Mumps
Encyclopedia
Mumps is a viral disease of the human
species, caused by the mumps virus
. Before the development of vaccination
and the introduction of a vaccine
, it was a common childhood disease worldwide. It is still a significant threat to health in the third world
, and outbreaks still occur sporadically in developed countries.
Painful swelling of the salivary gland
s (classically the parotid gland
) is the most typical presentation. Painful testicular swelling (orchitis
) and rash
may also occur. The symptoms are generally not severe in children. In teenage males and men, complications such as infertility
or subfertility are more common, although still rare in absolute terms. The disease is generally self-limiting
, running its course before receding, with no specific treatment apart from controlling the symptoms with pain medication
.
Other symptoms of mumps can include dry mouth, sore face and/or ears and occasionally in more serious cases, loss of voice. In addition, up to 20% of persons infected with the mumps virus do not show symptoms, so it is possible to be infected and spread the virus without knowing it.
Fever and headache are prodromal symptoms of mumps, together with malaise
and anorexia
.
A person infected with mumps is contagious from approximately 6 days before the onset of symptoms until about 9 days after symptoms start. The incubation period
(time until symptoms begin) can be from 14–25 days but is more typically 16–18 days.
may be carried out; a newer diagnostic confirmation, using real-time nested polymerase chain reaction
(PCR) technology, has also been developed. An estimated 20%-30% of cases are asymptomatic. As with any inflammation of the salivary glands, serum amylase is often elevated.
, invented by Maurice Hilleman
at Merck
. The vaccine may be given separately or as part of the MMR immunization
vaccine which also protects against measles
and rubella
. In the US, MMR is now being supplanted by MMRV, which adds protection against chickenpox
. The WHO
(World Health Organization) recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 15 months. The American Academy of Pediatrics
recommends the routine administration of MMR vaccine at ages 12–15 months and at 4–6 years. In some locations, the vaccine is given again between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. The efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%. The Jeryl Lynn strain is most commonly used in developed countries but has been shown to have reduced efficacy in epidemic situations. The Leningrad-Zagreb strain commonly used in developing countries appears to have superior efficacy in epidemic situations.
Because of the outbreaks within college and university settings, many governments have established vaccination programs to prevent large-scale outbreaks. In Canada, provincial governments and the Public Health Agency of Canada have all participated in awareness campaigns to encourage students ranging from grade 1 to college and university to get vaccinated.
Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. There is no evidence whatsoever to support the claim that the wild disease is beneficial, or that the MMR
vaccine is harmful. Claims have been made that the MMR vaccine is linked to autism and inflammatory bowel disease
, including one study by Andrew Wakefield
(the paper was discredited and retracted in 2010 and Wakefield was later stripped of his license after his work was found to be an "elaborate fraud" ) that indicated a link between gastrointestinal disease, autism, and the MMR vaccine. However, all further studies since that time have indicated no link between vaccination with the MMR and autism. Since the dangers of the disease are well known, while the dangers of the vaccine are quite minimal, most doctors recommend vaccination.
The WHO
, the American Academy of Pediatrics
, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
, the American Academy of Family Physicians
, the British Medical Association
and the Royal Pharmaceutical Society of Great Britain
currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.
Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000). In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%). The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968. Since 2001, the case average was only 265 per year, excluding an outbreak of >6000 cases in 2006 attributed largely to university contagion in young adults.
. Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms.
According to the Department of Health of Minnesota there is no effective post-exposure recommendation to prevent secondary transmission, as well as the post-exposure use of vaccine or immunoglobulin is not effective.
Patients are advised to avoid acidic foods and beverages, since these stimulate the salivary glands, which can be painful.
Known complications of mumps include:
After the illness, life-long immunity
to mumps generally occurs; reinfection is possible but tends to be mild and atypical.
Human
Humans are the only living species in the Homo genus...
species, caused by the mumps virus
Mumps virus
Mumps virus is the causative agent of mumps, a well-known common childhood disease characterised by swelling of the parotid glands and other epithelial tissues, causing high morbidity and in some cases more serious complications such as deafness...
. Before the development of vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
and the introduction of a vaccine
Mumps vaccine
Several varieties of mumps vaccine have been used since 1949, and at least 10 strains were in use in 2006:The first vaccine was a killed mumps virus vaccine developed in 1948 and used in the United States from 1950-1978. This vaccine produced little immune memory, thus had a short duration of...
