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Mumps
Cem S Demirci, MD, Fellow in Endocrinology, Children's Hospital of Pittsburgh
Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease,
Department of Pediatrics, Hurley Medical Center
Updated: Nov 20, 2009

Introduction

Background
Mumps is a single-stranded RNA virus and a member of the family Paramyxoviridae, genus Paramyxovirus. It has 2 major
surface glycoproteins: the hemagglutinin-neuraminidase and the fusion protein. Mumps virus is sensitive to heat and ultraviolet
light.

Mumps vaccine was licensed in the United States in December 1967, and the Advisory Committee on Immunization Practices
(ACIP) recommended that its use be considered for children approaching puberty, for adolescents, and for adults. At that
time, the public health community considered mumps control a low priority, and the ACIP stated that mumps immunization
should not compromise the effectiveness of established public health programs. However, in 1972, the ACIP
recommendations were strengthened to indicate that mumps vaccination was particularly important for the initially targeted age
groups; in 1977, the ACIP recommended the routine vaccination of all children aged 12 months or older.

The use of mumps vaccine in young children was facilitated by the introduction (in 1977) and extensive use of the measles-
mumps-rubella (MMR) vaccine. In 1980, stronger recommendations called for the vaccination of susceptible children,
adolescents, and adults, unless such vaccination was contraindicated. Following these increasingly comprehensive
recommendations and the enactment of state laws requiring mumps vaccination for school entry and attendance, the reported
incidence of mumps steadily declined. However, during 1986 and 1987, large outbreaks occurred among underimmunized
cohorts of persons born during 1967-1977, resulting in a shift in peak incidence from persons aged 5-9 years to persons
aged 10-19 years.[1 ]In 1989, the ACIP recommended that a second dose of measles-containing vaccine be administered to
children aged 4-6 years (at time of entry to kindergarten or first grade) and designated MMR as the vaccine of choice.[1,2 ]

The incidence of mumps during 1988-1998 decreased among all age groups. The greatest decrease occurred among
persons aged 10-19 years, which was the same age group in which the greatest increases had occurred during 1986 and
1987, when a resurgence of outbreaks occurred among susceptible adolescents and young adults. Subsequent outbreaks
have occurred among highly vaccinated populations. During 1989-1990, a large outbreak occurred among students in a
primary and a secondary school; most of the students in these schools had been vaccinated, suggesting that vaccination
failure, in addition to failure to vaccinate, might have contributed to the outbreak. In 1991, another outbreak occurred in a
secondary school where most of the students had been vaccinated; this outbreak was also mostly attributed to primary
vaccination failure.

The shift in higher risk for mumps to these other age groups (ie, from younger children of school ages to older children,
adolescents, and young adults), which occurred after the routine use of the mumps vaccine was initiated, has persisted
despite minimal fluctuations in disease incidence that occurred in recent years among the various age groups.

Pathophysiology
Mumps virus produces a generalized infection. After entry into the oropharynx, viral replication occurs, causing subsequent
viremia and involving glands or nervous tissue.

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Child with mumps.

The virus may be isolated from saliva, blood, urine, and cerebrospinal fluid (CSF). Affected glands show edema and
lymphocyte infiltration.
Frequency
United States

After the licensure of the mumps vaccine in the United States in December 1967 and the subsequent introduction of state
immunization laws in an increasing number of states, reported incidence of mumps substantially decreased. The 666 cases of
mumps reported in 1998 reflect a 99% decrease from the 152,209 cases reported for 1968. Although incidence decreased in
all age groups, the largest decreases (>50% reduction in incidence rate per 100,000 population) occurred in persons aged 10
years or older. Overall, the incidence of mumps was lowest in states with comprehensive school immunization laws requiring
mumps vaccination and was highest in states without such requirements.

