Mumps

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©2024 UpToDate®

Mumps
Author: Mary A Albrecht, MD
Section Editors: Martin S Hirsch, MD, Sheldon L Kaplan, MD
Deputy Editor: Milana Bogorodskaya, MD

Contributor Disclosures

All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Sep 2024. | This topic last updated: Oct 23, 2023.

INTRODUCTION

Mumps is a contagious viral illness that is largely preventable via vaccination [1]. Typically,
it begins with a few days of fever, headache, myalgia, fatigue, and anorexia, followed by
parotitis; the illness is usually self-limited.

The epidemiology, clinical manifestations, diagnosis, treatment, and prevention of mumps

are discussed here. Issues related to vaccination for prevention of mumps are discussed
separately. (See "Measles, mumps, and rubella immunization in infants, children, and
adolescents" and "Measles, mumps, and rubella immunization in adults".)

EPIDEMIOLOGY

Mumps occurs worldwide; the peak incidence is typically in the late winter to early spring,
although sporadic outbreaks occur at any time of year. Mumps occurs most commonly
among school-aged children and college-aged young adults; it is rare among infants less
than one year of age, who have protection via maternal antibodies.

Before the United States mumps vaccination program began in 1967, about 186,000 cases
were reported each year; the actual number of cases was likely much higher due to
underreporting. Since implementation of routine vaccination, there has been a more than
99 percent decrease in mumps cases in the United States [2]. (See "Measles, mumps, and
rubella immunization in infants, children, and adolescents" and "Measles, mumps, and
rubella immunization in adults".)
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From year to year in the United States, mumps cases can range from a few hundred to a
few thousand ( figure 1) [3-5]. The number of cases reported in 2016 and 2017 (6369 and
5629, respectively) were the highest in a decade [6].

Transmission — Mumps is highly infectious and is transmitted by respiratory droplets,

direct contact, or fomites [7]. Mumps spreads rapidly among susceptible individuals living
in close quarters, such as young adults living in college dormitories. Infection among
school-aged children may be associated with further spread to household family members.

Viral shedding in respiratory secretions precedes the onset of symptomatic illness. The
incubation period is usually 16 to 18 days (range 12 to 25 days) from exposure to onset of
symptoms [8-11]. In one review including 15 studies monitoring mumps infectivity over
time, infectivity could be detected as early as seven days onset to eight days after onset of
parotitis [12]. The highest rate of infectivity (highest titer of virus) was present immediately
preceding the onset of parotitis, with rapid decrease of virus shedding over the next five
days. By days 6 to 9 following onset of parotitis, virus titers and infectivity were very low.

Outbreaks — Several sporadic mumps outbreaks (the occurrence of ≥3 cases linked by

place and time) have occurred since 2006 among susceptible individuals in a variety of
settings in the United States and the United Kingdom, including military posts [13], schools
[14-16], colleges and universities [17-22], and summer camps [23,24]. There have also been
hospital-based [25-27], workplace [28], and community-based outbreaks [29-31], including
among men who have sex with men [32].

Factors that contribute to local outbreaks of mumps include closed environments (eg,
college dormitories) [33] and a delay in recognition of mumps by healthcare providers [34].
During outbreaks, mumps cases have occurred among vaccinated individuals [35]. The
shift in mumps epidemiology in the United States from a childhood disease (prior to
routine vaccination) to a disease primarily affecting vaccinated young adults raises the
possibility that waning immunity may be a factor in outbreaks [22]. However, high
vaccination coverage helps limit the size, duration, and spread of mumps. Mumps still
occurs much more frequently in unvaccinated than vaccinated individuals.

Issues related to management of outbreaks are discussed further below. (See 'Prevention'
below.)

CLINICAL MANIFESTATIONS

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The incubation period is usually 16 to 18 days (range 12 to 25 days) from exposure to onset
of symptoms [8-11]. In one review, the highest rate of infectivity was present immediately
preceding the onset of parotitis, with rapid decrease of virus shedding over the next five
days [12]. (See 'Transmission' above.)

Mumps typically begins with a few days of fever, headache, myalgia, fatigue, and anorexia;
these manifestations are usually followed by development of salivary gland swelling within
48 hours.

Parotitis occurs most commonly among children between two and nine years of age;
tenderness, occasionally associated with earache, typically precedes parotid swelling
[36,37]. Parotitis may be unilateral or bilateral; initial unilateral involvement is followed by
contralateral involvement a few days later in 90 percent of cases [1]. Parotid swelling can
last up to 10 days.

