C. Rota, S. Salmaso, et al. "Epidemiology of Measles, Mumps and Rubella in Italy." Epidemiology and Infection 129 (December 2002): 543–550.

Kimmel, S. R. "Vaccine Adverse Events: Separating Myth From Reality." American Family Physician 66 (December 1, 2002): 2113–2120.

Madsen, K. M., A. Hviid, M. Vestergaard, et al. "A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism." New England Journal of Medicine 347 (November 7, 2002): 1477–1482.

Makela, A., J. P. Nuorti, and H. Peltola. "Neurologic Disorders After Measles-Mumps-Rubella Vaccination." Pediatrics 110 (November 2002): 957–963.

McKie, A., D. Samuel, B. Cohen, and N. A. Saunders. "A Quantitative Immuno-PCR Assay for the Detection of Mumps-Specific IgG." Journal of Immunological Methods 270 (December 1, 2002): 135–141.

Nielsen, S. E., O. H. Nielsen, B. Vainer, and M. H. Claesson. "Inflammatory Bowel Disease—Do Microorganisms Play a Role?" [in Danish] Ugeskrift for laeger 164 (December 9, 2002): 5947–5950.

Pugh, R. N., B. Akinosi, S. Pooransingh, et al. "An Outbreak of Mumps in the Metropolitan Area of Walsall, UK." International Journal of Infectious Diseases 6 (December 2002): 283–287.

Organizations

American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove Village, IL 60007. (847) 434-4000. .

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. .

Other

Recommended Childhood Immunization Schedules, United States, 1995. June 16, 1995, Volume 44, RR-5. Can be purchased from Superintendent of Documents, U. S. Government Printing Office, Washington, DC 20402-9325. (202) 783-3238.

Update: Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions September 6, 1996, Volume 45, RR-12. Can be purchased from Superintendent of Documents, U. S. Government Printing Office, Washington, DC 20402-9325. (202) 783-3238.

[Article by: Mai Tran; Rebecca J. Frey, PhD]

Definition

Mumps is a relatively mild short-term viral infection of the salivary glands that usually occurs during childhood.

Description

Typically, mumps is characterized by a painful swelling of both cheek areas, although the person could have swelling on one side or no perceivable swelling at all. The salivary glands are also called the parotid glands; therefore, mumps is sometimes referred to as an inflammation of the parotid glands (epidemic parotitis). The word mumps comes from an old English dialect, meaning lumps or bumps within the cheeks.

Demographics

Mumps is a very contagious infection that spreads easily in such highly populated environments as daycare centers and schools. Although not as contagious as measles or chickenpox, mumps was once quite common. Prior to the release of a mumps vaccine in the United States in 1967, approximately 92 percent of all children had been exposed to mumps by the age of 15. In the pre-vaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 1941 when approximately 250 cases were reported for every 100,000 people. In 1968, the year after the live mumps vaccine was released, only 76 cases were reported for every 100,000 people. By 1985, fewer than 3,000 cases of mumps were reported throughout the entire United States, the equivalent of about one case per 100,000 people. The reason for the decline in mumps was the increased usage of the mumps vaccine. However, 1987 noted a five-fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws. After that, state-enforced school entry requirements achieved student immunization rates of nearly 100 percent in kindergarten and first grade. In 1996, the Centers for Disease Control and Prevention (CDC) reported only 751 cases of mumps nationwide, that is, about one case for every 5 million people.

Causes and Symptoms

The paramyxovirus that causes mumps is harbored in the saliva and is spread by sneezing, coughing, and other direct contact with another person's infected saliva. Once the person is exposed to the virus, symptoms generally occur in 14 to 24 days. Initial symptoms include chills, headache, loss of appetite, and a lack of energy. However, an infected person may not experience these initial symptoms. Swelling of the salivary glands in the face (parotitis) generally occurs within 12 to 24 hours of the above symptoms. Accompanying the swollen glands is pain on chewing or swallowing, especially with acidic beverages, such as lemonade. A fever as high as 104°F (40°C) is also common. Swelling of the glands reaches a maximum on about the second day and usually disappears by the seventh day. Once individuals have contracted mumps, they become immune to the disease, despite how mild or severe their symptoms may have been.

While the majority of cases of mumps are uncomplicated and pass without incident, some complications can occur. Complications are, however, more noticeable in adults who get the infection. In 15 percent of cases, the covering of the brain and spinal cord becomes inflamed (meningitis). Symptoms of meningitis usually develop within four or five days after the first signs of mumps. These symptoms include a stiff neck, headache, vomiting, and a lack of energy. Mumps meningitis is usually resolved within seven days, and damage to the brain is exceedingly rare.

