What is the management approach for mumps?

Management of Mumps

Mumps management is primarily supportive care focused on symptom relief, strict isolation precautions, and vigilant monitoring for potentially serious complications, as there is no specific antiviral treatment for this self-limiting viral illness. 1

Immediate Symptomatic Management

• Provide pain and fever control with acetaminophen or NSAIDs to manage fever, headache, and parotid gland pain 1, 2
• Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful 1, 2
• Recommend soft foods and avoidance of acidic foods that stimulate salivary flow and worsen parotid pain 1

Critical Isolation Measures

• Implement droplet precautions immediately upon diagnosis, as patients are contagious from 7 days before through 8 days after parotitis onset 1, 2
• Isolate patients for 5 days after onset of parotitis to limit spread to susceptible contacts 1
• Educate patients and family members about transmission through respiratory droplets and direct contact with saliva 1, 2
• In healthcare settings, maintain respiratory isolation for 9 days after symptom onset 3

Systematic Monitoring for Complications

Neurological Complications (High Priority)

• Monitor for aseptic meningitis (occurs in 4-6% of cases): severe headache, neck stiffness, photophobia, or altered mental status 1, 2
• Watch for encephalitis signs: seizures, paralysis, or cranial nerve palsies, which can cause permanent sequelae including aqueductal stenosis and hydrocephalus 1, 2
• Assess for hearing loss, including sudden sensorineural deafness, which was a major cause of childhood deafness in the pre-vaccine era 1, 2

Reproductive System Complications

• In postpubertal males, assess for orchitis (occurs in up to 38% of cases): testicular pain and swelling, though sterility is rare 1, 2, 4
• Orchitis typically develops approximately 10 days after parotitis onset 4
• In postpubertal females, monitor for oophoritis (ovarian inflammation) 1

Other Systemic Complications

• Watch for pancreatitis: severe abdominal pain, nausea, and vomiting 1, 2

Special Management: Facial Nerve Involvement

If facial nerve inflammation with weakness 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 1
• Provide eye protection to prevent corneal damage in patients with facial weakness 1
• Reassure patients that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1

Important Clinical Caveats

• Parotitis is not present in all cases—only 30-40% of mumps infections produce typical acute parotitis, while 15-20% are asymptomatic and up to 50% present with nonspecific or respiratory symptoms 1, 5, 6
• Complications are more common and severe in adults than children, making age an important consideration in monitoring intensity 1
• Mumps disease is generally self-limiting, with most patients recovering without intervention beyond supportive care 1
• Serious complications can occur even without evidence of parotitis 4

Outbreak Control Considerations

• Exclude susceptible persons from affected institutions until 26 days after onset of parotitis in the last case 3
• In healthcare settings, exclude workers lacking immunity from the 12th day after first exposure through the 26th day after last exposure 3
• Conduct active surveillance until two incubation periods (5-6 weeks) have elapsed since onset of the last case 3