On physical examination, parotid swelling may obscure the angle of the mandible (
picture 1), and the orifice of Stensen's duct is erythematous and enlarged ( figure 2).
Laboratory findings include leukopenia with a relative lymphocytosis and an elevated
serum amylase concentration.

Mumps is usually self-limited; most individuals recover completely within a few weeks.

Some patients have nonspecific symptoms and may not present for clinical evaluation
[5,36,38]. Asymptomatic infection occurs in 15 to 20 percent of cases; it is more common in
adults than in children. Adults who do have symptomatic infection are more likely to have
severe manifestations than children with symptomatic infection.

There is no firm evidence for an association between mumps infection during pregnancy
and complications [1,39-42].

COMPLICATIONS

Complications of mumps may include orchitis and neurologic manifestations (including

meningitis, encephalitis, and deafness); these may occur even among vaccinated
individuals who develop mumps [43]. Complications of mumps may occur in the absence
of parotitis [15,44,45].

Orchitis or oophoritis — Epididymoorchitis is the most common complication of mumps

infection; it occurs among postpubertal males in 15 to 30 percent of cases [1,37,46,47].

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Symptoms typically occur 5 to 10 days after onset of parotitis and include abrupt onset of
fever (39 to 41ºC) and severe testicular pain accompanied by swelling and erythema of the
scrotum. Involvement is unilateral in 60 to 80 percent of cases [48].

In one mumps outbreak including 11 men (mean age 32 years, range 17 to 55) with
mumps orchitis, all required hospitalization for management of testicular pain and
swelling [49]. Of these, 82 percent had parotitis approximately 10 days prior to
development of orchitis, and 91 percent had never received mumps vaccination. In
another series including 67 men with orchitis (unilateral in 90 percent and bilateral in 10
percent), approximately half required hospitalization, and nine patients also had mumps
meningitis [50].

Testicular atrophy has been observed in 30 to 50 percent of unvaccinated patients

following mumps orchitis, and decreased fertility has been reported in cases of bilateral
orchitis; however, these complications are uncommon and sterility is very rare [49,51].
Sterility has been observed more frequently among men with bilateral orchitis than men
with unilateral orchitis [52]. No causal link has been definitively established between
mumps orchitis and the subsequent development of testicular cancer; a possible
association has been evaluated in several retrospective case series [51,53]. (See
"Epidemiology and risk factors for testicular cancer".)

Oophoritis develops in 5 percent of postpubertal females with mumps and presents with
lower abdominal pain, fever, and vomiting [1]. Mumps has also been associated with
mastitis and premature menopause; these are rare [1]. It is unknown whether mumps is
associated with female infertility.

Neurologic complications — The most common neurologic complications of mumps

include meningitis, encephalitis, and deafness. Prior to widespread vaccination, mumps
was a leading cause of viral meningitis and encephalitis as well as the most common cause
of acquired sensorineural hearing loss in children [54-59].

Less common neurologic syndromes associated with mumps infection include Guillain-
Barré syndrome/ascending polyradiculitis [60-62], transverse myelitis [63-66], and facial
palsy [67-70].

Meningitis — Aseptic meningitis is the most common neurologic complication of mumps

virus infection; it occurs in 1 to 10 percent of patients [55,71-74] and is three times more
common in males than in females [72,75]. Meningitis can occur before, during, or after
mumps parotitis. In some series, up to half of patients presented with meningitis in the
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absence of parotitis [71,75]. Clinical manifestations typically include headache, low-grade

fever, and mild nuchal rigidity.

Cerebrospinal fluid (CSF) examination may demonstrate 10 to 2000 white blood

cells/microL [56,72,74-76]. The predominating cells are usually lymphocytes, but an early
polymorphonuclear predominance may be seen. The CSF total protein concentration is
generally normal or mildly elevated. CSF glucose concentration can be mildly depressed,
but values below 30 to 40 mg/dL (1.7 to 2.2 mmol/L) have been reported.

Mumps aseptic meningitis generally has a benign course with full neurologic recovery and
no permanent deficits. (See "Aseptic meningitis in adults" and "Viral meningitis in children:
Clinical features and diagnosis", section on 'Other viruses'.)

Encephalitis — Prior to widespread vaccination, the incidence of mumps encephalitis was

approximately 1 in 6000 cases [55,56]. Widespread vaccination has been associated with
virtual disappearance of mumps encephalitis.

