Mumps

Definition

Mumps is a relatively mild short-term viral infection of the salivary glands that usually occurs during childhood. A contagious disease, mumps is characterized by a painful swelling of both cheek areas. The salivary glands are also called the parotid glands, therefore, mumps is sometimes referred to as an inflammation of the parotid glands (epidemic parotitis). The word mumps comes from an Old English dialect, meaning lumps or bumps within the cheeks.

Description

Mumps is a very contagious disease that spreads easily in such highly populated areas as day care centers and schools. Although not as contagious as measles or chickenpox, mumps was once quite common. Prior to the release of a mumps vaccine in the United States in 1967, approximately 92% of all children had been exposed to mumps by the age of 15. In these prevaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 1941 when approximately 250 cases were reported for every 100,000 people. In 1968, the year after the live mumps vaccine was released, only 76 cases were reported for every 100,000 people. By 1985, less than 3,000 cases of mumps were reported throughout the entire United States, which works out to about 1 case per 100,000 people. The reason for the decline in mumps was the increased usage of the mumps vaccine. However, 1987 noted a five–fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws. Since then, state-enforced school entry requirements have achieved student immunization rates of nearly 100% in kindergarten and first grade. In 1996, the Centers for Disease Control and Prevention (CDC) reported only 751 cases of mumps nationwide, or, in other words, about one case for every five million people.




The visible swollen gland (right) of a 2 year old boy with mumps parotitis, a viral infection of the parotid salivary gland (located beneath the ear).





The visible swollen gland (right) of a 2 year old boy with mumps parotitis, a viral infection of the parotid salivary gland (located beneath the ear).
(Dr P. Marazzi/Science Source)
Risk factors

When the mumps virus is present in areas, such as schools, where close contact between people allows the virus to spread, outbreaks may occur. People who are not vaccinated against mumps are at higher risk of getting mumps and spreading the virus to others.

Although the risk of exposure to mumps for most travelers is be relatively low, travelers should be fully vaccinated or immune. This is especially important if traveling to states or countries experiencing mumps outbreaks.

Demographics

According to the CDC, before the introduction of a vaccine to protect against mumps, mumps was a common childhood disease in the United States, sometimes causing severe complications, such as permanent deafness in children and, occasionally, swelling of the brain (encephalitis). There are normally only a few hundred cases of mumps every year in the United States. Mumps is most common in children 5 to 14 years of age who are not vaccinated, but the virus can infect a person at any age.

Causes and symptoms

The paramyxovirus that causes mumps is harbored in the saliva and is spread by sneezing, coughing, and other direct contact with another person's infected saliva. Once the person is exposed to the virus, symptoms generally occur in 14–24 days. Initial symptoms include chills, headache, loss of appetite, and a lack of energy. However, an infected person may not experience these initial symptoms. Swelling of the salivary glands in the face (parotitis) generally occurs within 12–24 hours of the above symptoms. Accompanying the swollen glands is pain on chewing or swallowing, especially with acidic beverages, such as lemonade. A fever as high as 104°F (40°C) is also common. Swelling of the glands reaches a maximum on about the second day and usually disappears by the seventh day. Once a person has contracted mumps, they become immune to the disease, despite how mild or severe their symptoms may have been.




Mumps

While the majority of cases of mumps are uncomplicated and pass without incident, some complications can occur. Complications are, however, more noticeable in adults who get the infection. In 15% of cases, the covering of the brain and spinal cord becomes inflamed (meningitis). Symptoms of meningitis usually develop within four or five days after the first signs of mumps. These symptoms include a stiff neck, headache, vomiting, and a lack of energy. Mumps meningitis is usually resolved within seven days, and damage to the brain is exceedingly rare.

The mumps infection can spread into the brain causing inflammation of the brain (encephalitis). Symptoms of mumps encephalitis include the inability to feel pain, seizures, and high fever. Encephalitis can occur during the parotitis stage or one to two weeks later. Recovery from mumps encephalitis is usually complete, although complications, such as seizure disorders, have been noted. Only about 1 in 100 with mumps encephalitis dies from the complication.

