Medical Care
Prehospital Care
Supportive care is usually all that is needed for patients with mumps.
Persons exposed to the virus should be counseled on vaccination and risks.
Emergency Department Care
Supportive care with analgesics and antipyretics as needed. Symptomatic treatment with warm and/or cold compresses over the parotid gland may also be comforting. and outpatient follow up is indicated for straightforward infections.
Complications due to mumps should be treated based on presentation, as follows:
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Testicular ultrasonography for orchitis
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Ice packs applied to scrotal area for swelling
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Discharge with scrotal support and anti-inflammatory agents
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Intravenous hydration for severe pancreatitis
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Lumbar puncture for symptomatic meningitis or encephalitis
Consultations
Consultations should be requested as needed for specific complications.
Prevention
Vaccination remains the best protection. The Centers for Disease Control and Prevention posts the latest immunization schedules on their Web site.
All children older than 1 year and all adults should receive the full two-dose mumps vaccine unless contraindicated. The vaccine is live and is prepared within a chicken embryo and usually given as the mumps, measles, and rubella (MMR) vaccine. Groups who are of concern include those with severe egg allergies, pregnant women, and people who have high fevers or other severe illness or in the immunocompromised host.
If the history of being infected with the mumps virus or vaccination status is questioned, blood tests may be performed to check antibody levels, or the vaccine should simply be administered. In January 2018, The Advisory Committee on Immunization Practices (ACIP) recommended that persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications. Studies show that high-risk individuals during a mumps outbreak who had received a third dose of MMR vaccine had a lower risk of mumps than did those who had received two doses. [24]
The main reported adverse reactions to the vaccine have been pain, redness, and swelling at the injection site; joint or muscle aches; fevers; and, rarely, parotitis. Other more serious reported complications include CNS effects, such as deafness, febrile seizures, [25] and encephalitis, which are extremely rare and should not deter vaccination.
Acute mumps in an individual and/or community may result from a combination of factors, including incomplete vaccination, waning immunity over time (≥10 years since vaccination), and/or antigenic variation of mumps viruses. [26]
Current evidence suggests that patients diagnosed with mumps should be isolated with standard and droplet precautions in a hospital setting for 5 days from the onset of parotitis, including the exclusion of healthcare personnel from work during this period. Transmissibility is greatest immediately after onset of parotitis and decreases rapidly over the subsequent 5 days. Transmission may also occur from patients prior to development of parotitis or with subclinical mumps. [27]
In the past 15 years, the use of MMR has decreased because of a reported connection between vaccinations (especially MMR) and autism. A retrospective cohort study was conducted using an administrative claims database associated with a large US health plan comparing younger siblings with older siblings with autism spectrum disorder (ASD) versus younger siblings with older siblings without ASD.
Of 95,727 children with older siblings, 994 (1.04%) were diagnosed with ASD, and 1,929 (2.02%) had an older sibling with ASD. Of those with older siblings with ASD, 134 (6.9%) had ASD, versus 860 (0.9%) children with unaffected siblings (P < .001). MMR vaccination rates (1 dose) were 84% n = 78,549) at age 2 years and 92% (n = 86,063) at age 5 years for children with unaffected older siblings, versus 73% (n = 1409) at age 2 years and 86% (n = 1,660) at age 5 years for children with affected siblings. MMR vaccine receipt was not associated with an increased risk of ASD at any age. For children with older siblings with ASD, at age 2 years, the adjusted relative risk (RR) of ASD for 1 dose of MMR vaccine versus no vaccine was 0.76 (95% CI, 0.48-1.22; P = 0.25), and, at age 5 years, the RR of ASD for 2 doses compared with no vaccine was 0.56 (95% CI, 0.30-1.04; P = 0.07). For children whose older siblings did not have ASD, at age 2 years, the adjusted RR of ASD for 1 dose was 0.91 (95% CI, 0.68-1.20; P = 0.50) and, at age 5 years, the RR of ASD for 2 doses was 1.09 (95% CI, 0.76-1.54; P = 0.65). [28]
The study showed no association between either 1 or 2 doses of MMR vaccination and an increased ASD risk, even in children with an increased risk for ASD.
The American Academy of Pediatrics (AAP) reports that no available evidence supports the hypothesis that MMR vaccine causes autism or associated disorders. They also report that separate administration of measles, mumps, and rubella vaccines to children provides no benefit over the administration of the combination MMR vaccine. The AAP concluded that autism is a complex disorder of uncertain and multiple etiologies. [29]
Further Inpatient Care
Patients with specific complications may require further inpatient care.
Persons with encephalitis, meningitis, nephritis, myocarditis, or severe pancreatitis require inpatient management and monitoring.
Further Outpatient Care
Classic mumps with no 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. [27]
Scrotal support, ice, and analgesia are indicated.
Hearing testing is performed upon resolution of symptoms.
Transfer
Transfer is rarely needed. Indication to transfer would be if major complications are present and current hospital does not have appropriate services to treat the patient appropriately.
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Child with mumps.