Patients with mumps encephalitis typically present with fever, altered consciousness,
seizures, and partial or complete paralysis [71-74]. As many as one-third of patients
present with encephalitis in the absence of parotitis [77].

The CSF profile is similar to that seen with mumps aseptic meningitis [76]. (See 'Meningitis'
above.)

Most patients with mumps encephalitis recovery completely. Cerebellitis and cerebellar
ataxia are usually self-limited [78]. Hydrocephalus has been reported rarely [79,80].

Deafness — Most patients with hearing loss associated with mumps present with acute
symptoms; occasionally, some exhibit a more gradual clinical course. Unilateral and
bilateral involvement has been reported. Symptoms improve in many cases, although
permanent deafness has been described [57,59].

Some patients with sensorineural hearing loss during mumps infection develop concurrent
vestibular symptoms [81,82]. One patient with acute deafness due to mumps infection
noted subsequent development of labyrinthitis and endolymphatic hydrops (Ménière
syndrome) [81].

Other complications — Less common complications occasionally associated with mumps

infection include thyroiditis [83-85], myocardial involvement, pancreatitis, interstitial
nephritis [86-90], and arthritis [91,92].
● Arthritis – Arthropathy is a relatively infrequent complication of mumps; it affects
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males more often than females. Both monoarticular involvement (of large joints such
as knee and hip) and polyarticular involvement have been described [45,92].
● Pancreatitis – Acute pancreatitis has been described in children and adults with
mumps infection [93-95]. The clinical course is typically benign; most cases resolve
with conservative management.
● Myocardial involvement – Mumps has been associated with myocardial involvement.
Transient electrocardiographic changes including ST segment depression may be
observed in up to 15 percent of patients with mumps [56,96,97]. Rare cases of rapidly
progressive myocarditis with dilated cardiomyopathy attributed to acute mumps
infection have been described [98-103].

DIAGNOSIS

Patients with typical manifestations — The diagnosis of mumps should be suspected in

patients with typical clinical manifestations (parotitis [or other salivary gland swelling],
orchitis, or oophoritis) and relevant epidemiologic exposure (respiratory or household
contact with an individual with known or suspected mumps). Individuals who are known to
be unimmunized are at highest risk for infection, though mumps should also be suspected
among vaccinated individuals with relevant symptoms and signs and epidemiologic
exposure. Patients being evaluated for mumps should be placed on droplet precautions.
(See 'Prevention' below.)

In the setting of parotitis (or other salivary gland swelling), the diagnosis may be
established by laboratory testing [104]. Laboratory confirmation of mumps virus infection
may be achieved via one or more of the following [104]:
● Detection of mumps virus RNA by reverse-transcriptase polymerase chain reaction
(RT-PCR; performed on serum or buccal or oral swab; the same specimen may also be
used for virus culture)
● Positive serum mumps immunoglobulin (Ig)M antibody (typically remains positive for
up to four weeks)

At the initial clinical presentation, two diagnostic specimens should be collected: a buccal
or oral swab (for mumps virus RT-PCR; the same specimen may also be used for culture)
and an acute-phase serum specimen (for serum mumps IgM antibody, acute-phase serum

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mumps IgG antibody, and serum mumps virus RT-PCR). The buccal or oral specimen
should be obtained as soon as possible after onset of parotitis (ideally within three days
and not more than eight days after parotitis onset) by gently massaging the parotid gland
prior to swabbing the area around Stensen's duct with a synthetic swab [104].

The IgM response may not be detectable until five days after symptom onset in some
cases. Therefore, if the acute-phase serum sample was collected ≤3 days after parotitis
onset and is negative for both mumps IgM antibody and mumps virus RT-PCR, serum
mumps IgM testing should be repeated on an additional serum sample collected 5 to 10
days after symptom onset.

Laboratory confirmation of mumps in individuals with history of mumps vaccination is

challenging. In general, serum mumps IgM is negative in approximately half of vaccinated
individuals (regardless of the timing of specimen collection). In addition, RT-PCR results
may be falsely negative since vaccinated individuals may shed lower quantities of virus and
may shed virus for a shorter duration. IgG seroconversion is no longer used routinely as a
marker of mumps infection in this setting, since among vaccinated persons a four-fold rise
is rarely detected [104].

Serologic tests cannot differentiate between vaccination and prior mumps exposure, and
the level of mumps IgG antibody needed for protection against mumps infection is not
known [105].

