Mumps

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Contents

Introduction

Hippocrates described Mumps before 400 BC.

Until there's more information on ganfyd, try the HPA information on mumps here. During 2004-5 there was an epidemic of mumps in teenagers in the UK - this is explained here.

Aetiology

Viral infection. Paramyxovirus. RNA

Clinical

Individuals with Mumps will have fever and usually, swelling and tenderness of one or more of the salivary glands in the neck, and possibly in the mouth or throat. Classically the parotid glands are the main focus and the patient is often said by the family to resemble a hamster. If severe the patient can be quite unwell and the skin over the swollen parotid may look pale, thin and almost transparent. A one sided Mump is occasionally seen and can cause diagnostic confusion with a stone in the parotid duct. The gland swelling in Mumps is usually more diffuse and less tender than a blocked duct. The other side may swell within a day or so or remain uninvolved.

The symptoms may be very mild, or absent, however:-

  • Neurological complications include meningitis and encephalitis. Mumps was the commonest cause of viral meningitis in children under 15 before MMR vaccine became available.
  • It can cause permanent unilateral deafness at any age.
  • Other complications include pancreatitis, oophoritis (inflammation of the ovaries) and orchitis (inflammation of the testes) – although even when the latter is bilateral, sterility only follows in a few cases, contrary to public expectation.
  • In young adults Mumps may require hospital admission and is not a minor illness.

Investigations

No diagnostic tests are usually required for clinical purposes, although the virus can be identified from saliva or serum samples during the acute phase.

For epidemiological reasons a follow-up saliva test is usually recommended, at least 10 days after the onset of illness. If mumps IgM is identified, this indicates that there has been a recent infection. IgG at this stage usually indicates prior infection or vaccine-induced immunity.

Blood tests

Seldom required for diagnosis, but serology for mumps IgG/IgM is available (and may also be performed on oral fluid).

Radiology

Not usually required.

Treatment

Medical

Usually self-limiting.

If it hurts to swallow, thick smooth drinks may be easier to tolerate.

Incubation period

The incubation period is normally 14-21 days. Mumps is most infectious from 7 days before symptoms appear until 5 days after the swelling starts.

Prevention

  • Spread of the disease can be limited by making sure the infected person covers their mouth and nose when coughing and sneezing
  • A combined vaccine against measles, mumps and rubella (MMR) is given routinely to babies at one year of age with a 2nd dose before school entry

Mumps can be safely and effectively prevented by vaccination - in the UK, the only available and licensed vaccine is MMR.

  • There is no upper age limit to receiving MMR vaccine and every opportunity should be taken to offer it to previously un-immunised older children and adults - although individuals born prior to 1980 are likely to be immune to all three diseases.
  • As with measles, rubella, and chickenpox, all health care workers who do not have a good history of having had two doses of MMR, or of having confirmed disease, should have their antibody levels checked for immunity, or should be fully vaccinated. (As no harm is done when vaccinating somebody who's already immune, it may be simplest to vaccinate than to check antibody levels first.)
  • There are no ill-effects from immunising individuals who are already immune.
  • A cohort of people born around 1980 to 1992 are particularly at risk of mumps, as described in "Questions and answers about mumps and MMR".
  • In 1996 96 cases were confirmed in the UK, in 2005 43378 cases and in 2012 2466 cases.

Notification

Mumps should be notified on suspicion.

Confirmatory testing - using the saliva kit described above - will usually be required on notification, unless there is currently an epidemic. Any cases notified on suspicion which are shown on testing to have prior immunity will be "denotified".

Exclusion period

People with probable mumps should be excluded from school or work until 5 days from the onset of swollen glands, and until they feel well again.

In 2005 some UK GPs ran a catch-up campaign aiming to ensure everyone under 25 had received two doses of Mumps vaccine. This followed recognition that immunity in this age-group was lower than desirable; that due to a lapse in immunisation rates for small children there was more exposure, and that conditions for outbreaks were present.

Outbreaks of Mumps occurred in various Universities and Colleges.

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