Mumps

Mumps is a viral disease that causes swelling of the parotid glands (glands that produce saliva in the mouth).

Before a vaccine became widely available in the United States in 1967, mumps was considered a routine childhood disease and more than 200,000 cases were reported each year. Today, there are only a few hundred cases reported each year, according to the Centers for Disease Control and Prevention (CDC). However, mumps still occurs more often in countries where the vaccine is not in wide use.  

Mumps is spread when an infected person coughs or sneezes, or through contact with infected objects such as utensils and drinking glasses. It usually begins with a general sick feeling (malaise), fever, chills and a sore throat, followed by swelling of the parotid glands that causes the cheeks to puff out.

Mumps is usually diagnosed during a physical examination. Physicians can normally diagnose it by the symptoms experienced, but sometimes a viral culture or blood test is performed to confirm a diagnosis.

There is no cure for the mumps virus, but patients can relieve symptoms by using over–the–counter pain relievers, warm or cold compresses and drinking plenty of fluids.

The best way to prevent mumps is to receive the MMR (measles, mumps and rubella) vaccine. It is recommended that children receive a first dose of the vaccine between 12 to 15 months of age and another dose before entering school (between 3 and 6 years of age).

About mumps
Mumps is a contagious disease caused by a virus that results in swelling of the parotid glands (glands located below and in front of the ears that produce saliva in the mouth).

It is considered to be as contagious as influenza and rubella (German measles), but less contagious than measles or varicella (chickenpox). It occurs throughout the year, but is most common in late winter or early spring. Most cases occur in children ages 5 to 15, although infection is possible at any age and cases among adults are usually more severe than those involving children. Children under age 2 rarely develop mumps.

An infected person passes the mumps virus through droplets in their breath or mucus or by transmitting it through objects. After the virus enters the body, it grows in the nasopharynx (the upper part of the throat behind the nose) and lymph nodes. It can spread through the bloodstream to tissues in the body such as the meninges (membranes surrounding the brain and spinal cord), pancreas, testes and ovaries.

Mumps usually begins with a general sick feeling (malaise), fever, chills and a sore throat, followed by swelling of the parotid glands that causes the cheeks to puff out.

Most people who develop mumps recover fully. Complications of the disease are rare, but they are potentially serious. They include:

• Aseptic meningitis. Illness characterized by headache, fever and inflammation of the lining of the brain that is not caused by bacteria. According to the Centers for Disease Control and Prevention (CDC), tests of fluid in the brain and spinal cord indicate that 50 to 60 percent of mumps patients develop aseptic meningitis, but most do not experience symptoms. Of that group, up to 15 percent of patients develop symptoms. Patients usually recover within several days.

• Testicular inflammation (orchitis). Per the CDC, this occurs in up to 50 percent of males who have reached puberty. Signs and symptoms include testicular swelling, tenderness, nausea, vomiting and fever. Some men may develop testicular atrophy, but sterility rarely occurs as a result of this condition.

• Ovarian inflammation (oophoritis). This occurs in 5 percent of females who have reached puberty but does not affect fertility, according to the CDC.

• Pancreatitis. A disease that causes swelling of the pancreas. It is rare, but symptoms include pain in the upper abdomen, nausea and vomiting.

• Deafness. According to the CDC, deafness occurs in approximately 1 in 20,000 cases of mumps. Onset is usually sudden and results in permanent hearing impairment.

• Miscarriage. Pregnant women who develop mumps during the first trimester of pregnancy have a greater chance of miscarriage (spontaneous termination of pregnancy).

In some rare cases, mumps causes inflammation of the brain (encephalitis) or spinal cord (myelitis). Other complications of mumps that are even rarer include arthralgia (pain in the joints), arthritis (inflammation of the joints) and nephritis (inflammation of the kidneys). An average of one death from mumps per year was reported between 1980 through 1999, according to the CDC.

Before a vaccine was licensed in the United States in 1967, mumps was considered a routine childhood illness. There were more than 200,000 cases of mumps reported each year. Since introduction of the vaccine, the number of cases has dropped dramatically. In 2003, there were 231 cases of mumps reported in the United States, according to the CDC.

However, mumps is common in other countries and is easily contracted by those who have not been vaccinated or already had the disease.

Risk factors and causes of mumps

Mumps is caused by a paramyxovirus that is found in saliva. When an infected person sneezes or coughs, droplets spray into the air and mucus can land in other people's noses and throats when they breathe. The virus can also be spread by sharing utensils or drinking glasses with an infected person.

The incubation period (the time that elapses between exposure to the virus and the development of symptoms) for mumps is between 14 and 25 days. A patient with mumps is contagious two to three days before the parotid glands (glands that produce saliva in the mouth) begin to swell and until the swelling subsides (usually about nine days later).

Mumps is rare in the United States because most people receive vaccinations at a young age. However, exposure to an infected person may result in mumps in those who have not received vaccinations or have received only a partial vaccination and have not developed sufficient immunity to the disease. Mumps is more common in other countries because the vaccine is not as widely available.

People who have had mumps develop a resistance against it and, therefore, will probably not get it again. People who were born or lived in the United States before 1957 are also likely to be immune from mumps because they probably lived through an epidemic and were exposed to it. After exposure, the immune system develops resistance, even if symptoms are not experienced.

Signs and symptoms of mumps

Up to 20 percent of patients with mumps will experience no symptoms, according to the Centers for Disease Control and Prevention (CDC).

