What is the recommended management for a patient with mumps, considering their vaccination status and medical history?

Management of Mumps

Mumps management is primarily supportive care focused on symptom relief, strict isolation precautions, and vigilant monitoring for complications, as there is no specific antiviral therapy available. 1

Immediate Isolation and Infection Control

Implement droplet precautions immediately upon diagnosis, as patients are contagious from 7 days before through 8 days after parotitis onset. 1

• Isolate patients for 5 days after onset of parotitis to prevent transmission to susceptible contacts 1
• Educate patients and family members that transmission occurs through respiratory droplets and direct contact with saliva 1
• Report the case to local health authorities, as mumps is reportable in most states 2

Symptomatic Management

Provide pain and fever control with acetaminophen or NSAIDs to manage fever, headache, and parotid gland pain. 1

• Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful 1
• Recommend soft foods and avoidance of acidic foods that may stimulate salivary flow and worsen parotid pain 1
• Treatment is generally supportive with bed rest, scrotal support if orchitis develops, and local cooling measures 3

Monitoring for Complications

Neurological Complications (Monitor Closely)

Watch for aseptic meningitis, which occurs in 4-6% of cases, characterized by severe headache, neck stiffness, photophobia, or altered mental status. 1

• Monitor for signs of encephalitis including seizures, paralysis, or cranial nerve palsies, which can cause permanent sequelae 1
• Assess for hearing loss, including sudden sensorineural deafness, which was a major cause of childhood deafness in the pre-vaccine era 1

Reproductive System Complications (Age-Dependent Risk)

In postpubertal males, assess for orchitis (occurs in up to 38% of cases), characterized by testicular pain and swelling. 1, 3

• Reassure patients that sterility is rare despite the high incidence of orchitis 1
• Consider scrotal exploration only if bacterial orchitis cannot be excluded or if there is diagnostic uncertainty 3
• Monitor postpubertal females for oophoritis (ovarian inflammation) 1

Other Systemic Complications

Watch for pancreatitis, characterized by severe abdominal pain, nausea, and vomiting. 1

Special Consideration: 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. 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

Vaccination Status Considerations

For Unvaccinated or Incompletely Vaccinated Patients

Adults born during or after 1957 without documentation of vaccination, laboratory evidence of immunity, or physician-diagnosed mumps should receive MMR vaccine after recovery. 4

• A second dose of MMR is recommended for adults who live in a community experiencing a mumps outbreak, are students in postsecondary institutions, work in healthcare facilities, or plan to travel internationally 4
• Do not administer MMR vaccine during acute illness; wait until recovery is complete 4

For Previously Vaccinated Patients

Recognize that mumps can occur in highly vaccinated populations due to waning immunity, particularly in crowded environments like college dormitories. 4

• The 2006 U.S. outbreak demonstrated that 44% of cases occurred in persons who had received at least 2 doses of vaccine 4
• Consider a third dose during outbreak settings for high-risk populations, though this is not routinely recommended 4

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. 1, 5

• Complications are more common and severe in adults than children, making age an important consideration in monitoring intensity 1
• The disease is generally self-limiting, with most patients recovering without intervention beyond supportive care 1
• Unilateral presentation can occur and may involve synchronous swelling of both parotid and submandibular glands 6
• Consider bacterial superinfection if fever persists beyond 3-5 days or if clinical deterioration occurs; antibiotics may be warranted if bacterial orchitis or parotitis cannot be excluded 3