The prevalence of mumps is at record low levels because of the recommendation of 2 doses of MMR vaccine and its high
coverage rate in the United States. During the 1990s, mumps cases substantially declined, from 5,292 reported cases in 1990
to 266 reported cases in 2001, meeting the Healthy People 2000 objective of less than 500 cases per year. In 2003, the
Centers for Disease Control and Prevention (CDC) reported a total of 231 cases.[3 ]

However, on July 26, 2005, an epidemic occurred in Sullivan County, New York at a summer camp.[4 ]An investigation
conducted by the New York State Department of Health (NYSDOH) identified 31 cases of mumps, likely introduced by a camp
counselor who had traveled from the United Kingdom and had not been vaccinated for mumps. Even in a population with 96%
vaccination coverage, as was the case with participants in the summer camp, a mumps outbreak can result from exposure to
virus imported from a country with an ongoing mumps epidemic. The likelihood of disease in US residents caused by imported

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virus from areas with mumps epidemics remains high.

International

Because the virus is present throughout the world, risk of exposure to mumps outside the United States may be high. Mumps
remains endemic in many countries throughout the world, and mumps vaccine is used in only 57% of countries that belong to
the World Health Organization, predominantly in countries with more developed economies.[5 ]In England and Wales, an
epidemic of mumps began in 2005, with 56,390 notified cases reported.[6 ]

Mortality/Morbidity
Death due to mumps is rare; more than half of the fatalities occur in persons older than 19 years.

Mumps encephalitis occurrence ranges as high as 5 cases per 1000 reported mumps cases, and males are affected 3-5
times more frequently than females. Permanent sequelae are rare, but the reported encephalitis case-fatality rate has
averaged 1.4%.

Approximately 10% of all infected patients develop a mild form of meningitis, which could be confused with bacterial
meningitis. Encephalitis, transient myelitis, or polyneuritis is rare. Unilateral hearing loss is associated with mumps infection but
is also rare.

Orchitis occurs in 10-20% of patients; subsequent sterility is rare. Oophoritis is quite rare and is usually a benign inflammation
of the ovaries. Other rare complications include myocarditis, nephritis, arthritis, thyroiditis, pancreatitis, thrombocytopenia
purpura, mastitis, and pneumonia. These usually resolve within 2-3 weeks without sequelae.

Race
During 1990-1998, race and ethnicity were reported for approximately two thirds of cases in each of 28 states and the District
of Columbia. Mumps incidence decreased for people of all races during this 4-year period. For each year, incidence was
highest among black persons, ranging from 1.2-8.2 times the incidence of any other racial group. In people of every age
group, incidence rates for black persons exceeded rates for people of other racial groups; this relationship was most notable
for persons aged 5-19 years.

Although incidence rates for Hispanics exceeded the rates for non-Hispanics in every age group, differences in rates were
minimal for children younger than 5 years and for persons aged 20 years or older. The greatest difference in incidence rates
between Hispanics and non-Hispanics was in persons aged 5-19 years.

Sex
No sexual predilection is observed.

Age
As in the prevaccine era, most reported mumps cases still occur in school-aged children (aged 5-14 y). Almost 60% of
reported cases occurred in this population from 1985-1987, compared with an average of 75% of reported cases from
1967-1971, the first 5-year period postlicensure. However, for the first time since mumps became a reportable disease, the
reported peak incidence rate shifted from children aged 5-9 years to older age groups for 2 consecutive years (ie, 1986,
1987).

Persons aged 15 years or older accounted for more than one third of the reported total from 1985-1987, whereas during the
period 1967-1971, an average of only 8% of reported cases occurred among this population. Although reported mumps
incidence increased in all age groups from 1985-1987, the most dramatic increases were among adolescents aged 10-14
years (almost a 7-fold increase) and young adults aged 15-19 years (more than an 8-fold increase).

Increased occurrence of mumps in susceptible adolescents and young adults has been demonstrated in several recent
outbreaks in high schools, on college campuses, and in occupational settings.[7 ]Nonetheless, despite this age shift in
reported mumps, the overall reported risk of disease in persons aged 10-14 and those aged 15 years or older is still lower

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than that in the prevaccine and early postvaccine era.

Clinical

History
The incubation period is 14-21 days, and mumps is communicable from 6 days before to 9 days after facial swelling is
apparent. However, 30% of infections are subclinical.