The mumps infection can spread into the brain causing inflammation of the brain (encephalitis). Symptoms of mumps encephalitis include the inability to feel pain, seizures, and high fever. Encephalitis can occur during the parotitis stage or one to two weeks later. Recovery from mumps encephalitis is usually complete, although complications, such as seizure disorders, have been noted. Only about one person in 100 with mumps encephalitis dies from the complication.

About one-fourth of all post-pubertal males who contract mumps can develop a swelling of the scrotum (orchitis) about seven days after the parotitis stage. Symptoms include marked swelling of one or both testicles, severe pain, fever, nausea, and headache. Pain and swelling usually subside after five to seven days, although the testicles can remain tender for weeks.

Girls occasionally suffer an inflammation of the ovaries (oophoritis) as a complication of mumps, but this condition is far less painful than orchitis in boys.

Diagnosis

When mumps reaches epidemic proportions, diagnosis is relatively easy on the basis of the physical symptoms. The doctor will take the child's temperature, gently palpate (touch) the skin over the parotid glands, and look inside the child's mouth. If the child has mumps, the openings to the ducts inside the mouth will be slightly inflamed and have a "pouty" appearance. With so many people vaccinated as of the early 2000s, a case of mumps must be properly diagnosed in the event the salivary glands are swollen for reasons other than viral infection. For example, in persons with poor oral hygiene, the salivary glands can be infected with bacteria. In these cases, antibiotics are necessary. Also in rare cases, the salivary glands can become blocked, develop tumors, or swell due to the use of certain drugs, such as iodine. A test can be performed to determine whether the person with swelling of the salivary glands actually has the mumps virus.

In late 2002, researchers in London reported the development of a bioassay for measuring mumps-specific IgG. This test would allow a doctor to check whether an individual patient is immune to mumps and allow researchers to measure the susceptibility of a local population to mumps in areas with low rates of vaccination.

Treatment

When mumps does occurs, the illness is usually allowed to run its course. The symptoms, however, are treatable. Because of difficulty swallowing, the most important challenge is to keep the patient fed and hydrated. The individual should be provided a soft diet, consisting of cooked cereals, mashed potatoes, broth-based soups, prepared baby foods, or foods put through a home food processor. Aspirin (only for individuals over the age of 20), acetaminophen, or ibuprofen can relieve some of the pain due to swelling, headache, and fever. Patients should void fruit juices and other acidic foods or beverages that can irritate the salivary glands. They should also avoid dairy products that can be hard to digest. In the event of complications, a physician should be contacted at once. For example, if orchitis occurs, a physician should be called. Also, supporting the scrotum in a cotton bed on an adhesive-tape bridge between the thighs can minimize tension. Ice packs are also helpful.

Prognosis

When mumps is uncomplicated, prognosis is excellent. However, in rare cases, a relapse occurs after about two weeks. Complications can also delay complete recovery.

Prevention

A vaccine exists to protect against mumps. The vaccine preparation (MMR) is usually given as part of a combination injection that helps protect against measles, mumps, and rubella. MMR is a live vaccine administered in one dose between the ages of 12 and 15 months, between four and six years of age, or 11 and 12 years of age. Persons who are unsure of their mumps history and/or mumps vaccination history should be vaccinated. Susceptible healthcare workers, especially those who work in hospitals, should be vaccinated. Because mumps is still prevalent throughout the world, susceptible persons over the age of one year who are traveling abroad would benefit from receiving the mumps vaccine.

The mumps vaccine is extremely effective, and virtually everyone should be vaccinated against this disease. There are, however, a few reasons why people should not be vaccinated against mumps:

• Pregnant women who contract mumps during pregnancy have an increased rate of miscarriage but not birth defects. As a result, pregnant women should not receive the mumps vaccine because of the possibility of damage to the fetus. Women who have had the vaccine should postpone pregnancy for three months after being vaccinated.
• Unvaccinated persons who have been exposed to mumps should not get the vaccine, as it may not provide protection. The persons should, however, be vaccinated if no symptoms result from the exposure to mumps.
• Persons with minor fever-producing illnesses, such as an upper respiratory infection, should not get the vaccine until the illness has subsided.
• Because mumps vaccine is produced using eggs, individuals who develop hives, swelling of the mouth or throat, dizziness, or breathing difficulties after eating eggs should not receive the mumps vaccine.
• Persons with immune deficiency diseases and/or those whose immunity has been suppressed with anti-cancer drugs, corticosteroids, or radiation should not receive the vaccine. Family members of immunocompromised people, however, should get vaccinated to reduce the risk of mumps.
• The CDC recommends that all children infected with human immunodeficiency disease (HIV) who are asymptomatic should receive an the MMR vaccine at 15 months of age.

