What is the management approach for mumps?

Management Approach for Mumps

The management of mumps is primarily supportive, focusing on symptom relief while the infection runs its self-limited course, with isolation of infected individuals for 9 days after symptom onset to prevent transmission. 1, 2

Clinical Presentation and Diagnosis

• Mumps presents with unilateral or bilateral parotid gland swelling in 30-40% of infections, typically occurring 16-18 days after exposure 1, 3
• Prodromal symptoms often include fever, headache, malaise, myalgia, and anorexia 1, 2
• 15-20% of infections are asymptomatic, while up to 50% present with nonspecific or primarily respiratory symptoms 1, 3
• Laboratory confirmation is recommended through one of the following methods:
  • 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 1, 2

Supportive Treatment

• Provide adequate hydration to prevent dehydration 4, 2
• Administer analgesics such as acetaminophen or NSAIDs for pain relief and fever reduction 4, 5
• Recommend soft, bland foods that don't require significant chewing to minimize parotid gland pain 2
• Apply warm or cold compresses to swollen parotid glands for comfort 5

Management of Complications

• For orchitis (affecting up to 38% of postpubertal males):

  • Provide analgesics and scrotal support
  • Apply cold compresses to reduce inflammation 1, 5

• For aseptic meningitis (affecting 4-6% of clinical cases):

  • Monitor neurological status
  • Provide pain management and hydration 1, 6

• For facial nerve palsy:

  • Consider corticosteroid therapy (prednisone 1-2 mg/kg/day for 5-7 days followed by a taper)
  • Implement eye protection if facial weakness prevents complete eye closure 4

Infection Control Measures

• Implement respiratory isolation precautions for 9 days after onset of symptoms 1

• In school settings during outbreaks:

  • Exclude susceptible students from affected schools
  • Allow readmission immediately after vaccination
  • Unvaccinated students with exemptions should be excluded until at least 26 days after the onset of parotitis in the last person with mumps 1

• In healthcare settings:

  • Healthcare workers without immunity should be excluded from the facility from the 12th day after first exposure through the 26th day after last exposure 1
  • Implement droplet precautions for hospitalized patients 4

Prevention Strategies

• The principal strategy to prevent mumps is achieving and maintaining high immunization levels through routine vaccination of all children with two doses of MMR vaccine 1, 3
• During outbreaks, identify and vaccinate susceptible contacts to limit spread 4, 7
• Vaccine effectiveness is approximately 88% after two doses 3, 8

Surveillance and Reporting

• Report probable or confirmed cases of mumps immediately to state and local health departments 1
• Conduct active surveillance during outbreaks until two incubation periods (5-6 weeks) have elapsed since the onset of the last case 1
• Follow up with susceptible contacts to monitor for symptom development 1

Special Considerations

• Mumps during pregnancy: While associated with increased risk of fetal death in the first trimester, it is not associated with congenital malformations 1
• Complications are generally more common and severe in adults than in children 1, 6
• Permanent sequelae from mumps meningoencephalitis can include paralysis, seizures, cranial nerve palsies, and hydrocephalus 1, 7