Symptoms in the history mostly consist of fever, headache, and malaise. Within 24 hours, patients report an ear pain
localized near the lobe of the ear and aggravated by a chewing movement of the jaw. The fever usually subsides after a
variable period of as long as 1 week, well before the salivary gland edema disappears.

Older children may describe a sensation of swelling at the angle of the jaw in the early stage, especially with a sour
taste.

Physical
After the prodromal period, one or both parotid glands begin to enlarge; 70-80% of cases are bilateral. Edema over the
parotid gland typically occurs with nondiscrete borders, pain with pressure, and obscured angle of the mandible. A recent
study investigated the difficulty in definitive mumps diagnosis, noting that only 14% of 2082 cases during an outbreak were
laboratory confirmed.[8 ]The conclusion was that the clinical acumen for mumps diagnosis based solely on clinical presentation
is low.

Parotitis: The classic illness of mumps consists of swelling of the parotid gland (ie, parotitis, parotiditis). However,
mumps is no longer the most common cause of parotitis. Systemic symptoms include low-grade fever, headache,
malaise, anorexia, and abdominal pain. Acid-containing foods may aggravate discomfort of the parotid gland. Ordinarily,
the parotid gland is not palpable, but in patients with mumps, it rapidly progresses to maximum swelling over several
days. Unilateral swelling usually occurs first, followed by bilateral parotid involvement. Occasionally, simultaneous
involvement of both parotid glands occurs. Unilateral parotid disease occurs in fewer than 25% of patients. Fever
subsides within 1 week and disappears before swelling of the parotid gland resolves, which may require as long as 10
days. Other salivary glands may be involved, including both submaxillary glands and sublingual glands, and orifices of
the ducts may be erythematous and edematous.

Orchitis: Approximately one third of postpubertal male patients develop unilateral orchitis. It usually follows parotitis but
may precede parotitis or occur in the absence of parotitis. Usually, it appears in the first week of parotitis, but it can
occur in the second or third week. Bilateral orchitis occurs much less frequently, and although gonadal atrophy may
follow orchitis, sterility is rare even with bilateral involvement. Prepubertal boys may develop orchitis, but it is
uncommon in those younger than 10 years. Orchitis is accompanied by high fever, severe pain, and swelling. Nausea,
vomiting, and abdominal pain are not uncommon. Fever and gonadal swelling usually resolve in 1 week, but tenderness
may persist.

Meningoencephalitis
CNS involvement with mumps is not uncommon, and it occurs more often as meningitis rather than true
encephalitis. It may precede parotitis or appear in the absence of parotitis but usually occurs in the first week
after parotitis. Headache, fever, nausea, vomiting, and meningismus are common. Marked changes in
sensorium and convulsions are not usual. Pleocytosis of the CSF occurs in a high percentage of persons
without clinical evidence of central nervous system involvement.
In clinically diagnosed meningoencephalitis, a CSF mononuclear pleocytosis occurs, as does normal glucose,
although hypoglycorrhachia has been reported. The mumps virus may be isolated from CSF early in the illness.
Mumps meningoencephalitis carries a good prognosis and is usually associated with an uneventful recovery.
Other clinical manifestations of mumps include pancreatitis accompanied by severe abdominal pain, chills,

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fever, and persistent vomiting. Thyroiditis, oophoritis, and mastitis occasionally occur.

Deafness: Neuritis of the auditory nerve may result in deafness. Sudden onset of tinnitus, ataxia, and vomiting is
followed by permanent deafness. Other neurologic complications include facial nerve neuritis and myelitis.

Other complications: Less common complications include arthritis, myocarditis, and hematologic complications.

Causes

Lack of immunization, international travel, and immune deficiencies can make a child more prone to infection by
Paramyxovirus mumps virus.

Differential Diagnoses
Human Immunodeficiency Virus Infection

Other Problems to Be Considered

Coxsackievirus parotitis
Influenza virus parotitis
Parainfluenza virus parotitis
Suppurative parotitis commonly caused by Staphylococcus aureus or other bacteria
Adenitis
Recurrent parotitis
Calculus of Stensen duct
Tumors of the parotid gland
Mikulicz syndrome
Meningoencephalitis

Workup

Laboratory Studies

Diagnosis of mumps is clinical, and laboratory tests are unnecessary. The virus can be isolated from saliva or mouth
washings in primary monkey kidney tissue culture.