In patients who experience symptoms, mumps may start with one or more of the following:

• General sick feeling (malaise)
• Fever of up to 103 degrees Fahrenheit (39.4 degrees Celsius)
• Chills
• Sore throat
• Swelling of the temples or jaw (temporomandibular area)
• Weakness or fatigue
• Headache
• Face pain
• Loss of appetite

The most highly recognized symptom of mumps is swelling and pain in the parotid glands (glands located below and in front of the ears that produce saliva in the mouth). Fever and malaise usually precede this swelling. The glands normally become increasingly swollen and painful over a period of one to three days. The pain is usually worsened by chewing, swallowing, talking or drinking acidic juices (e.g.,  orange juice).

Both the left and right glands may be affected, with one side swelling before the other, or only one side swelling. In rare cases, swelling may occur under the tongue, under the jaw, or down to the front of the chest.

Other symptoms that may be present in men include:

• Testicle pain
• Testicle lump
• Scrotal swelling

Diagnosis and treatment of mumps
Mumps is usually diagnosed by a physician during a physical examination that includes a medical history. Patients may be expected to describe symptoms experienced.

A physician can usually diagnose mumps based on the symptoms being experienced by the patients. However, in some cases, a physician may perform a virus culture or blood test to confirm the diagnosis. A blood test can detect mumps antibodies, which indicates whether there has been a recent or past infection.

There is no cure for the mumps virus. Therefore patients must let the virus run its course. Most children and adults recover from mumps within two weeks.

A number of steps may be taken to relieve the symptoms associated with mumps. They include:

• Rest in bed rest until fever subsides.

• Isolate patients to prevent spread of the virus.

• Take over-the-counter pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) to ease pain and swelling. Aspirin should not be given to children because it has been linked to Reye’s syndrome (a potentially fatal disease that affects the brain and other organs).

• Use either warm or cold compresses to ease pain due to swollen glands.

• Wear athletic supporters to ease pain caused by tender testicles.

• Avoid foods that require a lot of chewing. Instead, patients should have broth–based soups or soft foods, such as mashed potatoes or cooked oatmeal.

• Avoid drinking tart or acidic fruit juices (e.g., orange juice, grapefruit juice or lemonade).

• Drink plenty of fluids to avoid dehydration.

• Reduce activity level.

Patients experiencing abdominal pain should be monitored closely because it may indicate inflammation of the pancreas (pancreatitis) in both sexes or inflammation of the ovaries (oophoritis) in females. Males with high fever and swelling of the testicles should be monitored closely because it may indicate inflammation of the testicles (orchitis).

Because mumps can result in inflammation of the brain and other serious complications, a physician should be contacted if a patient is experiencing any of the following symptoms:

• Stiff neck
• Convulsions (seizures)
• Extreme drowsiness
• Severe headache
• Changes in consciousness

Prevention methods for mumps
The best way to prevent mumps is to have an MMR (measles, mumps and rubella) vaccine, a combined inoculation that contains the safest and most effective form of each vaccine. It is recommended that children receive a first dose of the MMR vaccine between 12 and 15 months of age and again between 3 and 6 years of age before entering school. Babies are usually immune to mumps for the first year of life because of the immunity acquired from their mothers during pregnancy.

The MMR vaccine provides protection against mumps and two other formerly common diseases of childhood, measles and rubella (German measles). The availability of the vaccine has greatly reduced the incidence of all three diseases.

The Centers for Disease Control and Prevention (CDC) has recommendations for the MMR vaccine. People who do not need to get the vaccine include:

• Those who have had two doses of the MMR vaccine after age one or one dose of the MMR vaccine, plus a second dose of the measles vaccine.

• Those who have had blood tests that prove they are immune to mumps, measles and rubella.

• Men born before 1957.

• Women born before 1957 that do not plan to have any more children, already had the rubella vaccine or have had a positive rubella test.

Individuals should get a vaccine if they do not meet the above criteria and:

• Are nonpregnant women of childbearing age
• Attend college, trade school or postsecondary school
• Work in a hospital, medical facility, childcare center or school
• Plan to travel abroad or take a cruise

The vaccine is not recommended for the following:

• Pregnant women or those planning to get pregnant within the next month

• People who have experienced life–threatening allergic reactions to gelatin or the antibiotic neomycin, which are components of the vaccine

Individuals with cancer, blood disorders or other diseases that impact the immune system should consult a physician before getting the vaccine.

Most people experience no side effects from the vaccination. Some people develop a fever between five and 12 days after the vaccination. Others develop a mild rash. It was once commonly believed that people who are allergic to eggs cannot receive vaccines grown in chick embryos, such as the mumps vaccine. However, this is not true.

In recent years, some parents have refused to have their children vaccinated because of fears that the MMR vaccine can cause autism (lifelong developmental disability that affects brain function). The number of children diagnosed with autism has increased significantly in recent years, during the same time that the number of recommended childhood vaccines has increased.

The National Academy of Sciences Institute of Medicine reviewed safety concerns of the MMR vaccine at the request of the CDC and the National Institutes of Health. Their report concluded that the increase in autism cases cannot be linked to the MMR vaccine, although there is insufficient information to exclude the vaccine as a cause in rare circumstances. The CDC has not changed its recommendations that children should receive the MMR vaccine to prevent mumps.

Questions for your doctor regarding mumps
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following mumps–related questions:

1. If the vaccine has nearly wiped out mumps in the United States, why do I (or my child) need to receive a vaccination against it?

2. I was born before 1957. Do I still need to get the mumps vaccination?

3. What are the symptoms of mumps?

4. Are there conditions or diseases other than mumps that may explain my symptoms?

5. I'm pregnant. Is it safe to get the mumps vaccine?

6. How long does it take to recover from mumps?

7. What steps can I take to ease my symptoms?