What is the treatment and management for someone suspected of having mumps?

Management of Suspected Mumps

The management of suspected mumps is primarily supportive care with isolation measures for 5 days after the onset of parotitis to prevent transmission, as there is no specific antiviral treatment for mumps. 1

Diagnosis

Clinical Evaluation

• Mumps should be suspected in patients presenting with 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
• Common symptoms include upper respiratory symptoms, fever, headache, and parotitis (which may be unilateral or bilateral) 2
• Clinical diagnosis alone is unreliable as parotitis may have other infectious and noninfectious causes 1

Laboratory Confirmation

• Laboratory confirmation is preferred for accurate diagnosis and should include: 1

  • PCR testing of CSF (most accurate for mumps encephalitis)
  • Viral culture or PCR from parotid gland duct swabs (taken after massaging the parotid gland for 30 seconds)
  • Buccal (saliva) swabs for viral culture or PCR (useful within 9 days of symptom onset)
  • Urine samples (less sensitive but may be positive for at least 5 days after detection in the mouth)
  • Serologic testing for mumps IgM antibodies

• The laboratory criteria for diagnosis of mumps include: 1

  • Isolation of mumps virus from a clinical specimen
  • Significant rise between acute and convalescent-phase titers in serum mumps IgG antibody
  • Positive serologic test for mumps IgM antibody

Treatment

• Treatment for mumps is primarily supportive care as there is no specific antiviral therapy available 3, 2
• Supportive measures include: 2, 4
  • Analgesics for pain relief
  • Adequate hydration
  • Rest
  • Application of warm or cold compresses to swollen glands for comfort

Infection Control Measures

Isolation Precautions

• Patients with suspected mumps should be isolated for 5 days after the onset of parotitis 1
• In healthcare settings: 1
  • Implement droplet precautions
  • Only healthcare personnel with adequate evidence of immunity should be exposed to the patient
  • Use standard precautions plus respiratory precautions (gown and gloves) for patient contact
  • Negative pressure rooms are not required

Management of Contacts

• All contacts should be evaluated for evidence of mumps immunity 1
• Healthcare personnel with no evidence of mumps immunity who are exposed should: 1
  • Be offered the first dose of MMR vaccine as soon as possible
  • Be excluded from duty from day 12 after first unprotected exposure through day 25 after most recent exposure
• Healthcare personnel with documentation of one vaccine dose may remain at work but should receive the second dose 1
• Immune globulin is not routinely used for postexposure protection as there is no evidence of effectiveness 1

Special Considerations

Complications to Monitor

• Aseptic meningitis and encephalitis (common complications) 3, 5
• Orchitis in adult males and oophoritis in adult females 3, 4
• Permanent deafness 3, 5
• Pancreatitis 3, 4

HIV Testing

• HIV testing should be performed on all patients with encephalitis or suspected encephalitis regardless of risk factors, as HIV can predispose to CNS infections 1

Prevention

• MMR vaccination is approximately 80% effective against mumps after one dose 3
• Two doses of MMR vaccine are recommended for adequate protection 1
• During outbreaks, consider MMR vaccination for persons born before 1957 who may be exposed and susceptible 1
• Serologic screening before vaccination during outbreaks is not recommended as rapid vaccination is necessary to halt transmission 1

Reporting Requirements

• Probable or confirmed cases of mumps should be reported immediately to state and local health departments 1, 2
• Active surveillance for mumps should be conducted until two incubation periods (5-6 weeks) have elapsed since onset of the last case during outbreaks 1