Diagnosis can also be made by significant rise between acute and convalescent phase titers in serum mumps
immunoglobulin G (IgG) antibody level using any standard serologic assay or positive serologic test for mumps
immunoglobulin M (IgM) antibody. Interpretation of titer rise may have limitations because of mumps cross-reaction with
parainfluenza viruses.

Serum amylase is elevated in mumps parotitis and pancreatitis. Serum lipase is elevated in pancreatitis.

CBC count reveals a normal or elevated WBC count with lymphocyte predominance.

Viruria is common even in uncomplicated mumps.

Imaging Studies

Imaging may only be needed for complicated cases that involve certain organ systems.

Other Tests

Complicated cases may need further testing, if determining organ system involvement is necessary.

Procedures

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Lumbar puncture may be needed to obtain cell profile and culture information if meningoencephalitis is the prominent
presentation.

Treatment

Medical Care

Conservative therapy is indicated in patients with mumps.

Generous offering of fluids is essential because adequate hydration and alimentation of patients is important.

Foods and liquids that contain acid may cause swallowing difficulty as well as gastric irritation.

Prescribe analgesics for severe headaches or discomfort due to parotitis. In orchitis, stronger analgesics may be
needed.

No antiviral agent is indicated for mumps, which is a self-limited disease.

Consultations

Consultation may be considered in complicated cases with multiple organ system involvement.

Diet

A light diet with generous fluid intake is recommended.

Avoiding acid-containing foods (eg, tomato, vinegar-containing food additives) and liquids (eg, orange juice) are
beneficial to reduce pain.

Activity

Bed rest is recommended for a faster recovery and is needed for patients with complicated cases.

Medication

Analgesics
These agents may be prescribed for severe headaches or discomfort due to parotitis. In orchitis, stronger analgesics may be
needed.

Ibuprofen (Advil, Motrin)

DOC for patients with mild-to-moderate pain and fever. Inhibits inflammatory reactions and pain by decreasing prostaglandin
synthesis.

Dosing

Adult

200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d

Pediatric

10 mg/kg/dose q8h prn for relief of pain/fever; not to exceed 2.4 g/d

Interactions

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Coadministration with aspirin increases risk of inducing serious NSAID-related side effects; probenecid may increase
concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may
decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding);
may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic
function; caution in anticoagulation abnormalities or during anticoagulant therapy

Acetaminophen (Tylenol, Tempra)

DOC for pain in patients with documented hypersensitivity to NSAIDs, with upper GI disease, or who are taking PO
anticoagulants. Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body
heat via vasodilation and sweating.

Dosing

Adult

325-650 mg PO q4-6h or 1000 mg tid/qid; not to exceed 4 g/d

Pediatric

15 mg/kg/dose q4-6h prn for relief of pain/fever; not to exceed 2.6 g/d

Interactions

Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and
isoniazid may increase hepatotoxicity

Contraindications

Documented hypersensitivity; known G-6-P deficiency

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hepatotoxicity possible in people with long-term alcoholism following various dose levels; severe or recurrent pain or high or
continued fever may indicate a serious illness; APAP is contained in many OTC products, and combined use with these
products may result in cumulative APAP doses exceeding recommended maximum dose

Vaccines (measles, mumps, rubella)

Prevention of mumps through immunization cannot be overemphasized. All children younger than 7 years should receive the
mumps vaccine. In the United States, mumps vaccine is recommended and is usually combined with MMR.

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Measles, mumps, and rubella vaccine (M-M-R)

Live virus vaccine. Combined MMR vaccine is recommended for the prevention of mumps, measles, and rubella. For children,
the typical recommended 2 dose schedule is administered at age 12-15 mo for the 1st dose and the second dose at 4-6 y of
age.