Parental Concerns

The mumps vaccine has been controversial in the early 2000s because of concern that its use was linked to an increased rate of childhood autism. The negative publicity given to the vaccine in the mass media led some parents to refuse to immunize their children with the MMR vaccine. One result has been an increase in the number of mumps outbreaks in several European countries, including Italy and the United Kingdom.

In the fall of 2002, the New England Journal of Medicine published a major Danish study disproving the hypothesis of a connection between the MMR vaccine and autism. A second study in Finland showed that the vaccine is also not associated with aseptic meningitis or encephalitis. Since these studies were published, U.S. primary care physicians have once again reminded parents of the importance of immunizing their children against mumps and other childhood diseases.

Resources

Books

Gutierrez, Kathleen A. "Mumps Virus." In Principles andPractice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

Maldonado, Yvonne A. "Mumps." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

[Article by: Ron Gasbarro, PharmD Rebecca J. Frey, PhD Rosalyn Carson DeWitt, MD]

Mumps is an acute infectious disease caused by a paramyxovirus. Humans are the only known natural host. Mumps disease is usually mild, characterized by fever and swelling of one or both parotid salivary glands. The parotiditis usually develops an average of sixteen to eighteen days after direct contact, through the nose or mouth, with the saliva of an infected individual. In approximately 20 to 40 percent of cases, however, mumps disease occurs asymptomatically or with an uncharacteristic presentation.

Even though mumps is regarded as a fairly benign disease in the twenty-first century, in the prevaccine era mumps caused much morbidity and mortality in the United States. In 1967, mumps accounted for over one-third of encephalitis cases and one death occurred out of approximately 20,000 mumps cases. Mumps infection during pregnancy is not associated with birth defects, but infection during the first trimester is associated with a greater occurrence of fetal death. Other conditions caused by mumps include meningitis, orchitis, mastitis, pancreatitis, neuritis, arthritis, nephritis, thryroiditis, pericarditis, and deafness.

Mumps parotiditis occurs equally among males and females. Severe mumps disease, however, such as encephalitis, has been observed to occur more frequently among boys than girls. Other gender-specific manifestations are also influenced by age. After puberty, orchitis commonly occurs among males, though sterility rarely results. Among post-pubescent females, mastitis is a common manifestation.

Mumps infection can be confirmed by isolation of the virus from throat swabs, urine, or spinal fluid. Blood tests to detect antibodies to mumps virus can be used to differentiate between a current mumps infection and a previous infection. Skin testing is not reliable.

In countries without mumps vaccination, epidemics occur every two to five years, affecting most frequently those ages five to nine. Mumps disease exhibits seasonally with more cases occurring during the winter and spring. Historically, mumps outbreaks occur in situations where individuals are grouped together, such as military camps, prisons, boarding schools, and aboard ships. In community outbreaks, school-aged children are often infected first and then infect family members at home.

The mumps virus was first identified in 1934. By 1948 a killed virus vaccine was licensed, but it was later discontinued because it did not produce long-lasting immunity. The current mumps vaccine in the United States is a live, attenuated vaccine (the Jeryl-Lynn strain) licensed in December 1967. Since introduction of the Jeryl-Lynn mumps vaccine, the reported number of mumps cases in the United States has decreased dramatically, from over 150,000 in 1968 to 387 cases in 1999.

The availability of this vaccine, the use of the combination measles, mumps, and rubella (MMR) vaccine beginning in 1986, and the two-dose recommendation in 1989 of MMR has immunized many children who would have otherwise have developed mumps disease.

(SEE ALSO: Communicable Disease Control; Immunizations)

Bibliography

American Academy of Pediatrics (2000). "Mumps." In 2000 Red Book: Report of the Committee on Infectious Diseases, 25th edition, ed. L. K. Pickering. Elk Grove Village, IL: American Academy of Pediatrics.

Baum, S. G., and Litman, N. A. (2000). "Mumps Virus." In Principles and Practice of Infectious Diseases, 5th edition, eds. G. L. Mandell, J. E. Bennett, and R. Dolin. Philadelphia: Churchill Livingstone.

