Mumps Treatment & Management

Mumps without associated major complications can be managed on an outpatient basis with supportive care and good follow up.

Current evidence suggests that patients diagnosed with mumps should be isolated for 5 days from the onset of symptoms.

Also see Management of Acute Presentation of Mumps.

Medical care

Conservative, supportive medical therapy is indicated in patients with mumps. No antiviral agent is indicated for viral illness, as it is a self-limited disease.

Generous offering of fluids is essential, because maintenance of adequate hydration and alimentation of patients are important. Refrain from acidic foods and liquids as they may cause swallowing difficulty, as well as gastric irritation.

Prescribe analgesics (acetaminophen, ibuprofen) for severe headaches or discomfort due to parotitis. Topical application of warm or cold packs to the swollen parotid may soothe the area. Stronger analgesics may be required for patients with orchitis. Bed rest, scrotal support, and ice packs are recommended.

Patients with specific complications may require inpatient care for fluid stabilization and observation.

Persons with encephalitis, meningitis, nephritis, myocarditis, or severe pancreatitis require more supportive care.

Consultation may be considered in complicated cases with multiple organ system involvement.

Transfer is rarely needed. An indication to transfer would be if major complications are present and the current hospital cannot support the appropriate treatment services.

A light diet with generous fluid intake is recommended.

Avoiding acid-containing foods (eg, tomato, vinegar-containing food additives) and liquids (eg, orange juice) is beneficial for pain reduction.

Bed rest is recommended to foster a faster recovery and is indicated for patients with complicated cases.

The principal strategy to prevent mumps is to achieve and maintain high immunization levels, primarily in infants and young children. Universal immunization as part of good health care should be routinely carried out in physicians' offices and public health clinics. Programs aimed at vaccinating children with MMR should be established and maintained in all communities. In addition, all other persons thought to be susceptible should be vaccinated, unless otherwise contraindicated. This is especially important for adolescents and young adults in light of the observed increased risk of disease in these populations.

If a case of mumps occurs in a childcare facility, notify the local health department and parents. Make sure all children and adults follow good handwashing practices. In large facilities, follow appropriate group separation practices. Review the immunization records of all children in the facility to assure that they have received their first mumps vaccination. Those not adequately vaccinated should be referred to their physicians. Closely observe all children for symptoms and refer anyone developing symptoms to his or her physician.

One study evaluated the vaccine effectiveness of 1 and 2 doses of the MMR vaccine during an outbreak of mumps in Ontario, Canada that occurred between September 1, 2009, and June 10, 2010. The study also aimed to estimate the coverage level required to achieve “herd” immunity and interrupt community transmission. Using data from Ontario's Public Health Information System, 134 confirmed cases were identified; 114 of those reported receipt of MMR vaccine. Of those, 63 received 1 dose (49.2-81.6% effectiveness), while 32 received 2 doses (66.3-88% effectiveness). The study concludes that vaccine coverage of 88.2% and 98% would be needed to interrupt community transmission of mumps, emphasizing the need for routine vaccination and warning against complacency in vaccination programs.^[21]

It is recommended that those persons who have been exempted from vaccination for medical, religious, or other reasons should be excluded from school or daycare until at least 26 days after the onset of parotitis in the last person with mumps in the affected facility.

Initially, children were excluded from school and childcare centers for 9 days after the onset of parotid gland swelling. However in 2007, the American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) changed their recommendation from 9-day isolation guidance (standard precautions and droplets precautions) to 5 days after the onset of clinical symptoms (eg, parotitis) based on current medical evidence.^[22]

However, isolation measures as cited can be difficult to command as the virus is present in saliva days prior to the onset of parotid swelling and viral shedding does occur in asymptomatic persons.