Dosing

Adult

0.5 mL SC in outer aspect of upper arm

Adults in 1957 or after should receive one dose of MMR unless they have a medical contraindication, history of mumps,
laboratory evidence of immunity
A second dose is recommended for adults in an age group affected during a mumps outbreak, students in postsecondary
educational institutions, work in a health care facility, or for international travel

Pediatric

0.5 mL SC in outer aspect of upper arm

Administer 1st dose between age 12-15 mo; administer the 2nd dose between age 4-6 y

Interactions

Patients receiving immunosuppressants, including corticosteroids or radiation therapy, may remain susceptible despite
immunization because of poor immune response

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Fever, rash, lymphadenopathy, parotitis, allergic reactions, thrombocytopenia, arthralgia, arthritis, and persistent or recurrent
arthropathy; interference with tuberculin skin tests; contraception in females is advised for 3 mo following immunization; not
indicated for immunocompromised patients

Follow-up

Deterrence/Prevention

Droplet precautions are recommended until 9 days after the onset of parotid swelling in patients with mumps. Children
should be excluded for 9 days from the onset of parotid gland swelling from going to school and child care centers. If
outbreaks occur, all children should be vaccinated.

Susceptible children, adolescents, and adults should be vaccinated against mumps, unless vaccination is
contraindicated. Mumps vaccine is of particular value for children approaching puberty and for adolescents and adults
who have not had mumps. MMR vaccine is the vaccine of choice for routine administration and should be used in all
situations where recipients are also likely to be susceptible to measles, rubella, or both. The favorable benefit-to-cost
ratio for routine mumps immunization is more marked when vaccine is administered as MMR. Persons should be
considered susceptible to mumps unless they have documentation of (1) physician-diagnosed mumps, (2) adequate
immunization with live mumps virus vaccine on or after their first birthday, or (3) laboratory evidence of immunity.

Because live mumps vaccine was not used routinely before 1977 and because the peak age-specific incidence was in

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children aged 5-9 years before the vaccine was introduced, most persons born before 1957 are likely to have been
naturally infected from 1957-1977. Therefore, they may generally be considered to be immune, even if they may not
have had clinically recognizable mumps disease. However, this cutoff date for susceptibility is arbitrary. Although
outbreak control efforts should be focused on persons born after 1956, these recommendations do not preclude
vaccination of possibly susceptible persons born before 1957 who may be exposed in outbreak settings.

Persons who are unsure of their mumps disease history, mumps vaccination history, or both should be vaccinated. No
evidence indicates that persons who have previously either received mumps vaccine or had mumps are at any
increased risk of local or systemic reactions from receiving live mumps vaccine. Testing for susceptibility before
vaccination, especially among adolescents and young adults, is not necessary. In addition to the expense, some tests
(eg, mumps skin test, complement-fixation antibody test) may be unreliable, and tests with established reliability (eg,
neutralization test, enzyme immunoassay, radial hemolysis antibody test) are not readily available.

A single dose of vaccine in the volume specified by the manufacturer should be administered subcutaneously.
Although not routinely recommended, intramuscular vaccination is effective and safe.

Administration of the live mumps virus vaccine is recommended at any age on or after the first birthday for all
susceptible persons, unless a contraindication is present. Under routine circumstances, mumps vaccine should be
administered in combination with measles and rubella vaccines as MMR, following the currently recommended
schedule for administration of measles vaccine. It should not be administered to infants younger than 12 months
because persisting maternal antibody might interfere with seroconversion. To ensure immunity, all persons vaccinated
before the first birthday should be revaccinated on or after the first birthday.

When administered after exposure to mumps, live mumps virus vaccine may not provide protection. However, if the
exposure did not result in infection, vaccine should induce protection against infection from subsequent exposures. No
evidence indicates that the risk of vaccine-associated adverse events increases if vaccine is administered to persons
incubating disease.

Immunoglobulin has not been demonstrated to be of established value in postexposure prophylaxis and is not
recommended. Mumps immunoglobulin has not been shown to be effective and is no longer available or licensed for
use in the United States.