Plotkin, S. A., and Wharton, M. (1999). "Mumps Vaccine." In Vaccines, 3rd edition, eds. S. A. Plotkin and W. A. Orenstein. Philadelphia, PA: W. B. Saunders.

— LAURIE KAMIMOTO

An acute and contagious disease marked by fever and inflammation of the salivary glands. Caused by a virus, mumps is normally a childhood disease that passes with no aftereffects.

A communicable paramyxovirus disease of humans that attacks one or both of the parotid salivary glands. Called also epidemic parotitis. There is some evidence that the infection also occurs rarely in dogs and cats.

For other uses of the word Mumps or MUMPS, see Mumps (disambiguation).

Mumps
Classification and external resources
Child with mumps.
ICD-10	B26.
ICD-9	072
DiseasesDB	8449
MedlinePlus	001557
eMedicine	emerg/324 emerg/391 ped/1503
MeSH	D009107

Mumps and epidemic parotitis is a viral disease of the human species, caused by the mumps virus. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide, and is still a significant threat to health in the third world.^[1]

Painful swelling of the salivary glands (classically the parotid gland) is the most typical presentation.^[2] Painful testicular swelling (orchitis) and rash may also occur. The symptoms are generally not severe in children. In teenage males and men, complications such as infertility or subfertility are more common, although still rare in absolute terms.^[3][4][5] The disease is generally self-limited, running its course before receding, with no specific treatment apart from controlling the symptoms with painkillers.

Contents 1 Symptoms 2 Prodrome 3 Signs and tests 4 Transmission 5 Treatment 6 Prognosis 7 Prevention 8 See also 9 References 10 External links

Symptoms

Comparison of a person before and after contracting the mumps

The more common symptoms of mumps are:

• Parotid inflammation (or parotitis) in 60–70% of infections and 95% of patients with symptoms.^[2] Parotitis causes swelling and local pain, particularly when chewing. It can occur on one side (unilateral) but is more common on both sides (bilateral) in about 90% of cases.^[6]
• Fever
• Headache
• Orchitis, referring to painful inflammation of the testicle.^[7] Males past puberty who develop mumps have a 30 percent risk of orchitis.^[8]

Other symptoms of mumps can include dry mouth, sore face and/or ears and occasionally in more serious cases, loss of voice. In addition, up to 20% of persons infected with the mumps virus do not show symptoms, so it is possible to be infected and spread the virus without knowing it.^[9]

Prodrome

Fever and headache are prodromal symptoms of mumps, together with malaise and anorexia.

Signs and tests

A physical examination confirms the presence of the swollen glands. Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, a test of saliva, or blood may be carried out; a newer diagnostic confirmation, using real-time nested polymerase chain reaction (PCR) technology, has also been developed.^[10] An estimated 20%-30% of cases are asymptomatic.^[11] As with any inflammation of the salivary glands, serum amylase is often elevated.^[12][13]

Transmission

Mumps is a contagious disease that is spread from person-to-person through contact with respiratory secretions such as saliva from an infected person. When an infected person coughs or sneezes, the droplets aerosolize and can enter the eyes, nose, or mouth of another person. Mumps can also be spread by sharing food, sharing drinks, and kissing. The virus can also survive on surfaces and then be spread after contact in a similar manner.

A person infected with mumps is contagious from approximately 6 days before the onset of symptoms until about 9 days after symptoms start.^[14][15] The incubation period (time until symptoms begin) can be from 14–25 days but is more typically 16–18 days.^[16]

Treatment

There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck area and by acetaminophen/paracetamol (Tylenol) for pain relief. Aspirin is not used due to a hypothetical link with Reye's syndrome. Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms.

Patients are advised to avoid fruit juice or any acidic foods, since these stimulate the salivary glands, which can be painful.

Prognosis

Death is very unusual. The disease is self-limiting, and general outcome is good, even if other organs are involved.