, it was a common childhood disease worldwide. It is still a significant threat to health in the third world
Third World
The term Third World arose during the Cold War to define countries that remained non-aligned with either capitalism and NATO , or communism and the Soviet Union...
, and outbreaks still occur sporadically in developed countries.
Painful swelling of the salivary gland
Salivary gland
The salivary glands in mammals are exocrine glands, glands with ducts, that produce saliva. They also secrete amylase, an enzyme that breaks down starch into maltose...
s (classically the parotid gland
Parotid gland
The paired parotid glands are the largest of the salivary glands. They are each found wrapped around the mandibular ramus, and secrete saliva through Stensen's ducts into the oral cavity, to facilitate mastication and swallowing and to begin the digestion of starches.-Location:The parotid glands...
) is the most typical presentation. Painful testicular swelling (orchitis
Orchitis
Orchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection.-Symptoms:Symptoms of orchitis are similar to those of testicular torsion...
) and rash
Rash
A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...
may also occur. The symptoms are generally not severe in children. In teenage males and men, complications such as infertility
Infertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
or subfertility are more common, although still rare in absolute terms. The disease is generally self-limiting
Self-limiting (biology)
In biology, a self-limiting organism or colony of organisms limits its own growth by its actions. For example, a single organism may have a maximum size determined by genetics, or a colony of organisms may release waste which is ultimately toxic to the colony once it exceeds a certain population...
, running its course before receding, with no specific treatment apart from controlling the symptoms with pain medication
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
.
Signs and symptoms
The more common symptoms of mumps are:- ParotidParotid glandThe paired parotid glands are the largest of the salivary glands. They are each found wrapped around the mandibular ramus, and secrete saliva through Stensen's ducts into the oral cavity, to facilitate mastication and swallowing and to begin the digestion of starches.-Location:The parotid glands...
inflammationInflammationInflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
(or parotitisParotitisParotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation.-Infectious parotitis:...
) in 60–70% of infections and 95% of patients with symptoms. ParotitisParotitisParotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation.-Infectious parotitis:...
causes swelling and local pain, particularly when chewing. It can occur on one side (unilateral) but is more common on both sides (bilateral) in about 90% of cases. - FeverFeverFever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
- HeadacheHeadacheA headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
- OrchitisOrchitisOrchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection.-Symptoms:Symptoms of orchitis are similar to those of testicular torsion...
, referring to painful inflammation of the testicles. Males past puberty who develop mumps have a 30 percent risk of orchitisOrchitisOrchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection.-Symptoms:Symptoms of orchitis are similar to those of testicular torsion...
.
Other symptoms of mumps can include dry mouth, sore face and/or ears and occasionally in more serious cases, loss of voice. In addition, up to 20% of persons infected with the mumps virus do not show symptoms, so it is possible to be infected and spread the virus without knowing it.
Fever and headache are prodromal symptoms of mumps, together with malaise
Malaise
Malaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...
and anorexia
Anorexia (symptom)
Anorexia is the decreased sensation of appetite...
.
Cause
Mumps is a contagious disease that is spread from person to person through contact with respiratory secretions such as saliva from an infected person. When an infected person coughs or sneezes, the droplets aerosolize and can enter the eyes, nose, or mouth of another person. Mumps can also be spread by sharing food and drinks. The virus can also survive on surfaces and then be spread after contact in a similar manner.A person infected with mumps is contagious from approximately 6 days before the onset of symptoms until about 9 days after symptoms start. The incubation period
Incubation period
Incubation period is the time elapsed between exposure to a pathogenic organism, a chemical or radiation, and when symptoms and signs are first apparent...
(time until symptoms begin) can be from 14–25 days but is more typically 16–18 days.
Diagnosis
A physical examination confirms the presence of the swollen glands. Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, a test of saliva, or bloodSerology
Serology is the scientific study of blood serum and other bodily fluids. In practice, the term usually refers to the diagnostic identification of antibodies in the serum...
may be carried out; a newer diagnostic confirmation, using real-time nested polymerase chain reaction
Nested polymerase chain reaction
Nested polymerase chain reaction is a modification of polymerase chain reaction intended to reduce the contamination in products due to the amplification of unexpected primer binding sites....