Complications

Hearing loss

Meningitis or encephalitis

Orchitis

Oophoritis

Pancreatitis

Transient myelitis

Polyneuritis

Myocarditis

Nephritis

Arthritis

Thyroiditis

Thrombocytopenia purpura

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Mastitis

Pneumonia

Sensorineural deafness

Prognosis

Overall prognosis in uncomplicated mumps is excellent.

Prognosis of patients with meningoencephalitis is generally favorable; however, neurologic damage and death can
occur. Reported rates of mumps encephalitis range as high as 5 cases per 1000 reported mumps cases. Permanent
sequelae are rare, but the reported encephalitis case-fatality rate has averaged 1.4%.

Sensorineural deafness is one of the most serious of the rare complications involving the CNS. It occurs with an
estimated frequency of 0.5-5 cases per 100,000 reported mumps cases. Minor degrees of hearing loss or impairment
are likely to occur with higher incidence and are probably reversible. Deafness after mumps is rare, mostly unilateral
(20% bilateral), and often permanent.

Orchitis (usually unilateral) has been reported as a complication in 20-30% of clinical mumps cases in postpubertal
males. Some testicular atrophy occurs in about 35% of cases of mumps orchitis, but sterility rarely occurs.

Symptomatic involvement of other organs has been observed less frequently. Limited experimental, clinical, and
epidemiologic data suggest permanent pancreatic damage may result from injury caused by direct viral invasion.
Further research is needed to determine whether mumps infection contributes to the pathogenesis of diabetes
mellitus.

Mumps infection in pregnant women seems to increase the risk of embryonic and fetal death and spontaneous
abortions, especially during the first trimester of pregnancy (reported to be as high as 27%). No association was found
between mumps and congenital anomalies, and the studies relating maternal mumps infection to endocardial
fibroelastosis in the fetus are inconclusive. Mumps during pregnancy was rare even before immunization and is even
rarer with the widespread use of mumps immunization in childhood.

Patient Education

The principal strategy to prevent mumps is to achieve and maintain high immunization levels, primarily in infants and
young children. Universal immunization as a part of good health care should be routinely carried out in physicians'
offices and public health clinics. Programs aimed at vaccinating children with MMR should be established and
maintained in all communities. In addition, all other persons thought to be susceptible should be vaccinated unless
otherwise contraindicated. This is especially important for adolescents and young adults in light of the recently
observed increase in risk of disease in these populations.

Advise parents and educators to exclude the infected child from large-population facilities until 9 days after the swelling
begins or until the swelling subsides.

Advise all children and adults to follow good handwashing practices.

For excellent patient education resources, visit eMedicine's Common Childhood Illnesses Center, Children's Health
Center, and Bacterial and Viral Infections Center. Also, see eMedicine's patient education articles Mumps and
Immunization Schedule, Children.

Miscellaneous

Medicolegal Pitfalls

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Failure to advise isolation for the duration of the contamination period

Failure to check for complicated cases involving certain organ systems

Failure to check for pregnancy in postpubertal women, including asking if they are or may be pregnant, excluding those
who say they are, and explaining the theoretical risk to those who plan to receive the vaccine

Special Concerns

Mumps in a childcare facility: If a case of mumps occurs in a childcare facility, notify the local health department. Notify
parents. Exclude the infected child from the facility until 9 days after the swelling begins or until the swelling subsides.
Make sure all children and adults follow good handwashing practices. In large facilities, follow appropriate group
separation practices. Review the immunization records of all children in the facility to assure they have received their
first mumps vaccination. Those not adequately vaccinated should be referred to their physicians. Closely observe all
children for symptoms and refer anyone developing symptoms to his or her physician.

Adverse effects of vaccine use: In field trials before licensure, illnesses did not occur more often in vaccinees than in
unvaccinated controls. Reports of illnesses following mumps vaccination have mainly involved episodes of parotitis and
low-grade fever. Allergic reactions, including rash, pruritus, and purpura, have been temporally associated with mumps
vaccination but are uncommon, are usually mild, and are of brief duration. The reported occurrence of encephalitis
within 30 days of receipt of a mumps-containing vaccine (0.4 cases per million doses) is not greater than the observed
background incidence rate of CNS dysfunction in the healthy population. Other manifestations of CNS involvement,
such as febrile seizures and deafness, have also been infrequently reported.[9 ]Complete recovery is usual. Reports of
nervous system illness following mumps vaccination do not necessarily denote an etiologic relationship between the
illness and the vaccine.

