eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Mumps: Treatment & Medication

Author: Eileen C Quintana, MD, Assistant Professor, Departments of Pediatrics and Emergency Medicine, St Christopher's Hospital for Children
Coauthor(s): Hosseinali Shahidi, MD, MPH, Assistant Professor, Departments of Emergency Medicine and Pediatrics, State University of New York and Health Science Center at Brooklyn
Contributor Information and Disclosures

Updated: Jul 9, 2009

Treatment

Emergency Department Care

  • 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.9,10,11
    • 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 to 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 birth date before 1957. Vaccination should be offered before traveling 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.
    • 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.
  • Standard immune globulin is ineffective against mumps.

Medication

The goal of pharmacotherapy is to immunize the child.

Vaccines

Vaccines are used to induce active immunity.


Measles, mumps, and rubella vaccine combination (M-M-R II)

Used to induce immunity against viruses that cause measles, mumps, and rubella.

Adult

0.5 mL SC in outer aspect of upper arm
Birth date before 1957: Considered to be immune to measles and mumps, no further MMR vaccination required
Birth date during 1957 or later: Should receive 2 doses at least 4 wk apart unless they have a medical contraindication, documentation of 2 doses, history of confirmed measles infection, or laboratory evidence of immunity
Second dose recommended for the following adults: (1) those who have been recently exposed to measles or mumps in an outbreak setting, particularly if in their age group; (2) those who have been previously vaccinated with killed measles vaccine; (3) those who have been vaccinated with an unknown type of measles vaccine during 1963–1967; (4) those who are students in postsecondary educational institutions; (5) those who work in a health care facility; and (6) those who plan to travel internationally
Unreliable rubella vaccination history: Administer 1 dose
Unvaccinated health care workers born before 1957: If no evidence of mumps immunity; administer 1 dose; strongly consider a second dose during an outbreak situation

Pediatric

First dose: 0.5 mL SC initiated at age >12 months
Second dose: 0.5 mL at age 4-6 y; may be administered before age 4-6 y, provided >4 wk have elapsed since the first dose
Catch up doses: If not previously vaccinated by age 6 years, administer 2 doses of 0.5 mL SC with >4 wk between doses

Drugs that suppress immune system may diminish response to immunization

Documented hypersensitivity; cancer affecting bone marrow or lymphatic systems, blood dyscrasias, HIV, or other severe immunosuppressive condition; pregnant women or women who might become pregnant within 4 wk of receiving vaccine

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Contraception in females is advised for 3 mo following immunization; not indicated for severely immunocompromised patients; determine rubella immunity for women of childbearing years and counsel regarding congenital rubella syndrome

More on Pediatrics, Mumps

Overview: Pediatrics, Mumps
Differential Diagnoses & Workup: Pediatrics, Mumps
Treatment & Medication: Pediatrics, Mumps
Follow-up: Pediatrics, Mumps
References
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References

  1. CDC. Revised U.S. surveillance case definition for severe acute respiratory syndrome (SARS) and update on SARS cases--United States and worldwide, December 2003. MMWR Morb Mortal Wkly Rep. Dec 12 2003;52(49):1202-6. [Medline].

  2. MMWR Morb Mortal Wkly Rep. Severe acute respiratory syndrome (SARS) and coronavirus testing--United States, 2003. MMWR Morb Mortal Wkly Rep. Apr 11 2003;52(14):297-302. [Medline].

  3. Dobson R. Mumps cases rise among teenagers and young adults. BMJ. Jul 17 2004;329(7458):132. [Medline].

  4. Kancherla VS, Hanson IC. Mumps resurgence in the United States. J Allergy Clin Immunol. Oct 2006;118(4):938-41. [Medline].

  5. Koskiniemi M, Donner M, Pettay O. Clinical appearance and outcome in mumps encephalitis in children. Acta Paediatr Scand. Jul 1983;72(4):603-9. [Medline].

  6. Committee on Infectious Diseases, American Academy of Pediatrics. Report of the Committee on Infectious Diseases. In: Red Book. 2003:439-443.

  7. Hashimoto H, Fujioka M, Kinumaki H. An office-based prospective study of deafness in mumps. Pediatr Infect Dis J. Mar 2009;28(3):173-5. [Medline].

  8. Niizuma T, Terada K, Kosaka Y, Daimon Y, Inoue M, Ogita S, et al. Elevated serum C-reactive protein in mumps orchitis. Pediatr Infect Dis J. Oct 2004;23(10):971. [Medline].

  9. [Guideline] Averhoff FM, Williams WW, Hadler SC. Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. J Sch Health. Sep 1997;67(7):298-303. [Medline].

  10. CDC Immunization Schedules. Last updated March 2009. United States Centers for Disease Control and Prevention. Available at http://www.cdc.gov/vaccines/recs/schedules/default.htm.

  11. MMWR Morb Mortal Wkly Rep. Recommended immunization schedules for persons aged 0 through 18 years --United States, 2009. MMWR Morb Mortal Wkly Rep. Jan 2 2009;57(51):[Full Text].

  12. [Guideline] CDC. Updated recommendations for isolation of persons with mumps. MMWR Morb Mortal Wkly Rep. Oct 10 2008;57(40):1103-5. [Medline].

  13. Gilgen-Anner Y, Heim M, Ledermann HP, Bircher AJ. Iodide mumps after contrast media imaging: a rare adverse effect to iodine. Ann Allergy Asthma Immunol. Jul 2007;99(1):93-8. [Medline].

  14. Gold E. Almost extinct diseases: measles, mumps, rubella, and pertussis. Pediatr Rev. Apr 1996;17(4):120-7. [Medline].

  15. Hinman A. Eradication of vaccine-preventable diseases. Annu Rev Public Health. 1999;20:211-29. [Medline].

  16. MMWR Morb Mortal Wkly Rep. Status report on the Childhood Immunization Initiative: reported cases of selected vaccine-preventable diseases--United States, 1996. MMWR Morb Mortal Wkly Rep. Jul 25 1997;46(29):665-71. [Medline].

  17. Phillips C, Behrman RE, Vaughan VC, eds. Mumps. In: Nelson's Textbook of Pediatrics. 13th ed. 1987:673-5.

  18. Sherris JC, Ryan KJ, eds. Mumps. In: Medical Microbiology: An Introduction to Infectious Diseases. 2nd ed. 1994:517-9.

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Further Reading

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Keywords

mumps, mumps virus, MMR, parotitis, epidemic parotiditis, measles-mumps-rubella vaccine, MMR vaccine, paramyxovirus, viremia, viruria, viral pediatric disease, live-attenuated mumps virus vaccine, meningoencephalitis, parotid gland enlargement

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

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.

Medical Editor

Garry Wilkes, MBBS, FACEM, Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Director, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia, Australia.
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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