(PCR) technology, has also been developed. An estimated 20%-30% of cases are asymptomatic. As with any inflammation of the salivary glands, serum amylase is often elevated.
Prevention
The most common preventative measure against mumps is a vaccination with a mumps vaccineMumps vaccine
Several varieties of mumps vaccine have been used since 1949, and at least 10 strains were in use in 2006:The first vaccine was a killed mumps virus vaccine developed in 1948 and used in the United States from 1950-1978. This vaccine produced little immune memory, thus had a short duration of...
, invented by Maurice Hilleman
Maurice Hilleman
Maurice Ralph Hilleman was an American microbiologist who specialized in vaccinology and developed over three dozen vaccines, more than any other scientist...
at Merck
Merck & Co.
Merck & Co., Inc. , also known as Merck Sharp & Dohme or MSD outside the United States and Canada, is one of the largest pharmaceutical companies in the world. The Merck headquarters is located in Whitehouse Station, New Jersey, an unincorporated area in Readington Township...
. The vaccine may be given separately or as part of the MMR immunization
MMR vaccine
The MMR vaccine is an immunization shot against measles, mumps, and rubella . It was first developed by Maurice Hilleman while at Merck in the late 1960s....
vaccine which also protects against measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
and rubella
Rubella
Rubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
. In the US, MMR is now being supplanted by MMRV, which adds protection against chickenpox
Chickenpox
Chickenpox or chicken pox is a highly contagious illness caused by primary infection with varicella zoster virus . It usually starts with vesicular skin rash mainly on the body and head rather than at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring...
. The WHO
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(World Health Organization) recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 15 months. The American Academy of Pediatrics
American Academy of Pediatrics
The American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...
recommends the routine administration of MMR vaccine at ages 12–15 months and at 4–6 years. In some locations, the vaccine is given again between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. The efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%. The Jeryl Lynn strain is most commonly used in developed countries but has been shown to have reduced efficacy in epidemic situations. The Leningrad-Zagreb strain commonly used in developing countries appears to have superior efficacy in epidemic situations.
Because of the outbreaks within college and university settings, many governments have established vaccination programs to prevent large-scale outbreaks. In Canada, provincial governments and the Public Health Agency of Canada have all participated in awareness campaigns to encourage students ranging from grade 1 to college and university to get vaccinated.
Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. There is no evidence whatsoever to support the claim that the wild disease is beneficial, or that the MMR
MMR
MMR has numerous meanings.In science and medicine:* Measles, mumps and rubella, as in MMR vaccine* DNA mismatch repair, a genetic repair pathway* Mass miniature radiography, a screening X-ray photofluorography technique* Maternal Mortality Ratio...
vaccine is harmful. Claims have been made that the MMR vaccine is linked to autism and inflammatory bowel disease
Inflammatory bowel disease
In medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
, including one study by Andrew Wakefield
Andrew Wakefield
Andrew Wakefield is a British former surgeon and medical researcher, known as an advocate for the discredited claim that there is a link between the measles, mumps and rubella vaccine, autism and bowel disease, and for his fraudulent 1998 research paper in support of that claim.Four years after...
(the paper was discredited and retracted in 2010 and Wakefield was later stripped of his license after his work was found to be an "elaborate fraud" ) that indicated a link between gastrointestinal disease, autism, and the MMR vaccine. However, all further studies since that time have indicated no link between vaccination with the MMR and autism. Since the dangers of the disease are well known, while the dangers of the vaccine are quite minimal, most doctors recommend vaccination.
The WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
, the American Academy of Pediatrics
American Academy of Pediatrics
The American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...
, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
, the American Academy of Family Physicians
American Academy of Family Physicians
The American Academy of Family Physicians was founded in 1947 to promote the science and art of family medicine. It is one of the largest medical organizations in the United States, with over 100,000 members...
, the British Medical Association
British Medical Association
The British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association’s headquarters are located in BMA House,...
and the Royal Pharmaceutical Society of Great Britain
Royal Pharmaceutical Society of Great Britain
The Royal Pharmaceutical Society of Great Britain was formerly the statutory regulatory and professional body for pharmacists and pharmacy technicians in England, Scotland and Wales...
currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.
Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000). In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%). The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968. Since 2001, the case average was only 265 per year, excluding an outbreak of >6000 cases in 2006 attributed largely to university contagion in young adults.
Treatment
There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck/testicular area and by acetaminophen/paracetamol (Tylenol) for pain relief. Aspirin is not used due to a hypothetical link with Reye's syndromeReye's syndrome
Reye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver, as well as causing a lower than usual level of blood sugar . The classic features are liver damage, aspirin use and a viral infection...
. Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms.
According to the Department of Health of Minnesota there is no effective post-exposure recommendation to prevent secondary transmission, as well as the post-exposure use of vaccine or immunoglobulin is not effective.
Patients are advised to avoid acidic foods and beverages, since these stimulate the salivary glands, which can be painful.
Prognosis
Death is very unusual. The disease is self-limiting, and general outcome is good, even if other organs are involved.Known complications of mumps include:
- Infection of other organ systems
- Mumps viral infections in adolescent and adult males carry an up to 30% risk that the testes may become infected (orchitisOrchitisOrchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection.-Symptoms:Symptoms of orchitis are similar to those of testicular torsion...
or epididymitisEpididymitisEpididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...
), which can be quite painful; about half of these infections result in testicular atrophyTesticular atrophyTesticular atrophy is a medical condition in which the male reproductive organs diminish in size and may be accompanied by loss of function. This does not refer to temporary changes, such as those brought on by cold.Some medications can cause testicular atrophy...
, and in rare cases sterility can follow. - Spontaneous abortion in about 27% of cases during the first trimester of pregnancy.
- Mild forms of meningitisMeningitisMeningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
in up to 10% of cases (40% of cases occur without parotid swelling) - OophoritisOophoritisOophoritis is an inflammation of the ovaries.It is often seen in combination with salpingitis .-See also:* Pelvic inflammatory disease...
(inflammation of ovaries) in about 5% of adolescent and adult females, but fertility is rarely affected. - PancreatitisPancreatitisPancreatitis is inflammation of the pancreas. It occurs when pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine. It may be acute – beginning suddenly and lasting a few days, or chronic – occurring over many years...
in about 4% of cases, manifesting as abdominal pain and vomiting - EncephalitisEncephalitisEncephalitis is an acute inflammation of the brain. Encephalitis with meningitis is known as meningoencephalitis. Symptoms include headache, fever, confusion, drowsiness, and fatigue...
(very rare, and fatal in about 1% of the cases when it occurs) - Profound (91 dB or more) but rare sensorineural hearing loss, uni- or bilateral. Acute unilateral deafness occurs in about 0.005% of cases.
After the illness, life-long immunity
Immunity (medical)
Immunity is a biological term that describes a state of having sufficient biological defenses to avoid infection, disease, or other unwanted biological invasion. Immunity involves both specific and non-specific components. The non-specific components act either as barriers or as eliminators of wide...
to mumps generally occurs; reinfection is possible but tends to be mild and atypical.
External links
- Original version based on the National Library of Medicine's Medline Plus website. Update Date: 08/15/01. Update date included for cross-reference against newer versions.
- NHS.uk – Encyclopedia – 'NHS Direct Online Health Encyclopaedia: Mumps', National Health ServiceNational Health ServiceThe National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
(UK) - WHO.int – "Immunization, Vaccines and Biologicals: Mumps vaccine", World Health Organisation
- MicrobiologyBytes: Paramyxoviruses"
- nih.gov – "NIH database entry: complete genome of Miyahara strain of Mumps"
- cdc.gov – Collection of information from the CDCCenters for Disease Control and PreventionThe Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
concerning mumps - ontario.ca – Ontario Mumps Catch-Up Vaccination Campaign targeted at Students
- TWU.ca, SFU.ca – Information from 2008 Mumps Outbreak in British Columbia
- GNB.ca – New Brunswick Vaccination Campaign
- gov.pe.ca – P.E.I. Vaccination Campaign
- gov.yk.ca – Yukon Vaccination Campaign
- Public Health Agency of Canada – Public Health Agency of Canada Vaccination Campaigns
- Virus Pathogen Database and Analysis Resource (ViPR): Paramyxoviridae