Contraindications to vaccine use in pregnancy: Although mumps vaccine virus has been shown to infect the placenta
and fetus, no evidence indicates that it causes congenital malformations in humans. However, because of the
theoretical risk of fetal damage, avoiding administration of live virus vaccine to pregnant women is prudent. Vaccinated
women should avoid pregnancy for 3 months after vaccination. Routine precautions for vaccinating postpubertal
women include asking if they are or may be pregnant, excluding those who say they are, and explaining the theoretical
risk to those who plan to receive the vaccine. Vaccination during pregnancy should not be considered an indication for
termination of pregnancy. However, the final decision about interruption of pregnancy must rest with the individual
patient and her physician.

Severe febrile illness: Vaccine administration should not be postponed because of minor or intercurrent febrile
illnesses, such as mild upper respiratory infections. However, vaccination of persons with severe febrile illnesses
should generally be deferred until they have recovered.

Allergies: Because live mumps vaccine is produced in chick embryo cell culture, persons with a history of anaphylactic
reactions (ie, hives, swelling of the mouth and throat, difficulty breathing, hypotension, shock) after egg ingestion should
only be vaccinated with caution using published protocols. Children with known allergy should not leave the vaccination
site for 20 minutes. Evidence indicates that persons are not at increased risk if they have egg allergies that are not
anaphylactic in nature. Such persons may be vaccinated in the usual manner. No evidence indicates that persons with
allergies to chickens or feathers are at increased risk of reaction to the vaccine. Because mumps vaccine contains
trace amounts of neomycin (25 mcg), persons who have experienced anaphylactic reactions to topically or systemically
administered neomycin should not receive mumps vaccine.

Recent immunoglobulin injection: Passively acquired antibody can interfere with the response to live attenuated-virus
vaccines. Therefore, mumps vaccine should be administered at least 2 weeks before the administration of
immunoglobulin or deferred until approximately 3 months after the administration of immunoglobulin.

Exceptions: An exception to these general recommendations is in children infected with human immunodeficiency virus
(HIV); all asymptomatic HIV-infected children should receive MMR vaccination at 15 months of age. Patients with
leukemia in remission whose chemotherapy has been terminated for at least 3 months may also receive live mumps

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virus vaccine.

Multimedia

Media file 1: Child with mumps.

References

1. CDC. Mumps--United States, 1985-1988. MMWR Morb Mortal Wkly Rep. Feb 24 1989;38(7):101-5. [Medline].

2. [Guideline] Watson JC, Hadler SC, Dykewicz CA, et al. Measles, mumps, and rubella--vaccine use and strategies for
elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the
Advisory Committee on Immunization Practices (ACIP). MMWR - Morbidity & Mortality Weekly Report. May
22 1998;47(RR-8):1-57. [Medline].

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Keywords
mumps, parotitis, epidemic parotiditis, measles-mumps-rubella vaccine, MMR vaccine, mumps virus, mumps encephalitis,
meningitis, transient myelitis, polyneuritis, oophoritis, myocarditis, nephritis, arthritis, thyroiditis, pancreatitis, thrombocytopenia
purpura, mastitis, pneumonia, parotitis, orchitis, meningoencephalitis

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Contributor Information and Disclosures

Author

Cem S Demirci, MD, Fellow in Endocrinology, Children's Hospital of Pittsburgh

Disclosure: Nothing to disclose.

Coauthor(s)

Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric
Infectious Disease, Department of Pediatrics, Hurley Medical Center
Walid Abuhammour, MD, FAAP is a member of the following medical societies: American Medical Association and Pediatric
Infectious Diseases Society
Disclosure: Nothing to disclose.

Medical Editor

Gary J Noel, MD, Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University
Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy,
Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious
Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society
of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint
Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical
Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases
Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and
teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter
Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor,
Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American
Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of
America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and
Southern Medical Association
Disclosure: None None None

Further Reading
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