Patients with neurologic involvement — The diagnosis of mumps meningitis or

encephalitis should be suspected in patients with relevant clinical manifestations (fever,
headache, and nuchal rigidity suggest meningitis; fever and altered consciousness suggest
encephalitis) and relevant epidemiologic exposure (respiratory droplet or household
contact with an individual with known or suspected mumps). Individuals who are known to
be unimmunized are at highest risk, though mumps infection should also be suspected
among vaccinated individuals with relevant symptoms and epidemiologic exposure.

The confirmation of mumps meningitis or encephalitis can be established via lumbar

puncture. Typical cerebrospinal fluid CSF findings are described above. (See 'Meningitis'
above.)

Patients with CSF parameters consistent with viral infection warrant further CSF testing
with mumps RT-PCR and mumps virus culture. Polymerase chain reaction testing enables
prompt diagnosis [106-110]. Mumps virus is most readily isolated from CSF collected
during the first three days of symptoms; the techniques are time consuming and may
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require several days to establish a diagnosis [73,111]. Use of CSF mumps IgM antibody
testing has also been described [112].

Issues related to evaluation of aseptic meningitis and encephalitis are discussed further
separately. (See "Aseptic meningitis in adults" and "Viral encephalitis in adults" and "Viral
meningitis in children: Clinical features and diagnosis" and "Acute viral encephalitis in
children: Clinical manifestations and diagnosis".)

DIFFERENTIAL DIAGNOSIS

The differential diagnosis of mumps includes [113]:

● Parotitis

• Other viral causes of parotitis – Viral infections associated with parotitis include
influenza A virus, parainfluenza, adenovirus, coxsackievirus, Epstein-Barr virus
(EBV), cytomegalovirus, herpes simplex virus, human immunodeficiency virus
(HIV), and lymphocytic choriomeningitis virus [114-117]. Viral parotitis may be
distinguished from suppurative (bacterial) parotitis by a prodromal period
followed by acute swelling of the involved gland, which can last 5 to 10 days and is
often bilateral. Viral parotitis does not cause a purulent discharge from Stensen's
duct [114]. The approach to diagnosis depends on the clinical presentation (see
related topics).

Patients with EBV infection and a positive monospot test may have a cross-reactive
false-positive serum mumps IgM antibody test result. This is because the immune
response to EBV produces a polyclonal B cell stimulation with broadly reactive
cross-reacting antibodies. Among patients with true mumps infection, the
likelihood of a cross-reactive false-positive monospot test result is low. (See
"Infectious mononucleosis".)

• Suppurative (bacterial) parotitis – The microbiology of acute suppurative parotitis

is variable and is often polymicrobial; Staphylococcus aureus is the most
frequently isolated pathogen. Suppurative parotitis is characterized by sudden
onset of firm, erythematous swelling of the pre- and postauricular areas that
extends to the angle of the mandible, associated with exquisite tenderness;
systemic findings of high fevers, chills, and toxicity are typical. (See "Suppurative
parotitis in adults".)
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• Noninfectious etiologies of parotitis:

- Salivary gland stone – Sialolithiasis typically presents with pain and swelling;
painless swelling may occur. The diagnosis is clinically based on characteristic
history and physical examination. (See "Salivary gland stones".)
- Salivary gland tumor – Most patients with salivary gland tumor present with
painless mass or swelling. The evaluation includes radiographic imaging and
fine needle aspiration. (See "Salivary gland tumors: Epidemiology, diagnosis,
evaluation, and staging".)
- Sjögren's disease – Sjögren's disease may present with a gradual swelling of
the parotid or submandibular glands, typically bilaterally. The diagnosis is
established based on clinical criteria. (See "Clinical manifestations of Sjögren's
disease: Exocrine gland disease" and "Diagnosis and classification of Sjögren's
disease".)
- Sarcoidosis – Extrapulmonary sarcoidosis affecting the parotid glands (up to 5
percent of cases) is characterized by bilateral painless parotid enlargement;
the diagnosis is established by clinical and radiographic manifestations and
histopathologic detection of noncaseating granulomas. (See "Clinical
manifestations and diagnosis of sarcoidosis".)
● Epididymoorchitis

• Other viral causes of orchitis – Viral infections associated with orchitis in children
and adolescents include rubella, coxsackie, echovirus, lymphocytic
choriomeningitis virus, and parvovirus [118] (see related topics). (See "Causes of
scrotal pain in children and adolescents".)

