What is mumps?

Mumps: Diagnosis, Complications, and Management

Mumps is an acute viral infection characterized by fever and inflammation of the salivary glands (typically the parotid glands), which can range from subclinical infection to serious complications including meningitis, deafness, orchitis, and encephalitis. 1, 2

Clinical Presentation

Mumps presents with the following characteristics:

• Classic presentation: Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary glands lasting ≥2 days without other apparent cause 1
• Subclinical infection: 20-40% of cases may be asymptomatic 1
• Atypical presentation: Up to one-third of mumps cases do not cause salivary gland swelling, presenting instead as a respiratory tract infection 1
• Infectious period: Virus can be isolated from saliva from 7 days before through 8 days after onset of salivary gland swelling 1

Complications

Mumps can lead to several serious complications:

• Aseptic meningitis: Occurs in approximately 10% of patients 2
• Orchitis: Common in post-pubertal males (20-30%), but rarely leads to sterility 1, 2
• Encephalitis: Less common but more serious, can result in death or disability 3
• Permanent hearing loss: Approximately 1 per 20,000 cases 2
• Other complications: Oophoritis, pancreatitis, thyroiditis, mastitis, glomerulonephritis, thrombocytopenia, arthritis, myocarditis, and endocardial fibroelastosis 1, 2
• Pregnancy: Increased risk of fetal death in first trimester, though not associated with congenital malformations 2

Diagnosis

A comprehensive diagnostic approach includes:

1. Clinical case definition: Acute onset of unilateral or bilateral tender swelling of parotid/salivary glands for ≥2 days without other apparent cause 1

2. Laboratory confirmation (preferred over clinical diagnosis alone):

   • RT-PCR: Oral/buccal swab specimens, preferably collected from the parotid duct within 3 days of symptom onset 2
   • Serology: Mumps IgM antibodies and paired acute and convalescent serum samples to demonstrate a 4-fold rise in mumps IgG antibodies 2
   • Viral isolation: From clinical specimens 1

Management

The primary treatment for mumps is supportive care, as there is no specific antiviral therapy available for this self-limiting viral infection. 2

Management includes:

• Supportive care:

  • Analgesics for pain relief
  • Adequate hydration
  • Warm or cold compresses to reduce parotid pain and swelling 2

• Isolation measures:

  • Infected individuals should be isolated to prevent spread 2
  • In school outbreaks, exclusion of susceptible students should be considered 1
  • Students can be readmitted immediately after vaccination 1
  • Those exempt from vaccination should be excluded until at least 26 days after the onset of parotitis in the last person with mumps 1

• Complication management:

  • Specific treatment for complications such as meningitis, orchitis, and pancreatitis 2
  • Closer monitoring for immunocompromised patients 2

Prevention

The most effective proven means of preventing mumps is vaccination with the live attenuated MMR (measles, mumps, rubella) vaccine. 1, 2

• Vaccination schedule: First dose at 12-15 months, second dose at 4-6 years of age 1
• Effectiveness: One dose is approximately 80% effective; two doses provide better protection 2, 3
• Coverage targets: Childhood mumps vaccination should aim at ≥80% coverage rate 4
• Impact: Countries with high vaccination coverage have shown rapid decline in mumps morbidity (≥80% for one-dose schedule, ≥97% for two-dose schedule) 3

Public Health Considerations

• Mumps remains a significant public health concern despite vaccination efforts
• Outbreaks can occur even in vaccinated populations 5
• Immediate reporting of probable or confirmed cases to health departments is essential 1
• Active surveillance should continue until two incubation periods (5-6 weeks) have elapsed since the last case in an outbreak 1

Mumps diagnosis should be confirmed by laboratory testing whenever possible, as parotitis can have other infectious and non-infectious causes, leading to more accurate assessment of true mumps incidence 1.