What is the management of mumps in patients, including treatment and prevention strategies?

Management of Mumps

Primary Treatment Approach

Mumps management is entirely supportive—there is no specific antiviral therapy, and treatment focuses on symptom control, strict isolation, and vigilant monitoring for complications that are significantly more severe in adults. 1, 2, 3

Symptomatic Management

• Administer acetaminophen or NSAIDs for pain and fever control to manage fever, headache, and parotid gland pain 1, 2, 3
• Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful 1, 2, 3
• Recommend soft foods and avoid acidic foods that stimulate salivary flow and worsen parotid pain 1, 2, 3

Critical Isolation Requirements

Implement droplet precautions immediately and isolate the patient for 5 days after onset of parotitis, as patients are contagious from 7 days before through 8 days after parotitis onset 1, 2, 3

• Educate patients and family members about transmission through respiratory droplets and direct contact with saliva 1, 2, 3
• Report probable or confirmed cases immediately to state and local health departments 1, 3

Monitoring for Complications

Neurological Complications (More Common and Severe in Adults)

• Watch for aseptic meningitis (occurs in 4-6% of cases): severe headache, neck stiffness, photophobia, or altered mental status 4, 1, 2, 3
• Assess for encephalitis signs: seizures, paralysis, or cranial nerve palsies—these can cause permanent sequelae including aqueductal stenosis and hydrocephalus 4, 1, 2, 3
• Monitor for hearing loss: sudden sensorineural deafness can be bilateral and permanent—mumps was a major cause of childhood deafness in the pre-vaccine era 4, 1, 2, 3

Reproductive System Complications

• In postpubertal males, assess for orchitis (occurs in up to 38% of cases): testicular pain and swelling, though sterility is rare 4, 1, 2, 5
• In postpubertal females, monitor for oophoritis (ovarian inflammation) 1, 2

Other Systemic Complications

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

Special Management for 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, 3

• Provide eye protection to prevent corneal damage if facial weakness prevents complete eye closure 1, 2, 3
• Reassure patients that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1, 2

Management in Pregnancy

• Treatment follows the same supportive care principles with acetaminophen or NSAIDs for pain control, hydration, and soft foods 3
• Mumps infection during first trimester increases risk for fetal death, but is NOT associated with congenital malformations 4, 3
• Do not administer mumps vaccine during pregnancy due to theoretical risk from live-virus vaccine 1, 3

Prevention Strategies

Vaccination

• The principal strategy to prevent mumps is achieving and maintaining high immunization levels with two doses of MMR vaccine 4
• One dose of mumps vaccine is approximately 80% effective against disease 6
• The two-dose MMR vaccination schedule (at ages 1 and 4 years) decreases mumps incidence by immunizing children who did not respond to the first dose 4, 7
• Enactment and enforcement of state vaccination laws requiring students be vaccinated before school entry has contributed more to reducing mumps incidence than any other measure 4

Outbreak Control Measures

• Identify and vaccinate susceptible contacts immediately in outbreak settings 3
• Exclude susceptible students from affected schools until they are vaccinated or until 26 days after onset of parotitis in the last case 3
• Maintain active surveillance for two incubation periods (5-6 weeks) after the last case 3

Critical 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, 2

• Laboratory confirmation is preferred over clinical diagnosis alone, as parotitis has multiple infectious and noninfectious causes 1, 3
• Laboratory criteria include isolation of mumps virus from clinical specimens, significant rise in serum mumps IgG antibody, or positive serologic test for mumps IgM antibody 1, 3
• Suitable specimens for testing are serum, saliva, urine, and cerebrospinal fluid 7

Common Pitfalls to Avoid

• Do not assume immunity based on vaccination alone—recent outbreaks have occurred in highly vaccinated populations, particularly among young adults in college settings 1, 6, 8
• Do not overlook complications in patients without parotitis—serious complications can occur without evidence of parotid swelling 1
• Do not forget that complications are significantly more common and severe in adults than children, requiring heightened surveillance in young adults 1, 2, 3
• Consider bacterial orchitis in the differential and administer antibiotics if bacterial infection cannot be excluded at initial presentation 5