What are the prevention and treatment options for Epstein-Barr Virus (EBV) and mumps?

Prevention and Treatment Options for Epstein-Barr Virus (EBV) and Mumps

Mumps Prevention

The primary strategy to prevent mumps is to achieve and maintain high immunization levels through routine vaccination of all children with two doses of MMR (measles, mumps, rubella) vaccine. 1

Mumps Vaccination Recommendations:

• MMR vaccine is the cornerstone of mumps prevention, with the first dose administered at age 12-15 months and the second dose at age 4-6 years before school entry 1
• The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps is 72% after one dose and 86% after two doses 2
• Effectiveness in preventing mumps transmission among household contacts is approximately 74% 2
• State vaccination laws requiring immunization before school entry have contributed significantly to reducing mumps incidence 1

During Mumps Outbreaks:

• Widespread vaccination during a mumps outbreak may help terminate the outbreak 1
• Revaccination with MMR is recommended for all attendees and their siblings who have not received two doses of measles-containing vaccine 1
• Persons exempted from vaccination for medical, religious, or other reasons should be excluded from involved institutions until 21 days after the onset of rash in the last case 1

Epstein-Barr Virus (EBV)

Unlike mumps, there is currently no vaccine available for prevention of EBV infection.

EBV Transmission and Infection:

• EBV is transmitted primarily through saliva but can rarely spread through semen or blood (e.g., organ transplantations and blood transfusions) 3
• EBV infects over 90% of the world's population, typically during childhood or adolescence 4
• Infection during adolescence can result in infectious mononucleosis, characterized by sore throat, cervical lymph node enlargement, fatigue, and fever 4

EBV Management:

• No specific antiviral treatment is currently recommended for EBV infections
• Management is primarily supportive care for symptoms
• EBV has been associated with certain autoimmune conditions including systemic lupus erythematosus, Sjögren's syndrome, rheumatoid arthritis, and multiple sclerosis 3

Post-Exposure Prophylaxis

For Mumps:

• Unlike measles, post-exposure vaccination with MMR does not prevent or alter the clinical severity of mumps 1
• However, widespread vaccination during an outbreak may help terminate the outbreak 1

For Measles (as part of MMR):

• If administered within 72 hours of initial measles exposure, MMR vaccine may provide some protection 1
• For susceptible household contacts not vaccinated within 72 hours, immune globulin (IG) is recommended 1
• The recommended dose of IG is 0.25 mL/kg of body weight (maximum dose = 15 mL) for immunocompetent persons 1
• For immunocompromised persons, the recommended dose is 0.5 mL/kg of body weight (maximum dose = 15 mL) 1

Special Populations

Immunocompromised Individuals:

• MMR vaccine is not recommended for severely immunocompromised persons with HIV 1
• Severely immunocompromised patients exposed to measles should receive immune globulin prophylaxis regardless of vaccination status 1
• For patients receiving intravenous immune globulin (IGIV) therapy, a standard dose of 100-400 mg/kg within 3 weeks before measles exposure should be sufficient to prevent infection 1

Pregnant Women:

• Mumps infection during the first trimester of pregnancy has been associated with increased risk for fetal death 1
• However, mumps infection during pregnancy is not associated with congenital malformations 1

Common Pitfalls and Caveats

• Failing to provide MMR vaccine 5-6 months after IG administration leaves patients vulnerable to future exposures 5
• Using inappropriate IG dosing for immunocompromised patients (0.5 mL/kg) versus immunocompetent patients (0.25 mL/kg) can result in ineffective prophylaxis 5
• Mistaking rubella for measles can lead to inappropriate management 5
• IG is not recommended for preventing rubella or mumps infection after exposure 5
• The MMR vaccine can cause mild adverse effects including fever and rash, but serious complications are rare 2
• There is evidence supporting an association between MMR vaccination and febrile seizures and idiopathic thrombocytopenic purpura, but the risk is smaller than after natural infection 2