Known complications of mumps include:

• Infection of other organ systems
• Mumps viral infections in adolescent and adult males carry an up to 30% risk that the testes may become infected (orchitis or epididymitis), which can be quite painful; about half of these infections result in testicular atrophy, and in rare cases sterility can follow.^[17]
• Spontaneous abortion in about 27% of cases during the first trimester of pregnancy.^[17]
• Mild forms of meningitis in up to 10% of cases^[17] (40% of cases occur without parotid swelling)
• Oophoritis (inflammation of ovaries) in about 5% of adolescent and adult females,^[17] but fertility is rarely affected.
• Pancreatitis in about 4% of cases, manifesting as abdominal pain and vomiting
• Encephalitis (very rare, and fatal in about 1% of the cases when it occurs)^[17]
• Profound (91 dB or more) but rare sensorineural hearing loss, uni- or bilateral. Acute unilateral deafness occurs in about 0.005% of cases.^[17]

After the illness, life-long immunity to mumps generally occurs; reinfection is possible but tends to be mild and atypical.^[17]

Prevention

The most common preventative measure against mumps is immunization with a mumps vaccine. The vaccine may be given separately or as part of the MMR immunization vaccine which also protects against measles and rubella. In the US, MMR is now being supplanted by MMRV, which adds protection against chickenpox. The WHO (World Health Organization) recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 15 months. The American Academy of Pediatrics recommends the routine administration of MMR vaccine at ages 12–15 months and at 4–6 years.^[18] In some locations, the vaccine is given again between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. The efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%.^[19],[20] The Jeryl Lynn strain is most commonly used in developed countries but has been shown to have reduced efficacy in epidemic situations. The Leningrad-Zagreb strain commonly used in developing countries appears to have superior efficacy in epidemic situations.^[21]

Due to the outbreaks within college and university settings, many governments have established vaccination programs to prevent large-scale outbreaks. In Canada, provincial governments and the Public Health Agency of Canada have all participated in awareness campaigns to encourage students ranging from grade 1 to college and university to get vaccinated.^[22]

Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. Disagreeing, the WHO, the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the British Medical Association and the Royal Pharmaceutical Society of Great Britain currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.

Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000).^[23] In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%).^[24] The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968. Since 2001, the case average was only 265 per year, excluding an outbreak of >6000 cases in 2006 attributed largely to university contagion in young adults.^[25][26]

See also

• List of modern mumps outbreaks

References

1. ^ Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ, Eds. (2004). Harrison's Principles of Internal Medicine (16th ed.). McGraw-Hill Professional. ISBN 0-07-140235-7. 
2. ^ ^{a b} 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. ^ 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. 
4. ^ 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. 
5. ^ Tsvetkov D (1990). "[Spermatological disorders in patients with postmumps orchitis]". Akush Ginekol (Sofiia) 29 (6): 46–9. PMID 2100952. 
6. ^ Bedford H (2005). "Mumps: current outbreaks and vaccination recommendations". Nurs Times 101 (39): 53–4, 56. PMID 16218124. 
7. ^ Manson AL (1990). "Mumps orchitis". Urology 36 (4): 355–8. doi:10.1016/0090-4295(90)80248-L. PMID 2219620. 
8. ^ [1]^{[dead link]}
9. ^ Mumps, FAQ For Young Adults, Ministry of Health and Long-Term Care, Ontario.ca
10. ^ Krause CH, Eastick K, Ogilvie MM (November 2006). "Real-time PCR for mumps diagnosis on clinical specimens--comparison with results of conventional methods of virus detection and nested PCR". J. Clin. Virol. 37 (3): 184–9. doi:10.1016/j.jcv.2006.07.009. PMID 16971175. 
11. ^ Centers for Disease Control and Prevention (CDC) (April 2006). "Mumps epidemic--Iowa, 2006". MMWR Morb. Mortal. Wkly. Rep. (Centers for Disease Control and Prevention (CDC)) 55 (13): 366–8. PMID 16601665. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a3.htm. Retrieved 2009-11-13. 
12. ^ Amylase: The Test, Lab Tests Online UK
13. ^ Skrha J, Stĕpán J, Sixtová E (October 1979). "Amylase isoenzymes in mumps". Eur. J. Pediatr. 132 (2): 99–105. doi:10.1007/BF00447376. PMID 499265. 
14. ^ Symptoms of mumps
15. ^ Letter:Compliance with Exclusion Requirements to Prevent Mumps Transmission, By Stephanie M. Borchardt, Preethi Rao, and Mark S. Dworkin, Volume 13, Number 10–October 2007
16. ^ Conly J, Johnston B (January 2007). "Is mumps making a comeback?". Can J Infect Dis Med Microbiol 18 (1): 7–9. PMID 18923686. 
17. ^ ^{a b c d e f g} Senanayake SN (2008). "Mumps: a resurgent disease with protean manifestations". Med J Aust 189 (8): 456–9. PMID 18928441. http://www.mja.com.au/public/issues/189_08_201008/sen10220_fm.html. 
18. ^ [2]PDF^{[dead link]}
19. ^ Schlegel M, Osterwalder JJ, Galeazzi RL, Vernazza PL (1999). "Comparative efficacy of three mumps vaccines during disease outbreak in Eastern Switzerland: cohort study". BMJ 319 (7206): 352. PMID 10435956. PMC 32261. http://bmj.com/cgi/pmidlookup?view=long&pmid=10435956. 
20. ^ "Summary". WHO: Mumps vaccine. http://www.who.int/vaccines/en/mumps.shtml#summary. Retrieved 2006-04-18. 
21. ^ Peltola H, Kulkarni PS, Kapre SV, Paunio M, Jadhav SS, Dhere RM (August 2007). "Mumps outbreaks in Canada and the United States: time for new thinking on mumps vaccines". Clin. Infect. Dis. 45 (4): 459–66. doi:10.1086/520028. PMID 17638194. 
22. ^ Table 2: Provincial and Territorial recommendations for mumps-containing immunization, 2007, Information on Outbreaks of Mumps In Canada - Information for Health Professionals, Public Health Agency Canada
23. ^ Atkinson W, Humiston S, Wolfe C, Nelson R (Editors). (2006). Epidemiology and Prevention of Vaccine-Preventable Diseases (9th ed.). Centers for Disease Control and prevention. Fulltext. 
24. ^ Kanra G, Isik P, Kara A, Cengiz AB, Secmeer G, Ceyhan M (2004). "Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination". Pediatr Int 46 (6): 663–8. doi:10.1111/j.1442-200x.2004.01968.x. PMID 15660864. 
25. ^ McNabb SJ, Jajosky RA, Hall-Baker PA, et al. (March 2008). "Summary of notifiable diseases--United States, 2006". MMWR Morb. Mortal. Wkly. Rep. 55 (53): 1–92. PMID 18354375. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5553a1.htm. Retrieved 2009-11-13. 
26. ^ 2006 mumps outbreak occurred despite high vaccination rate - Los Angeles Times^{[dead link]}

