Treatment of Mumps
Mumps treatment is entirely supportive and symptomatic, as there is no specific antiviral therapy available for this self-limiting viral illness. 1, 2
Immediate Symptomatic Management
Provide pain and fever control with acetaminophen or NSAIDs to manage fever, headache, and parotid gland pain. 1 These medications address the primary discomfort patients experience during acute infection.
Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful. 1 Patients often reduce oral intake due to pain, increasing dehydration risk.
Recommend soft foods and strict avoidance of acidic foods that stimulate salivary flow and worsen parotid pain. 1 Acidic substances like citrus or vinegar-based foods can significantly exacerbate discomfort.
Critical Isolation and Infection Control
Implement droplet precautions immediately and isolate patients for 5 days after onset of parotitis. 3, 1, 4 This is non-negotiable for preventing nosocomial and community transmission.
Use standard precautions plus gown and gloves for all patient contact. 3 Negative pressure rooms are not required. 3
Patients are contagious from 7 days before through 8 days after parotitis onset, making early isolation critical even before diagnosis confirmation. 1
Report all probable or confirmed cases immediately to state and local health departments, as mumps is a reportable disease in most jurisdictions. 1, 5
Diagnostic Confirmation During Treatment
Obtain laboratory confirmation rather than relying on clinical diagnosis alone, as parotitis has multiple infectious and noninfectious causes and misdiagnosis occurs in approximately one-third of cases. 1, 4, 6
Laboratory options include:
- Mumps IgM antibody testing (primary confirmatory test) 1, 6
- Viral PCR from parotid duct swabs obtained after massaging the parotid gland for 30 seconds, collected within 9 days of symptom onset 3, 1, 6
- Buccal (saliva) swabs for viral culture or PCR within 9 days of symptoms 3, 6
- Urine PCR, which remains positive for at least 5 days after oral detection (though less sensitive) 3, 4, 6
Vigilant Monitoring for Complications
Complications are significantly more common and severe in adults than children, requiring heightened surveillance throughout the illness. 1
Monitor for aseptic meningitis (occurs in 4-6% of cases), characterized by severe headache, neck stiffness, photophobia, or altered mental status. 1 This is the most common serious complication.
Watch for encephalitis signs including seizures, paralysis, or cranial nerve palsies, which can cause permanent neurological sequelae. 1
Assess for sudden sensorineural hearing loss, as this can be bilateral and permanent. 1 This complication requires immediate audiological evaluation.
In postpubertal males, monitor for orchitis (occurs in up to 38% of cases), typically developing 4-8 days after parotitis onset. 4 Despite common concern, sterility is actually a rare sequela. 3
Watch for pancreatitis signs at days 3-5 of illness, including severe abdominal pain, nausea, and vomiting. 4
Special Management Considerations
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. 1
Provide eye protection to prevent corneal damage if facial weakness prevents complete eye closure. 1
Pregnancy
Treatment in pregnant women follows the same supportive care principles with acetaminophen or NSAIDs for pain control, hydration, and soft foods. 1
Mumps infection during first trimester increases risk for fetal death but is NOT associated with congenital malformations. 1 This distinguishes mumps from rubella, which causes severe teratogenic effects.
MMR vaccine is contraindicated during pregnancy due to theoretical risk from live-virus vaccine. 1
HIV Testing
Test for HIV in all patients with parotitis, regardless of apparent risk factors, as HIV can present with parotid swelling. 4, 6 This is a critical diagnostic consideration that should never be omitted.
What NOT to Do
Do not prescribe antibiotics for confirmed viral parotitis, as this contributes to antimicrobial resistance without clinical benefit. 4 Antibiotics are only indicated if bacterial superinfection is documented.
Do not administer MMR vaccine for post-exposure prophylaxis expecting immediate protection. 3, 4 The antibody response does not develop soon enough to provide effective prophylaxis after exposure, though vaccination should still be offered to non-immune contacts for future protection. 3
Do not use immune globulin for postexposure protection, as no evidence exists that it is effective for mumps. 3
Outbreak Control Measures
Identify and vaccinate susceptible contacts immediately in outbreak settings. 1
Exclude susceptible students from affected schools until they are vaccinated or until 26 days after onset of parotitis in the last case. 1
Maintain active surveillance for two incubation periods (5-6 weeks) after the last case. 1