What is the treatment and prevention for mumps?

Treatment and Prevention of Mumps

Mumps treatment is entirely supportive with acetaminophen or NSAIDs for symptom control, while prevention relies on two doses of MMR vaccine administered at least 28 days apart, which provides approximately 88% protection against disease. 1, 2

Treatment Approach

Symptomatic Management

• Provide pain and fever control using acetaminophen or NSAIDs to manage fever, headache, and parotid gland pain 2, 3
• Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful 2, 3
• Recommend soft foods and avoidance of acidic foods that stimulate salivary flow and worsen parotid pain 3
• Treatment is generally supportive, as mumps disease is self-limiting with most patients recovering without intervention beyond supportive care 3, 4

Isolation and Infection Control

• Implement droplet precautions immediately and isolate patients for 5 days after onset of parotitis, as patients are contagious from 7 days before through 8 days after parotitis onset 1, 3
• Use respiratory precautions (gown and gloves) for patient contact; negative pressure rooms are not required 1
• Educate family members about transmission through respiratory droplets and direct contact with saliva 2, 3

Monitoring for Complications

Neurological complications:

• Monitor for aseptic meningitis (occurs in 4-6% of cases), characterized by severe headache, neck stiffness, photophobia, or altered mental status 2, 3
• Watch for signs of encephalitis including seizures, paralysis, or cranial nerve palsies 2, 3
• Assess for hearing loss, including sudden sensorineural deafness, though rare 2, 3

Reproductive complications:

• Assess for orchitis in postpubertal males (occurs in up to 38% of cases), characterized by testicular pain and swelling, though sterility is rare 2, 3
• Monitor for oophoritis (ovarian inflammation) in postpubertal females 3

Other complications:

• Watch for pancreatitis, characterized by severe abdominal pain, nausea, and vomiting 2, 3

Special Consideration: Facial Nerve Involvement

• 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 if facial droop develops 5, 3
• Provide eye protection if facial weakness prevents complete eye closure 5
• Complete recovery occurs in approximately 70-80% of cases within 3-6 months 5, 3

Prevention Strategies

Vaccination

• All persons should receive two doses of MMR vaccine administered at least 28 days apart for presumptive evidence of immunity 1
• Two doses of MMR vaccine provide approximately 88% protection against mumps 2, 5
• Birth before 1957 is considered presumptive evidence of immunity 1
• Laboratory evidence of immunity or laboratory confirmation of disease also constitute presumptive evidence 1

Healthcare Personnel Vaccination Requirements

• All healthcare personnel should have documented presumptive evidence of immunity to mumps 1
• Prevaccination antibody screening before MMR vaccination is not necessary for healthcare personnel without adequate evidence of immunity 1
• During outbreaks, serologic screening before vaccination is not recommended because rapid vaccination is necessary to halt disease transmission 1

Post-Exposure Management

• MMR vaccine is not recommended for prophylactic purposes after exposure, as antibody response does not develop soon enough to provide effective prophylaxis 1
• However, exposed persons lacking presumptive evidence of immunity should be offered MMR vaccine to protect against future exposures 1
• Immune globulin is not routinely used for postexposure protection from mumps because no evidence exists that it is effective 1

Outbreak Control in Healthcare Settings

• Healthcare personnel with no evidence of mumps immunity who are exposed should be offered the first dose of MMR vaccine as soon as possible and excluded from duty from day 12 after first exposure through day 25 after most recent exposure 1
• Healthcare personnel with documentation of 1 vaccine dose may remain at work and should receive the second dose 1
• Healthcare personnel with mumps should be excluded from work for 5 days from onset of parotitis 1

Outbreak Control in Schools

• Exclude susceptible students from affected schools until they are vaccinated or until at least 26 days after onset of parotitis in the last person with mumps 1
• Excluded students can be readmitted immediately after vaccination 1
• Active surveillance should continue until two incubation periods (5-6 weeks) have elapsed since onset of the last case 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 3
• Complications are more common and severe in adults than children 3
• Clinical diagnosis of mumps based solely on parotid swelling is unreliable, as one-third of clinically diagnosed cases may have no serologic evidence of recent mumps infection 1