What is the management approach for mumps?

Management of Mumps

Mumps management is primarily supportive care with isolation, as there is no specific antiviral therapy available; treatment focuses on symptom relief, monitoring for complications, and preventing transmission through droplet precautions. 1, 2, 3

Acute Management of Active Infection

Supportive Care Measures

• Provide adequate hydration and pain control with acetaminophen or NSAIDs for fever and parotid pain 4, 2
• Encourage oral fluid intake to maintain hydration, particularly important given painful swallowing 2
• Apply warm or cold compresses to swollen parotid glands for symptomatic relief 3
• Recommend soft foods and avoidance of acidic foods/beverages that stimulate salivary flow and increase pain 3

Isolation and Infection Control

• Implement droplet precautions and isolate patients for 5 days after onset of parotitis to prevent transmission 4, 3
• Patients are contagious from approximately 7 days before through 8 days after parotid gland swelling onset 1
• Healthcare personnel should use appropriate personal protective equipment when caring for suspected or confirmed cases 3

Monitoring for Complications

Neurological Complications

• Monitor for signs of aseptic meningitis (occurs in 4-6% of clinical cases): severe headache, neck stiffness, photophobia, altered mental status 1, 2
• Watch for meningoencephalitis symptoms, which can cause permanent sequelae including paralysis, seizures, cranial nerve palsies, aqueductal stenosis, and hydrocephalus 1
• If facial droop develops, initiate corticosteroid therapy promptly with prednisone 1-2 mg/kg/day for 5-7 days followed by a taper over 5-7 days to reduce inflammation and improve nerve function 4
• Provide eye protection if facial weakness prevents complete eye closure 4

Gonadal Complications

• In postpubertal males, monitor for orchitis (occurs in up to 38% of cases): testicular pain, swelling, fever 1, 2
• In postpubertal females, assess for oophoritis: lower abdominal pain 1
• Reassure patients that sterility from orchitis occurs only rarely despite the high incidence 5

Other Complications

• Monitor for pancreatitis: severe abdominal pain, nausea, vomiting 1
• Assess for hearing changes, as sensorineural deafness can be sudden in onset, bilateral, and permanent 1, 2
• In pregnant women with first-trimester mumps, counsel about increased risk for fetal death, though mumps is not associated with congenital malformations 5, 1

Diagnostic Confirmation

Laboratory Testing

• Obtain buccal swab around affected parotid gland and Stensen's duct for viral culture or nucleic acid amplification testing (NAAT) 2
• Test for serum mumps IgM antibodies (positive in acute infection) 2
• Consider paired acute and convalescent serum for mumps IgG (4-fold rise indicates recent infection) 2
• The CDC recommends confirming diagnosis through clinical presentation plus laboratory confirmation via virus isolation, significant rise in serum mumps IgG antibody, or positive serologic test for mumps IgM antibody 4

Post-Exposure Management and Prevention

Contact Management

• Identify and vaccinate susceptible contacts to limit spread during outbreaks 4
• Vaccination remains the most effective prevention strategy, with two doses of MMR vaccine providing approximately 88% protection 1, 4
• Routine vaccination has reduced mumps incidence by 99% in the United States since its introduction 1

Reporting Requirements

• Mumps is reportable in most states; follow local public health reporting regulations and procedures 3
• Notify public health authorities promptly to facilitate outbreak investigation and control measures 3

Important Clinical Caveats

• Only 30-40% of mumps infections produce typical acute parotitis; 15-20% are asymptomatic and up to 50% present with nonspecific or respiratory symptoms 5, 1, 2
• Serious complications can occur without evidence of parotitis 5
• Inapparent infection is more common among adults than children, while parotitis occurs more commonly among children aged 2-9 years 5, 1
• Severity of disease generally increases with age, making adult cases particularly important to monitor closely 1
• Complete recovery from facial droop associated with mumps occurs in approximately 70-80% of cases within 3-6 months 4