• Bacterial etiologies – Bacterial causes of epididymitis include sexually transmitted

organisms (chlamydia and gonorrhea) and enteric organisms. The diagnosis is
established via urine culture and nucleic acid amplification testing for chlamydia
and gonorrhea. (See "Acute scrotal pain in adults: Evaluation and management of
major causes".)
● Lymphadenopathy – Cervical and pre- and postauricular lymphadenopathy may
occasionally be mistaken with the parotid swelling associated with mumps. Lymph
node swelling typically occurs behind the angle of the jawbone and does not cause
ear protrusion or obscure the angle of the mandible. Lymphadenopathy can be

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painful or painless, unilateral or bilateral, and localized or generalized. (See "Cervical

lymphadenitis in children: Diagnostic approach and initial management" and
"Peripheral lymphadenopathy in children: Evaluation and diagnostic approach" and
"Evaluation of peripheral lymphadenopathy in adults".)

TREATMENT

There is no specific antiviral therapy for treatment of mumps. Management consists of

supportive care and may include use of an analgesic/antipyretic agent such as
acetaminophen. Parotid discomfort may be managed by application of warm or cold packs.
Orchitis may be managed with nonsteroidal anti-inflammatory agents, support of the
inflamed testis, and cold packs.

PREVENTION

General principles — Control of mumps transmission is challenging since the virus is

present in saliva days before clinical parotitis occurs, and viral shedding can occur in
asymptomatic individuals.

Hospitalized patients with mumps should be isolated with droplet precautions until the
parotid swelling has resolved. Outpatients with mumps should avoid contact with others
from the time of diagnosis until at least five days after the onset of symptoms, by staying
home from school or work and staying in a separate room if possible [10]. (See "Infection
prevention: Precautions for preventing transmission of infection", section on 'Droplet
precautions'.)

Mumps infection is largely preventable by immunization prior to exposure. Following

mumps exposure, neither postexposure vaccination nor immune globulin has been shown
to prevent disease or lessen disease severity (in the absence of an outbreak). (See
'Outbreak settings' below and "Measles, mumps, and rubella immunization in adults".)

Immunization provides incomplete protection from mumps as immunity wanes over time.
In one outbreak, the incidence of mumps was lowest among those vaccinated more
recently (1.6 cases per 1000 if vaccinated within two years) and highest among those
vaccinated more remotely (17.6 cases per 1000 if vaccinated 16 to 23 years earlier) [119].

Outbreak settings — For individuals who are part of a group identified by public health
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authorities as being at increased risk for mumps because of an outbreak (the occurrence
of ≥3 cases linked by place and time), the approach to immunization is as follows:
● For individuals without evidence of immunity (unimmunized or unknown), mumps-
containing vaccine should be administered. In addition, all individuals (unimmunized,
incompletely immunized, or unknown) should be brought up to date with age-
appropriate vaccination (for adults this consists of two doses of measles, mumps, and
rubella [MMR] vaccine separated by at least 28 days) [104]. (See "Measles, mumps,
and rubella immunization in infants, children, and adolescents" and "Measles,
mumps, and rubella immunization in adults".)

It is reasonable to exclude unvaccinated students from schools affected by a mumps

outbreak, with readmission following vaccination. Given the incubation period of 12
to 25 days between exposure and onset of symptoms, unvaccinated individuals
should stay home from the 12th day after mumps exposure through the 26th day after
the onset of parotitis in the last person with mumps in the affected setting. Excluded
students may be readmitted immediately after they are vaccinated. Students who
have a history of one dose of MMR vaccination should be permitted to remain in
school and recommended to receive their second vaccine dose [104].
● For individuals who completed a two-dose series of a mumps virus-containing
vaccine prior to outbreak onset, we suggest a third MMR.

In January 2018, the Advisory Committee on Immunization Practices (ACIP)

recommended that individuals who are identified by public health authorities as
being part of a group at increased risk for mumps because of an outbreak who were
previously vaccinated with two doses of MMR vaccine receive a third MMR dose [6].

The benefit of third MMR dose increases with time since receipt of the second MMR
dose [119]; therefore, it is reasonable to prioritize booster vaccination to those who
have had longer intervals since their previous MMR immunization.