External links

Wikimedia Commons has media related to: Mumps

• Original version based on the National Library of Medicine's Medline Plus website. Update Date: 08/15/01. Update date included for cross-reference against newer versions.
• NHS.uk – Encyclopedia – 'NHS Direct Online Health Encyclopaedia: Mumps', National Health Service (UK)
• WHO.int – "Immunization, Vaccines and Biologicals: Mumps vaccine", World Health Organisation
• MicrobiologyBytes: Paramyxoviruses"
• nih.gov – "NIH database entry: complete genome of Miyahara strain of Mumps"
• cdc.gov – Collection of information from the CDC concerning mumps
• ontario.ca – Ontario Mumps Catch-Up Vaccination Campaign targeted at Students
• TWU.ca, SFU.ca – Information from 2008 Mumps Outbreak in British Columbia
• GNB.ca – New Brunswick Vaccination Campaign
• gov.pe.ca – P.E.I. Vaccination Campaign
• gov.yk.ca – Yukon Vaccination Campaign
• Public Health Agency of Canada – Public Health Agency of Canada Vaccination Campaigns

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mumps can also be caused if you kissed someone with the virus which is highly contagious

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Dansk (Danish)
n. pl. - fåresyge

Nederlands (Dutch)
bof, lamlendigheid

Français (French)
n. pl. - (Méd) oreillons

Deutsch (German)
n. pl. - Mumps

Ελληνική (Greek)
n. - (παθολ.) παρωτίτιδα (κν. μαγουλάδες)

Italiano (Italian)
orecchioni

Português (Portuguese)
n. - caxumba (f) (Med.)

Русский (Russian)
свинка (мед), хандра

Español (Spanish)
n. pl. - paperas, parotiditis

Svenska (Swedish)
n. - påssjuka, surmulenhet

中文（简体）(Chinese (Simplified))
耳下腺炎, 腮腺炎

中文（繁體）(Chinese (Traditional))
n. pl. - 耳下腺炎, 腮腺炎

한국어 (Korean)
n. pl. - 유행성 이하선염, 기분 상함

日本語 (Japanese)
n. - 耳下腺炎, おたふくかぜ, ふくれっつら

العربيه (Arabic)
‏(الاسم) نكاف, أبو ضغيم‏

עברית (Hebrew)
n. pl. - ‮חזרת (מחלה)‬

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