Susceptible children, adolescents, and adults should be vaccinated against mumps, unless vaccination is contraindicated. Mumps vaccine is of particular value for children approaching puberty and for adolescents and adults who have not had mumps. The MMR vaccine is the vaccine of choice for routine administration and should be used in all situations in which recipients are also likely to be susceptible to measles, rubella, or both. The favorable benefit-to-cost ratio for routine mumps immunization is more marked when vaccine is administered as MMR.

Persons should be considered susceptible to mumps unless they have documentation of (1) physician-diagnosed mumps, (2) adequate immunization with live mumps virus vaccine on or after their first birthday, or (3) laboratory evidence of immunity.

Since live mumps vaccine was not used routinely before 1977 and the peak age-specific incidence prior to this time was in children aged 5-9 years, most persons born before 1957 are likely to have been naturally infected between 1957 and 1977. Therefore, they may generally be considered to be immune, even if they may not have had clinically recognizable mumps disease. However, this cutoff date for susceptibility is arbitrary. Although outbreak control efforts should be focused on persons born after 1956, these recommendations do not preclude vaccination of possibly susceptible persons born before 1957 who may be exposed in outbreak settings.

Persons who are unsure of their mumps disease history, mumps vaccination history, or both should be vaccinated. No evidence indicates that persons who have previously either received mumps vaccine or had mumps are at any increased risk of local or systemic reactions from receiving live mumps vaccine. Testing for susceptibility before vaccination, especially among adolescents and young adults, is not necessary. In addition to the expense, some tests (eg, mumps skin test, complement-fixation antibody test) may be unreliable, and tests with established reliability (eg, neutralization test, enzyme immunoassay, radial hemolysis antibody test) are not readily available.

A single dose of vaccine in the volume specified by the manufacturer (standardly, 0.5 mL) should be administered subcutaneously (SC). Although not routinely recommended, intramuscular (IM) vaccination is effective and safe.

Administration of the live-attenuated mumps virus vaccine as the MMR or MMRV (measles-mumps-rubella-varicella) is recommended at any age on or after the first birthday for all susceptible persons, unless a contraindication is present. It should not be administered to infants younger than 12 months because persisting maternal antibody might interfere with seroconversion. To ensure immunity, all persons vaccinated before their first birthday should be revaccinated on or after the first birthday.^{[23, 24]} A second dose is administered at age 4-6 years. The second dose allows a safe guard to ensure immunity against potential vaccine failure.

It is estimated that there is a slightly higher risk of febrile seizures in children aged 12-23 months vaccinated with the measles-mumps-rubella-varicella (MMRV) when compared with separate MMR and varicella vaccine administration. The period of risk for febrile seizures is from 5-12 days after receipt of the vaccine. However, there is no increased risk of febrile seizures among patients aged 4-6 years receiving the MMRV. Thus, the American Academy of Pediatrics recommends that either MMR and varicella vaccines separately or the MMRV be used for the first dose of measles, mumps, rubella, and varicella vaccines administered at age 12-47 months. For the first dose of measles, mumps, rubella, and varicella vaccines administered at ages 48 months and older, and for dose 2 at any age (15 mo to 12 y), use of MMRV is preferred.^[25]

One study evaluated the vaccine effectiveness of 1 and 2 doses of the MMR vaccine during an outbreak of mumps in Ontario, Canada that occurred between September 1, 2009, and June 10, 2010. The study also aimed to estimate the coverage level required to achieve “herd” immunity and interrupt community transmission. Using data from Ontario's Public Health Information System, 134 confirmed cases were identified; 114 of those reported receipt of MMR vaccine. Of those, 63 received 1 dose (49.2-81.6% effectiveness), while 32 received 2 doses (66.3-88% effectiveness). The study concludes that vaccine coverage of 88.2% and 98% would be needed to interrupt community transmission of mumps, emphasizing the need for routine vaccination and warning against complacency in vaccination programs.^[21]

When administered after exposure to mumps, live mumps virus vaccine may not provide protection. However, if the exposure did not result in infection, vaccination should induce protection against infection from subsequent exposures. No evidence indicates that the risk of vaccine-associated adverse events increases if vaccine is administered to persons incubating disease.

