Management of Mumps
Primary Treatment Approach
Mumps management is entirely supportive and symptomatic, as there is no specific antiviral therapy available for this self-limiting viral illness. 1, 2, 3
Symptomatic Relief
- Provide acetaminophen or NSAIDs for pain and fever control 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 may stimulate salivary flow and worsen parotid pain 1, 2
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, 2
- Educate patients and family members about transmission through respiratory droplets and direct contact with saliva 1, 2
- Report probable or confirmed cases immediately to state and local health departments 2
Critical Diagnostic Caveat
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, 2, 4. Laboratory confirmation with mumps IgM antibody, significant rise in IgG, or viral isolation is recommended over clinical diagnosis alone 2, 5.
Monitoring for Complications
Complications are significantly more common and severe in adults than children, requiring heightened surveillance. 1, 2
Neurological Complications
- Monitor for aseptic meningitis (occurs in 4-6% of cases): severe headache, neck stiffness, photophobia, or altered mental status 6, 1, 2
- Watch for encephalitis signs: seizures, paralysis, or cranial nerve palsies, which can cause permanent sequelae including hydrocephalus and aqueductal stenosis 6, 1, 2
- Assess for hearing loss: sudden sensorineural deafness can be bilateral and permanent, as mumps was a major cause of childhood deafness in the pre-vaccine era 6, 1, 2
Reproductive System Complications
- Assess for orchitis in postpubertal males (occurs in up to 38% of cases): testicular pain and swelling, though sterility is rare 6, 1, 7
- Monitor for oophoritis in postpubertal females: ovarian inflammation presenting with pelvic pain 1, 2
Other Systemic Complications
Special Management: Facial Nerve Involvement
If facial droop or 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, 2
- Provide eye protection to prevent corneal damage if facial weakness prevents complete eye closure 1, 2
- Reassure patients that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1
Management in Pregnancy
Treatment in pregnant women follows the same supportive care principles with acetaminophen or NSAIDs for pain control, hydration, and soft foods 2, 8
- Mumps infection during first trimester increases risk for fetal death, but is NOT associated with congenital malformations 6, 2, 8
- Mumps vaccine is contraindicated during pregnancy due to theoretical risk from live-virus vaccine, though accidental vaccination has not been shown to cause maternal/fetal complications 6, 2, 8
Outbreak Control Measures
- Identify and vaccinate susceptible contacts immediately in outbreak settings 2
- Exclude susceptible students from affected schools until they are vaccinated or until 26 days after onset of parotitis in the last case 2
- Maintain active surveillance for two incubation periods (5-6 weeks) after the last case 2
Vaccination Considerations
Most adults born before 1957 are likely to have been infected naturally and can be considered immune, even without clinically recognizable mumps disease 6. Persons unsure of their mumps disease/vaccination history should be vaccinated 6. The two-dose MMR vaccination schedule has substantially reduced mumps incidence by immunizing children among whom the first dose did not elicit an immune response 6.