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Acute, generalized paramyxovirus infection usually presenting with unilateral or bilateral parotitis
- Painful parotitis occurs in 95% of symptomatic mumps, but 1/3 of mumps cases may be asymptomatic.
- Epidemics in late winter and spring, with transmission by respiratory secretions
- Incubation ∼14–24 days
- System(s) affected: Hematologic/Lymphatic/Immunologic; Reproductive; Skin/Exocrine
- Synonym(s): Epidemic parotitis; Infectious parotitis
- Predominant age: 85% occur before age 15:
- Adult cases typically more severe
- Predominant sex: Male = Female
- Geriatric population: Most are immune.
- Acute epidemic mumps:
- Most cases occur in children aged 5–15 years.
- Recent (2006) US epidemic in vaccinated college students aged 18–24 years with 5,700 US cases:
- Another US epidemic 2009–2010 in NY/NJ, >1,500 cases (1)
- Unusual in children <2 years of age
- Most infants <1 year are immune.
- Urban epidemics among nonvaccinated populations
- Communicable period 24 hours before to 72 hours after parotitis onset
- Incubation period 18 days
- 0.09/100,000 persons in the US
- Occasional epidemic outbreaks in a given region
- 0.0064/100,000 persons
- 90% of adults are seropositive even without history.
- 2 doses of live mumps vaccine or measles-mumps-rubella (MMR) vaccine recommended, 1st at 12–15 months and 2nd at 4–6 years of age
- 95% effective in studies, but field trials show 75–95% efficacy, which may be below level needed for herd immunity to prevent epidemic spread (3)[C].
- Successful prevention (Finland) may require 95% 1st-dose plus >80% 2nd-dose compliance (4).
- Adverse effects: Most common proven effect is ITP, with incidence of 3.3/100,000 doses.
- No relationship between MMR vaccine and autism (5)[A]
- Immunoglobulin is not effective in prevention.
- Postexposure vaccination does not protect from recent exposure.
- Isolate hospitalized patients until 5 days past onset (6)[C].
- Exclude nonimmune individuals for 26 days after last case onset.
- There are no proven complications of vaccine, but theoretically one should not vaccinate in pregnancy.
- Immunization of family may protect against later exposures but not the present one.
Mumps virus replicates in glandular epithelium of parotids, pancreas, and testes:
- Leads to interstitial edema and inflammation
- Interstitial glandular hemorrhage may occur.
- Pressure caused by edema of the testes against the tunica albuginea can lead to necrosis.
- Mumps paramyxovirus
- Other viruses, such as coxsackievirus (rare)