Mumps

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Mumps virus
TEM micrograph of the mumps virus.
Virus classification
Group: Group V ((-)ssRNA) Order: Mononegavirales Family: Paramyxoviridae Genus: Rubulavirus Species: Mumps virus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Overview

Mumps or epidemic parotitis is a highly contagious human viral disease that leads to painful swelling of the salivary glands. Mumps is spread through direct contact with an infected person. Symptoms include fever, glandular swelling, headache, sore throat, and orchitis. As disease, mumps is self-limiting, and the general outcome is good, even if other organs are involved.

Background

Mumps or epidemic parotitis is a viral disease of humans. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide, and is still a significant threat to health in the third world.

Painful swelling of the salivary glands (classically the parotid gland) and fever is the most typical presentation. Painful testicular swelling and rash may also occur. While symptoms are generally not severe in children, the symptoms in teenagers and adults can be more severe and complications such as infertility or subfertility are relatively common, although still rare in absolute terms.^,, The disease is generally self-limited, running its course before waning, with no specific treatment apart from controlling the symptoms with painkillers.

Causes and risks

The mumps are caused by a paramyxovirus, and are spread from person to person by saliva droplets or direct contact with articles that have been contaminated with infected saliva. The parotid glands (the salivary glands between the ear and the jaw) are usually involved. Unvaccinated children between the ages of 2 and 12 are most commonly infected, but the infection can occur in other age groups. Orchitis (swelling of the testes) occurs in 10–20% of infected males, but sterility only rarely ensues; a viral meningitis occurs in about 5% of those infected. In older people, the central nervous system, the pancreas, the prostate, the breasts, and other organs may be involved.

The incubation period is usually 18 to 21 days, but may range from as few as 12 to as many as 35 days. Mumps is generally a mild illness in children in developed countries. After adolescence, mumps tends to affect the ovary, causing oophoritis, and the testes, causing orchitis. The mature testis is particularly susceptible to damage from mumps which can lead to infertility. Adults infected with mumps are more likely to develop severe symptoms and complications.

Symptoms

Comparison of a person before and after contracting mumps

The more common symptoms of mumps are:

• Swelling of the parotid gland (or parotitis) in more than 90% of patients on one side (unilateral) or both sides (bilateral), and pain behind the lower jaw when chewing.
• Fever
• Headache
• Sore throat
• Orchitis, referring to painful inflammation of the testicle. Males past puberty who develop mumps have a 30 percent risk of orchitis.

Other symptoms of mumps can include, sore face and/or ears and occasionally in more serious cases, loss of voice.

Prodrome

Fever and headache can occur already as prodromal symptoms of mumps, together with malaise and anorexia.

Signs and tests

Where mumps is rare, diagnosis can be challenging since signs and symptoms are non-specific and laboratory evaluation is not straightforward. The CDC defines a clinical case of mumps as "An illness with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland(s), lasting at least 2 days, and without other apparent cause." Other etiologies of acute parotitis to consider include Epstein-Barr virus, coxsackievirus, influenza A virus, parainfluenza virus, and bacterial pathogens. Laboratory testing for mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, antigen detection by PCR, and serologic testing for IgM antibody or a significant rise in IgG antibody. However, there are many important caveats to be aware of when interpreting the results.

Treatment

There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck area and by Acetaminophen/Paracetamol (Tylenol) for pain relief. Aspirin use is discouraged in young children because of studies showing an increased risk of Reye's syndrome. Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms.

Patients are advised to avoid fruit juice or any acidic foods, since these stimulate the salivary glands, which can be painful.

Research treatments

• A research group published a 1996 report on a chemical extracted from Spirulina platensis, a species of blue-green algae, which inhibited Mumps virus in a viral plaque assay.

• A University of Tokyo group reported in 1992 that research compound TJ13025 ((6'R)-6'-C-methylneplanocin A) had an antiviral effect on four Mumps virus strains cultured in Vero cells.(see 16526604, tables 1 and 2) Additional research improved the synthesis of a particular isomer, RMNPA, of TJ13025 from the racemic product.

• A 2005 publication in a Russian journal reports that Myramistin has antiviral activity against Mumps virus in Vero cells culture.