About one-fourth of all post-pubertal males who contract mumps can develop a swelling of the scrotum (orchitis) about seven days after the parotitis stage. Symptoms include marked swelling of one or both testicles, severe pain, fever, nausea, and headache. Pain and swelling usually subside after five to seven days, although the testicles can remain tender for weeks.

Girls occasionally suffer an inflammation of the ovaries, or oophoritis, as a complication of mumps, but this condition is far less painful than orchitis in boys.

Diagnosis

Mumps tests may also be used to confirm that a person is immune to the virus due to previous infections or vaccination. Doctors however, most frequently diagnose current mumps infections based upon characteristic clinical findings.

Treatment

When mumps does occurs, the illness is usually allowed to run its course. The symptoms, however, are treatable. Because of difficulty swallowing, the most important challenge is to keep the patient fed and hydrated. The individual should be provided a soft diet, consisting of cooked cereals, mashed potatoes, broth-based soups, prepared baby foods, or foods put through a home food processor. Aspirin, acetaminophen, or ibuprofen can relieve some of the pain due to swelling, headache, and fever. Avoid fruit juices and other acidic foods or beverages that can irritate the salivary glands. Avoid dairy products that can be hard to digest. In the event of complications, a physician should be contacted at once. For example, if orchitis occurs, a physician should be called. Also, supporting the scrotum in a cotton bed on an adhesive-tape bridge between the thighs can minimize tension. Ice packs are also helpful.

Alternative treatment

Acupressure can be used effectively to relieve pain caused by swollen glands. The patient can, by using the middle fingers, gently press the area between the jawbone and the ear for two minutes while breathing deeply.

A number of homeopathic remedies can be used for the treatment of mumps. For example, belladonna may be useful for flushing, redness, and swelling. Bryonia (wild hops) may be useful for irritability, lack of energy, or thirst. Phytolacca (poke root) may be prescribed for extremely swollen glands. A homeopathic physician should always be consulted for appropriate doses for children, and remedies that do not work within one day should be stopped. A homeopathic preparation of the mumps virus can also be used prophylactically or as a treatment for the disease.

Several herbal remedies may be useful in helping the body recover from the infection or may help alleviate the discomfort associated with the disease. Echinacea (Echinacea spp.) can be used to boost the immune system and help the body fight the infection. Other herbs taken internally, such as cleavers (Galium aparine), calendula (Calendula officinalis), and phytolacca (poke root), target the lymphatic system and may help to enhance the activity of the body's internal filtration system. Since phytolacca can be toxic, it should only be used by patients under the care of a skilled practitioner. Topical applications are also useful in relieving the discomfort of mumps. A cloth dipped in a heated mixture of vinegar and cayenne (Capsicum frutescens) can be wrapped around the neck several times a day. Cleavers or calendula can also be combined with vinegar, heated, and applied in a similar manner.

QUESTIONS TO ASK YOUR DOCTOR

Public health role and response

Mumps is a public health issue because it can be prevented by immunization. Thanks to successful vaccination programs, measles, mumps, and rubella (MMR) are now much less common in the United States and countries that have MMR immunization programs than they used to be. Finland reports complete eradication. The first vaccine against mumps was licensed in the United States in 1967, and by 2005, high two-dose childhood vaccination coverage reduced disease rates by 99%.

Prognosis

When mumps is uncomplicated, prognosis is excellent. However, in rare cases, a relapse occurs after about two weeks. Complications can also delay complete recovery.

Prevention

The mumps vaccine is extremely effective, and virtually everyone should be vaccinated against this disease. There are, however, a few reasons why people should not be vaccinated against mumps:

The mumps vaccine has been controversial in recent years because of concern that its use was linked to a rise in the rate of childhood autism. The negative publicity given to the vaccine in the mass media led some parents to refuse to immunize their children with the MMR vaccine. One result has been an increase in the number of mumps outbreaks in several European countries, including Italy and the United Kingdom.

