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Acute Mumps

  • Author: Yonatan Yohannes, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
 
Updated: Nov 06, 2015
 

Background

Mumps is a systemic illness caused by the paramyxovirus. It is a human disease that occurs worldwide. The mumps vaccine was introduced in 1967, and the disease became nationally reportable in 1968. The incidence has decreased substantially with vaccination, but periods of resurgence have occurred in recent years.[1]

See the Centers for Disease Control and Prevention (CDC) recommended immunization schedule for persons aged 0 through 18 years,[2] the catch-up schedule for persons aged 4 months through 18 years,[3] and the adult immunization schedule for persons older than 18 years.[4] See the full recommendations for the measles, mumps, rubella (MMR) and measles, mumps, rubella, varicella (MMRV) vaccines from the Advisory Committee on Immunization Practices,[5] including benefit versus risk profile and contraindications.

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Pathophysiology

The mumps virus is transmitted by respiratory droplets. It has an incubation period of 14-25 days after which time prodromal symptoms occur and last anywhere from 3-5 days. After the prodrome, the symptoms of the virus depend on which organ is affected. The most common presentation is a parotitis, which occurs in 30-40% of patients. Other reported sites of infection are the testes, pancreas, eyes, ovaries, central nervous system, joints, and kidneys. A patient is considered infectious from about 3 days before the onset and up to 4 days after the start of active parotitis. Infections can be asymptomatic in up to 20% of persons.

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Epidemiology

United States

Prior to the vaccine about 50% of children contracted mumps. Approximately 200,000 cases were reported in 1964 before the introduction of the vaccine compared with 291 cases in 2005. A resurgence occurred in 1986 and 1987, with almost 13,000 cases reported, and it was associated with a lack of state requirements for immunizations. These cases were mostly in older school-aged children (10-19 y). In the 1990s, 30-40% of cases reported each year were in persons aged 15 years or older as opposed to 90% being younger than 15 years old in earlier years.[6]

A recent outbreak of mumps occurred in Iowa, with 219 cases reported in 2006. In addition, another 14 cases of people with symptoms consistent with the virus were reported in nearby states (Illinois, Nebraska, and Minnesota). This is the largest number of cases reported in the United States since 1988. The median age of the 219 persons was 21 years, with 30% being college students. In 1991, Iowa mandated that 2 doses of mumps vaccine be required for all people entering public schools. Vaccination history was studied in 133 people from this outbreak: 65% (87) of the patients had received 2 doses, 14% (19) had received only 1 dose, and 6% (8) received no vaccine at all.[7]

Amongst the infected, the most commonly reported symptoms were parotitis (83%), submaxillary/submandibular gland swelling (40%), fever (36%), and sore throat (32%). The average length of illness was 5.1 days. Complications, including encephalitis and orchitis, were reported in 5% of patients. The source of the Iowa epidemic is unknown.[7]

International

The variations in the number of persons who receive the mumps vaccination worldwide make it difficult to estimate the numbers affected. The incidence varies markedly from region to region.

The United Kingdom reported an epidemic of mumps in 2005, with 56,390 cases reported in persons aged 15-24 years who were not vaccinated.[6]

Sex

For parotitis, males and females are affected equally.

Symptomatic meningitis has a male-to-female ratio of 3:1.

Age

Before the mumps vaccine was introduced, most cases were in children aged 5-9 years, with 90% being younger than 15 years. The resurgence in the late 1980s affected older children aged 10-19 years. In more recent years, up to 30-40% of cases have been in persons older than 15 years.[1]

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Prognosis

Prognosis for mumps infection is usually good.

The most serious complication is encephalitis, with a mortality rate of 1.4%.

Unilateral orchitis rarely causes sterility; however bilateral orchitis carries an increased risk.

Unilateral sensorineural hearing loss is believed to be a rare complication; however, subclinical or unrecognized mumps may contribute toward a higher incidence of unilateral hearing loss in childhood than is currently known. Bilateral involvement has also been documented.

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Patient Education

For excellent patient education resources, visit eMedicine's Bacterial and Viral Infections Center. Also, see eMedicine's patient education article Mumps.

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Mortality/Morbidity

Between 1980 and 1999, an average of one death per year has occurred due to mumps. Most deaths occur in persons older than 19 years.

CNS involvement is common, but symptomatic meningitis only occurs in about 15% of patients. It usually resolves without complications, but adults are at a higher risk for sequelae. Encephalitis is rare and is seen in fewer than 2 per 100,000 cases. It has a mortality rate of 1.4%.[8, 9, 10, 11]

Orchitis (usually unilateral) occurs in 50% of postpubertal males. It causes testicular atrophy in as many as 50% of persons affected but rarely causes sterility. The risk of sterility is higher in bilateral orchitis.[9, 12] Oophoritis occurs in a small percentage of postpubertal girls.

Pancreatitis occurs in 5% of persons infected with mumps. The hyperglycemia that results is usually transient, but a few cases of diabetes mellitus have been reported. It is not conclusive that the mumps virus has been the definitive cause.[9]

Deafness has been reported in 1 per 20,000 cases of mumps. In 80% of cases, the hearing loss is reported to be unilateral.[13, 14]

Some deaths due to myocarditis have been reported. The incidence of this complication is reported to be up to 15%, but it is usually asymptomatic.[15]

The risk of spontaneous abortion is increased in women with mumps during the first trimester of pregnancy. Mumps during pregnancy has not been associated with congenital malformations.[16]

Other reported complications include chronic arthritis, arthralgias, and nephritis.[15]

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Causes

Mumps is typically caused by a single-stranded RNA virus belonging to the Paramyxovirus genus. Humans serve as the only natural host for the mumps virus.