Prognosis

Death is very unusual. The disease is self-limiting, and general outcome is good, even if other organs are involved. Sterility in men from involvement of the testes is very rare. After the illness, life-long immunity to mumps generally occurs.

Complications

Known complications of mumps include:

• Infection of other organ systems
• Sterility in men (this is quite rare, and mostly occurs in older men)
• Mild forms of meningitis (rare, 40% of cases occur without parotid swelling)
• Encephalitis (very rare, rarely fatal)
• Profound (91 dB or more) but rare sensorineural hearing loss, uni- or bilateral

Prevention

The most common preventative measure against mumps is immunization with a mumps vaccine. 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 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. 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 is commonly used in developing countries, but appears to have superior efficacy in epidemic situations.

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. Disagreeing, 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; in 1998 there were only 666 cases reported.

Current outbreaks

Canada (April 2007)

Dalhousie University, Halifax, Nova Scotia. Dalhousie University was struck with an outbreak of the mumps confirmed in many students and suspected cases in dozens of others. The main causes of the large outbreak include students being unaware of being infected, and other students who knowingly ignored quarantine restrictions. The outbreak began after St. Patrick's Day, and has spread beyond the university community, with confirmed cases reaching 350 cases of mumps since February, including about 24 new cases that have surfaced during the week ending June 9, 2007. The end of the university year in May meant that many students travelled to their homes across the country carrying the infection, leading to a large scale spread, the extent of which is still not clear, although the prevalence of the disease lay in people aged 17 to 24. Roughly 50 personnel of the Halifax-based navy ship HMCS Glace Bay were sent home as a precaution. Reported outbreaks have begun in New Brunswick (Approximately 100 cases), Prince Edward Island (1 case), Ontario (3 cases confirmed, 5 suspected), West Coast of Newfoundland (2 cases), and Toronto (3 cases). On October 3rd 2007, a new case was reported at Nipissing University/Canadore College, in North Bay, Ontario.

United Kingdom (2004–2007)

In the United Kingdom over the last two years, a mumps outbreak has involved more than 70,000 patients.[3] The cause of the outbreak is low immunity in those too old to have received MMR, but young enough to have not developed natural immunity through exposure. A catch-up programme of immunisation of under twenty five year olds, particularly in university towns such as Exeter was implemented.

• 12 November 2004: The University of Bath Internal News reports that twenty three students have presented to the University of Bath Medical Centre with Mumps. A "Mumps Vaccination programme" is announced, to commence 15 November 2004.

United States (2005-2006)

Although there may not be a direct link with the mumps outbreak in Ireland, United States CDC Director Dr. Julie Gerberding has been quoted stating that the genotype from the U.S. outbreak, "in the early cases of this outbreak, was the same genotype of virus that was associated with the United Kingdom outbreak." [4] Entrez Gene contains a placeholder database record for a new Mumps gene; the record is dated 23 Feb 2006.[5]

• 31 January 2007: 6404 cases of mumps in 2006 compared to 314 in 2005. As of today, YTD 15 deaths in the United States were reported.[6]

Iowa (2005-2006)

In early 2006, for reasons still not fully understood, the state of Iowa experienced a large surge in the number of reported mumps infections. [7]According to the New York Times, college students accounted for about a quarter of the 245 cases [8], while about half of the cases are people aged seventeen to twenty five. Doctors are attributing the rise in mumps case frequency to low vaccination rates in Iowa's youth, coupled with the close quarters in dormitories, classrooms and cafeterias.

“

When you expect five and you get 245, this is pretty serious... We're trying to get ahead of it and get it stopped... It could be that on some of these college campuses, they were not as well vaccinated as we'd like them to be, [but] our law does not allow us to identify entities associated with outbreaks.

”

According to Canadian media reports [9], there may be something novel about this mumps strain which indicates a standard MMR-series vaccination is not 95% effective, as was thought.

• 14 April 2006: Iowa has experienced more than 600 suspected cases since December. Other states reporting cases are California, Illinois, Kansas, Minnesota, Missouri, Nebraska, South Dakota, and Wisconsin. The Centers for Disease Control and Prevention agency has not yet released the name of the ninth Midwestern state, however there have been confirmed cases in Michigan [10]. The mumps outbreak is the nation's largest in twenty years.