In the fall of 2002, the New England Journal of Medicine published a major Danish study disproving the hypothesis of a connection between the MMR vaccine and autism. A second study in Finland showed that the vaccine is not associated with aseptic meningitis or encephalitis or autism. Since these studies were published, American primary care physicians have once again reminded parents of the importance of immunizing their children against mumps and other childhood diseases.

See also Measles ; Meningitis ; Vaccination .

KEY TERMS
Asymptomatic—
Persons who carry a disease and may be capable of transmitting the disease but who do not exhibit symptoms of the disease are said to be asymptomatic.
Autism—
A severe developmental disorder that usually begins before three years of age and affects a child's social as well as intellectual development. Some researchers theorized that immunization with the MMR vaccine was a risk factor for autism.
Encephalitis—
Inflammation of the brain.
Epidemic parotitis—
The medical name for mumps.
Immunoglobulin G (IgG)—
A group of antibodies against certain viral infections that circulate in the bloodstream. One type of IgG is specific against the mumps paramyxovirus.
Meningitis—
Inflammation of the membranes covering the brain and spinal cord.
Orchitis—
Inflammation or swelling of the scrotal sac containing the testicles.
Paramyxovirus—
A genus of viruses that includes the causative agent of mumps.
Parotitis—
Inflammation and swelling of the salivary glands.

Resources

BOOKS

Colligan, L. H. Measles and Mumps. New York, NY: Benchmark Books, 2010.

Hecht, Alan. Mumps. New York, NY: Chelsea House Publications, 2012.

Temesgen, Z., ed. Mayo Clinic Infectious Diseases Board Review. New York, NY: Oxford University Press, 2011.

PERIODICALS

Adalja. A. A. “Vaccines, immunity, whooping cough, and mumps.” Biosecurity and Bioterrorism 9, no. 1 (March 2011): 9–11.

Demicheli. V., et al. “Vaccines for measles, mumps and rubella in children.” Cochrane Database of Systematic Reviews 15, no. 2 (February 2012): CD004407.

Eriksen, J., et al. “Seroepidemiology of mumps in Europe (1996-2008): why do outbreaks occur in highly vaccinated populations?” Epidemiology and Infection 12 (June 2012): 1–16.

Ruijs, W. L., et al. “The role of schools in the spread of mumps among unvaccinated children: a retrospective cohort study.” BMC Infectious Diseases 11 (August 2011): 227.

Smith, S. D., and I. Gemmill. “Mumps: resurgence of a vanquished virus.” Canadian Family Physician 57, no. 7 (July 2011): 786–790.

White, S. J., et al. “Measles, mumps, and rubella.” Clinical Obstetrics and Gynecology 55, no. 2 (June 2012): 550–559.

Xu, P., et al. “The V protein of mumps virus plays a critical role in pathogenesis.” Journal of Virology 86, no. 3 (February 2012): 1768–1776.

WEBSITES

“Fast Facts about Mumps.” Centers for Disease Control. October 13, 2012. http://www.cdc.gov/mumps/about/mumps-facts.html

“Mumps.” Mayo Clinic. October 5, 2012. http://www.mayoclinic.com/print/mumps/DS00125/METHOD= print&DSECTION=all

“Mumps.” Medline Plus, 28 September 2012. http://www.nlm.nih.gov/medlineplus/mumps.html

ORGANIZATIONS

American Academy of Pediatrics (AAP), 141 Northwest Point Boulevard, Elk Grove Village, IL, 60007-1098, (847) 434-4000, Fax: (847) 424-8000, kidsdocs@aap.org, http://www.aap.org .

Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA, 30333, (800) 232-4636, cdcinfo@cdc.gov, http://www.cdc.gov .

National Foundation for Infectious Diseases, 4733 Bethesda Ave., Suite 750, Bethesda, MD, 20814, (301) 656-0003, Fax: (301) 907-0878, (800) 232-4636, http://www.nfid.org .

Ron Gasbarro, PharmD
Rebecca J. Frey, PhD

  This information is not a tool for self-diagnosis or a substitute for professional care.