Other viruses implicated in recurrent parotitis are influenza, echovirus, parainfluenza (types 1 and 3), and coxsackievirus A. More rare causes of parotitis seen in persons with HIV infection are adenovirus or cytomegalovirus.

Risk factors include lack of immunization or incomplete immunization, international travel, and immune deficiencies.

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Contributor Information and Disclosures
Author

Yonatan Yohannes, MD Resident Physician, Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital Center

Yonatan Yohannes, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Chief Editor for Medscape.

Additional Contributors

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Kristin A Carmody, MD, RDMS, FACEP Assistant Professor of Emergency Medicine, New York University Medical School

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

Disclosure: Nothing to disclose.

References
  1. Caplan CE. Mumps in the era of vaccines. CMAJ. 1999 Mar 23. 160 (6):865-6. [Medline].

  2. Centers for Disease Control and Prevention. Recommended adult immunization schedule, by vaccine and age group – United States 2015. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html. Accessed: September 28, 2015.

  3. Centers for Disease Control and Prevention. Recommended catch-up immunization schedule. For persons age 4 months through 18 years who start late or are more than 1 month behind – United States 2015. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html. Accessed: September 28, 2015.

  4. Centers for Disease Control and Prevention. Recommended adult immunization schedule, by vaccine and age group – United States 2015. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html. Accessed: September 28, 2015.

  5. Advisory Committee on Immunization Practices (ACIP). Use of combination measles, mumps, rubella, varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). National Guideline Clearinghouse. Available at http://www.guideline.gov/content.aspx?id=24052&search=mumps. Accessed: September 28, 2015.

  6. Global status of mumps immunization and surveillance. Wkly Epidemiol Rec. 2005 Dec 2. 80 (48):418-24. [Medline].

  7. CDC. Mumps Epidemic - Iowa, 2006. MMWR Weekly. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a3.htm. Accessed: September 29, 2008.

  8. Majda-Stanislawska E. Mumps cerebellitis. Eur Neurol. 2000. 43 (2):117. [Medline].

  9. Nussinovitch M, Volovitz B, Varsano I. Complications of mumps requiring hospitalization in children. Eur J Pediatr. 1995 Sep. 154 (9):732-4. [Medline].

  10. Saijo M, Fujita K. [Central nervous system infection caused by mumps virus]. Nihon Rinsho. 1997 Apr. 55 (4):870-5. [Medline].

  11. Sonmez FM, Odemis E, Ahmetoglu A, Ayvaz A. Brainstem encephalitis and acute disseminated encephalomyelitis following mumps. Pediatr Neurol. 2004 Feb. 30 (2):132-4. [Medline].

  12. Wharton IP, Chaudhry AH, French ME. A case of mumps epididymitis. Lancet. 2006 Feb 25. 367 (9511):702. [Medline].

  13. Kayan A, Bellman H. Bilateral sensorineural hearing loss due to mumps. Br J Clin Pract. 1990 Dec. 44 (12):757-9. [Medline].

  14. McQuone SJ. Acute viral and bacterial infections of the salivary glands. Otolaryngol Clin North Am. 1999 Oct. 32 (5):793-811. [Medline].

  15. Kabakuş N, Aydinoğlu H, Yekeler H, Arslan IN. Fatal mumps nephritis and myocarditis. J Trop Pediatr. 1999 Dec. 45 (6):358-60. [Medline].

  16. Siegel M, Fuerst HT. Low birth weight and maternal virus diseases. A prospective study of rubella, measles, mumps, chickenpox, and hepatitis. JAMA. 1966 Aug 29. 197 (9):680-4. [Medline].

  17. Hatchette TF, Mahony JB, Chong S, LeBlanc JJ. Difficulty with mumps diagnosis: what is the contribution of mumps mimickers?. J Clin Virol. 2009 Dec. 46 (4):381-3. [Medline].

  18. Utz JP, Houk VN, Alling DW. Clinical and laboratory studies of mumps. N Engl J Med. 1964 Jun 11. 270:1283-6. [Medline].

  19. Ogbuanu IU, Kutty PK, Hudson JM, Blog D, Abedi GR, Goodell S, et al. Impact of a third dose of measles-mumps-rubella vaccine on a mumps outbreak. Pediatrics. 2012 Dec. 130 (6):e1567-74. [Medline].

  20. [Guideline] Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP). Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine. MMWR Morb Mortal Wkly Rep. 2008 Mar 14. 57 (10):258-60. [Medline].

  21. Dayan GH, Rubin S. Mumps outbreaks in vaccinated populations: are available mumps vaccines effective enough to prevent outbreaks?. Clin Infect Dis. 2008 Dec 1. 47 (11):1458-67. [Medline].

  22. Kutty PK, Kyaw MH, Dayan GH, Brady MT, Bocchini JA, Reef SE, et al. Guidance for isolation precautions for mumps in the United States: a review of the scientific basis for policy change. Clin Infect Dis. 2010 Jun 15. 50 (12):1619-28. [Medline].

 
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