Management of Acute Presentation of Mumps 

  • Author: Kristin A Carmody, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 3, 2011
 

Workup

Diagnosis is usually clinical. Laboratory evaluation is usually undertaken in the emergency department (ED) to look for other causes of a patient's symptoms or to evaluate for complications or comorbidity. Mumps-specific tests are generally performed on an outpatient basis.

Go to Mumps for complete information on this topic.

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Treatment & Management

Supportive Care and Management of Comorbidity

Supportive care and outpatient follow-up are usually all that is needed for patients with mumps in cases of straightforward infection. Persons exposed to the virus should be counseled on vaccination and risks.

Complications due to mumps should be treated based on presentation:

  • Orchitis - Testicular ultrasonography; ice packs applied to the scrotal area for swelling; discharge with scrotal support and anti-inflammatory agents
  • Severe pancreatitis - Intravenous hydration
  • Symptomatic meningitis or encephalitis -Lumbar puncture

A live-virus vaccine should be subcutaneously administered, in the form of the combination MMR (mumps-measles-rubella) vaccination. Antibodies develop in 95% of all susceptible persons after a single dose.

Vaccination

MMR vaccine should be given routinely to children aged 12-15 months. A second dose of MMR vaccine is recommended for those aged 4-6 years in accordance with recommendations for routine measles vaccination. If this dose is missed, it should be given before age 12 years.

Revaccination is indicated because mumps can occur in highly vaccinated populations. MMR vaccine is not harmful if given to a patient already immune to one or more of the other viruses.

Mumps vaccination is imperative for patients approaching adolescence and adulthood. Persons should be considered susceptible unless they have documentation of at least 1 dose of vaccine on or after the first birthday, documentation of physician-diagnosed mumps, serologic evidence of immunity, or a birth date before 1957. Vaccination should be offered to patients before they travel, even though it is not a requirement of entry to many countries.

Precautions and contraindications to vaccination include the following:

  • Children with minor illnesses with or without fever can be vaccinated.
  • Allergic reactions to vaccination occasionally occur but tend to be minor.
  • Most children with egg sensitivity can be safely vaccinated.
  • Skin testing with MMR vaccine does not reliably predict which children will have a hypersensitivity reaction.

Live mumps vaccine should be given 2 weeks before or 3 months after administration of immunoglobulin or blood transfusion because of the theoretical possibility that the antibody will neutralize the vaccine virus and inhibit a successful immunization. Standard immune globulin is ineffective against mumps.

Patients with immunodeficiencies (eg, those on large doses of steroids, radiation, or chemotherapy) should not receive live-virus vaccine. The exceptions are patients with symptomatic HIV who are not severely immunocompromised; these patients should receive MMR vaccine. Vaccinating close susceptible contacts can reduce the risk of exposure for patients with altered immunity. Vaccines should not be administered during pregnancy.

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Contributor Information and Disclosures
Author

Kristin A Carmody, MD  Assistant Professor, Boston University Medical School; Attending Physician, Department of Emergency Medicine and Associate Director of Emergency Ultrasound, Boston Medical Center

Kristin A Carmody, MD is a member of the following medical societies: American College of Emergency Physicians, American Institute of Ultrasound in Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Eileen C Quintana, MD  Assistant Professor, Departments of Pediatrics and Emergency Medicine, St Christopher's Hospital for Children

Eileen C Quintana, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Hosseinali Shahidi, MD, MPH  Assistant Professor, Departments of Emergency Medicine and Pediatrics, State University of New York and Health Science Center at Brooklyn

Hosseinali Shahidi, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, and American Public Health Association

Disclosure: Nothing to disclose.

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Bunbury Hospital; Medical Consultant, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert M McNamara, MD, FAAEM  Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Medscape Reference. Available at http://emedicine.medscape.com/. Accessed April 6, 2011.

 
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