IN THE FIRST HALF of 2006, over 2,500 cases of mumps in 11 states were reported to the Centers for
Disease Control and Prevention (CDC). This is the largest number of mumps cases reported to the CDC in a single year since 1991. In 2001 to 2003, fewer than 300 cases of mumps were reported annually. The mumps outbreak is believed to have originated in late 2005 among college students in Iowa.

About 38% of people who contracted mumps were young adults, but the disease spread to people of all ages. What’s behind the resurgence of this once-common childhood disease? Among other factors, the CDC cites poor compliance with the recommended mumps immunization schedule of two doses of the measlesmumps- rubella (MMR) vaccine. Mumps can spread easily among susceptible people living in close quarters, such as college dormitories. In addition, many younger health care providers are unfamiliar with this now-unusual disease, leading to delays in diagnosis and treatment.

Although severe complications are rare, mumps can cause encephalitis, meningitis, orchitis, inflammation of the ovaries or breasts, spontaneous abortion, and permanent deafness. Make sure you know how to recognize and prevent this potentially dangerous disease by reading this review.

Signs and symptoms of mumps
A viral infection, mumps typically causes fever, headache, muscle aches, fatigue, and loss of appetite, followed by unilateral or bilateral swelling of salivary glands, usually the parotid glands Although swollen, tender parotid glands are considered the hallmark of mumps, up to half of people who get mumps have mild symptoms or none at all. The virus replicates in the patient’s respiratory tract and spreads to other people via airborne respiratory secretions, saliva, or contact with contaminated objects (fomites). The incubation period is 2 to 3 weeks from exposure to mumps to the development of signs and symptoms. An infected person can infect others for about 3 days before and 9 days after symptoms appear.

A mumps diagnosis is based on patient history and clinical examination. The CDC recommends confirmation by lab testing of serum and viral specimens (oral fluid or urine) at the onset of symptoms, if possible. A parotid gland/buccal swab is the preferred viral specimen. Keep specimens cold and send them for testing immediately, following health department and CDC protocols.

Caring for a person with mumps
Usually self-limiting, mumps is treated with supportive care, such as fluids and antipyretic or antiinflammatory medication. To prevent a patient with diagnosed or suspected mumps from infecting others, he should be isolated for up to 9 days after symptoms begin or until mumps has been ruled out. Teach the patient and his family to practice meticulous hand hygiene; avoid sharing food, drink, or eating utensils; and sanitize shared objects, including doorknobs and toys.

During a community outbreak, the CDC recommends that people who aren’t immunized remain quarantined for at least 25 days after the last person in the community has shown signs and symptoms of mumps. Health care workers who care for a patient with mumps must be immune and follow droplet precautions using a regular surgical or isolation mask. If you’re newly immunized, wait 2 weeks after vaccination before risking contact with someone with mumps to allow time for an adequate antibody response.

Preventing mumps
The MMR vaccination contains an effective live mumps virus vaccine. One dose of MMR is 75% to 91% effective
in preventing mumps; a second dose is even more protective. In one high-school mumps outbreak, students who’d received only one dose of MMR had an attack rate five times greater than those vaccinated with two doses.
Two MMR doses are recommended for children, with the first dose given after age 12 months and the second at age 4 to 6 years. (However, children can get the second dose at any age, provided 28 days have lapsed since the first dose.) People who’ve had mumps and those born before 1957 are considered to have an acquired immunity. The CDC recommends requiring two doses of MMR for school or college entry unless the person can establish his immunity (for example, via documentation of a mumps diagnosis).

NEW MUMPS VACCINATION GUIDELINES
Earlier this year, the Advisory Committee on Immunization Practices revised its recommendations on mumps vaccination.
Here’s a summary:
• Documentation of adequate mumps vaccination is now two doses (not one) of a live mumps virus vaccine (such as the measles-mumps-rubella [MMR] vaccine) for school-age children and adults at high risk (such as most health care workers, international travelers, and college students).
• Health care workers born during or after 1957 without other evidence of mumps immunity should receive two vaccine doses.
• Health care workers born before 1957 without other evidence of immunity should consider receiving one vaccine
dose.
• During a mumps outbreak, a second dose of live virus vaccine should be considered for children ages 1 to 4 years and adults at low risk (with at least 28 days between the first and second dose). Health care workers born before 1957 without other evidence of immunity are strongly recommended to receive two vaccine doses because their immunity can’t be guaranteed.

Source: Centers for Disease Control and Prevention,
Notice to readers: Updated recommendations
of the Advisory Committee on Immunization
Practice (ACIP) for the control and elimination of
mumps, Morbidity and Mortality Weekly Report,
55(early release):1-2, June 1, 2006.

Last updated Jan 4/07