• 18 April 2006: 815 cases have been reported [11] in Iowa alone, representing a caseload reporting increase of 200 in the last week.

• 25 April 2006: There are over 1,120 confirmed[12], probable and suspected cases of mumps. Over 1000 of the cases are confirmed.

• 2 May 2006: Iowa reports 1,487 cases.[13]

• 11 May 2006: Iowa reports 1,184 confirmed, 253 probable, and 237 suspect cases, or 1674 total. Template:PDFlink

Georgia (2006)

• 28 April 2006: A confirmed case of mumps is reported in a college student at the Georgia Institute of Technology campus in downtown Atlanta.[14]

Illinois (2006)

There have been three confirmed cases of the mumps at Southern Illinois University-Carbondale, Two cases at Loyola University Chicago, and has spread to three other neighboring counties in the Southern Illinois area. There has also been one confirmed case at Knox College, in Galesburg (Western Illinois). Wheaton College has also been affected by 93 cases since early September (as of Jan 9).[15]

• 9 May 2006: Illinois reports 279 total cases.[16]

• September 28, 2006: The Illinois Department of Public Health has reported 636 cases of mumps in Illinois between January 1, 2006 and September 28, 2006. [17]

Indiana (2006)

• 21 April 2006: A case is reported in a college student at Indiana University.[18]

Kansas (2006)

• 2 May 2006: With 340 mumps cases now reported in Kansas, state health officials have asked the U.S. Centers for Disease Control and Prevention to help.[19]

• 10 May 2006: Kansas reports 546 cases.Template:PDFlink

Kentucky (2006)

• 4 May 2006: Two cases diagnosed by Doctor Roach in Paducah,KY, a border town to Southern Illinois.[20]

Michigan (2006)

• 20 April 2006: A woman in Saginaw County was diagnosed with mumps, with another pending results [21]. Cases in Oakland County and Delta County were previously confirmed, and results in neighboring Bay County came back negative.

• 04 May 2006: A case of the mumps is reported in Plymouth-Canton High School, Canton. The three high schools in Canton are requiring students to provide documentation of vaccination.[22]

Minnesota (2006)

• May 2006: The Minnesota Department of Health has confirmed eleven mumps cases in Minnesota in 2006. Four of the eleven cases may be linked to Iowa. Please continue to check back for updates. [23]

Missouri (2006)

• 10 May 2006: Missouri reports twenty one confirmed, eighty eight probable, for a total of 109 cases [24]

Nebraska (2006)

• 10 May 2006: Nebraska reports sixty four confirmed, 193 probable, twenty two suspect, for a total of 279 cases in forty three counties. [25]Officials say many people with mumps in Nebraska had connections to Iowa.

North Carolina (2006)

• 4 May 2006: An 8-year-old in Mecklenburg County is diagnosed with the mumps, the first case in the county since 2002. [26] NOTE: This case may not be related to the current epidemic in the Midwest.

Oregon (2006)

• 18 May 2006: three cases in Lane County are confirmed, including a potential of four more at the University of Oregon alone. [27]
• 6 June 2006: twenty four confirmed and four presumptive cases in Lane County, two cases in Multnomah County, one each in Douglas, Hood River, and Linn Counties. [28]

South Dakota (2006)

• 12 May 2006: SD Department of Health reports thirty three confirmed cases, fifty three probable cases, and six suspect cases for a total of ninety two cases. [29]

Wisconsin (2006)

• 10 May 2006: 185 confirmed cases, at least one case in one out of three counties.

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.
• Schlegel M, Osterwalder JJ, Galeazzi RL, Vernazza PL (1999). "Comparative efficacy of three mumps vaccines during disease outbreak in Eastern Switzerland: cohort study". BMJ. 319 (7206): 352. PMID 10435956 fulltext @ BMJJournals.com.CS1 maint: Multiple names: authors list (link)
• NHS.uk - Encyclopedia - 'NHS Direct Online Health Encyclopaedia: Mumps', National Health Service (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 CDC concerning mumps
• [30] - Information on Wheaton College cases

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