Immunoglobulin has not been shown to benefit as postexposure prophylaxis and hence is not recommended. In the United States, mumps immunoglobulin is no longer available or licensed for use.

Adverse effects of vaccine use

In field trials before licensure, illnesses did not occur more often in vaccinated individuals than in unvaccinated controls. Reports of illnesses following mumps vaccination have cited episodes of parotitis and low-grade fever. Allergic reactions, including rash, pruritus, and purpura, have been temporally associated with mumps vaccination but are uncommon, are usually mild, and are of brief duration.

Encephalitis occurring within 30 days of receipt of a mumps-containing vaccine (0.4 cases per million doses) is not greater than the observed background incidence rate of CNS dysfunction in healthy populations. Other manifestations of CNS involvement, such as febrile seizures and deafness, have also been infrequently reported.^[26] Complete recovery is usual. Reports of CNS illness following mumps vaccination do not necessarily denote an etiologic relationship between the illness and the vaccine.

Contraindications to vaccine use in pregnancy

Although mumps vaccine virus has been shown to infect the placenta and fetus, no evidence indicates that it causes congenital malformations in humans. However, because of the theoretical risk of fetal damage, avoiding administration of live virus vaccine to pregnant women is prudent. Vaccinated women should avoid pregnancy for 3 months after vaccination.

Routine precautions for vaccinating postpubertal women include asking if they are or may be pregnant, excluding those who say they are, and explaining the theoretical risk to those who plan to receive the vaccine.

Vaccination during pregnancy should not be considered an indication for termination of pregnancy. However, the final decision about interruption of pregnancy must rest with the individual patient and her physician.

Severe febrile illness

Vaccine administration should not be postponed because of minor or intercurrent febrile illnesses, such as mild upper respiratory infections. However, vaccination of persons with severe febrile illnesses should generally be deferred until they have recovered.

Allergies

Because live mumps vaccine is produced in chick embryo cell culture, persons with a history of anaphylactic reactions (ie, hives, swelling of the mouth and throat, difficulty breathing, hypotension, shock) after egg ingestion should be vaccinated only with caution, using published protocols. Children with known allergy should be observed at the vaccination site for 20 minutes. Evidence indicates that persons are not at increased risk if they have egg allergies that are not anaphylactic in nature. Vaccination can proceed in the usual manner for these patients.

No evidence indicates that persons with allergies to chickens or feathers are at increased risk of reaction to the vaccine.

Mumps vaccine does contain trace amounts of neomycin (25 mcg); hence, persons who have experienced anaphylactic reactions to topically or systemically administered neomycin should not receive mumps vaccine. Typically, neomycin allergy presents as a contact dermatitis without systemic involvement; hence, administration of the vaccine in this setting is not contraindicated.

Recent immunoglobulin injection

Passively acquired antibody can interfere with the response to live-attenuated virus vaccines because antibody in these products neutralizes the vaccine virus and interferes with successful immunization. Therefore, mumps vaccine should be administered at least 2 weeks before or deferred until approximately 3 months after the administration of immunoglobulin or blood product transfusion.

Exceptions

An exception to these general recommendations is in children with immunodeficiency diseases or those receiving immunosuppressive therapy (eg, with HIV or oncologic disease, on high doses of corticosteroids). All HIV-infected children who are not severely immunocompromised (age-specific CD4⁺ T-lymphocyte counts of ≥15%) should receive MMR vaccination as scheduled.

Patients with leukemia in remission whose chemotherapy has been terminated for at least 3 months may also receive live-attenuated mumps virus vaccine (as MMR).

It is important to recognize the need to vaccinate close susceptible contacts of those patients who are immunocompromised to minimize their risk of mumps exposure. Immunized patients cannot transmit the mumps vaccine virus to others.