The approach to administration of a third MMR dose is supported by several observational

studies [119-123]. In one study including 20,496 enrolled university students, 259 students
were diagnosed with mumps during an outbreak (12.6 cases per 1000); 98 percent of
students had received at least two doses of MMR vaccine prior to the outbreak [119,122]. A
vaccination campaign was initiated targeting 19,705 students who had received no more
than two doses before the start of the outbreak; 4783 students received a third MMR dose
in the context of the outbreak. The attack rate was lower among the students who received
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three MMR doses than those who received two MMR doses (6.7 versus 14.5 cases per 1000
population; p<0.001). A multivariable regression analysis was performed with adjustment
for the amount of time following the third MMR dose and the time since receipt of the
second MMR dose; at seven days after receipt of a third MMR dose, booster vaccination
was associated with a 60 percent lower risk of mumps than receipt of a second MMR dose
(adjusted hazard ratio 0.40, 95% CI 0.26-0.62). The mumps attack rate was lowest among
students who had received their second dose of MMR within two years of the outbreak,
compared with those who completed the two-dose MMR series more than two years
earlier.

The available evidence is not sufficient to fully characterize the effect of a third MMR dose
on reducing the size or duration of an outbreak, and the duration of additional protection
conferred by a third MMR dose is not known [6].

SOCIETY GUIDELINE LINKS

Links to society and government-sponsored guidelines from selected countries and

regions around the world are provided separately. (See "Society guideline links:
Immunizations in adults".)

INFORMATION FOR PATIENTS

UpToDate offers two types of patient education materials, “The Basics” and “Beyond the
Basics.” The Basics patient education pieces are written in plain language, at the 5th to 6th
grade reading level, and they answer the four or five key questions a patient might have
about a given condition. These articles are best for patients who want a general overview
and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces
are longer, more sophisticated, and more detailed. These articles are written at the 10th to
12th grade reading level and are best for patients who want in-depth information and are
comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to
print or e-mail these topics to your patients. (You can also locate patient education articles
on a variety of subjects by searching on “patient info” and the keyword(s) of interest.)
● Basics topics (see "Patient education: Mumps (The Basics)" and "Patient education:
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Parotitis (The Basics)")

SUMMARY AND RECOMMENDATIONS

● Epidemiology and outbreaks – Mumps occurs worldwide. Since implementation of

routine vaccination in the United States, there has been a more than 99 percent
decrease in mumps cases; a few hundred to a few thousand cases continue to occur
each year ( figure 1). During outbreaks, mumps cases have occurred among
vaccinated individuals; however, high vaccination coverage helps limit the size,
duration, and spread of mumps. (See 'Epidemiology' above and 'Outbreaks' above.)
● Transmission – Mumps virus is highly infectious and is transmitted by respiratory
droplets, direct contact, or fomites. Viral shedding in respiratory secretions precedes
the onset of symptomatic illness. The incubation period is usually 16 to 18 days
(range 12 to 25 days) from exposure to onset of symptoms. In one review, the highest
rate of infectivity was present immediately preceding the onset of parotitis, with rapid
decrease of virus shedding over the next five days. (See 'Transmission' above.)
● Clinical manifestations – Mumps typically begins with a few days of fever, headache,
myalgia, fatigue, and anorexia; these symptoms and signs are usually followed by
development of salivary gland swelling within 48 hours. Parotitis may be unilateral or
bilateral; initial unilateral involvement may be followed by contralateral involvement a
few days later. Parotid swelling can last up to 10 days. Mumps is usually self-limited;
most individuals recover completely within a few weeks. (See 'Clinical manifestations'
above.)
● Complications – Complications of mumps include orchitis or oophoritis, neurologic
manifestations (including meningitis, encephalitis and deafness), and other less
common complications. Complications of mumps may occur in the absence of
parotitis. (See 'Complications' above.)
● Diagnosis

• When to suspect mumps – The diagnosis of mumps should be suspected in

patients with typical clinical manifestations (parotitis [or other salivary gland
swelling], orchitis, or oophoritis) and relevant epidemiologic exposure (respiratory
or household contact with an individual with known or suspected mumps).
Individuals who are known to be unimmunized are at highest risk for infection,
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though mumps should also be suspected among vaccinated individuals with

relevant symptoms and epidemiologic exposure. Patients being evaluated for
mumps should be placed on droplet precautions. (See 'Diagnosis' above.)

• Establishing the diagnosis – In the setting of parotitis (or other salivary gland
swelling), the diagnosis may be established by laboratory testing. Two diagnostic
specimens should be collected: a buccal or oral swab (for mumps virus reverse-
transcriptase polymerase chain reaction [RT-PCR]; the same specimen may also be
used for virus culture) and an acute-phase serum specimen (for serum mumps
IgM antibody, acute-phase serum mumps IgG antibody, and serum mumps virus
RT-PCR). (See 'Diagnosis' above.)
● Treatment – There is no specific antiviral therapy for treatment of mumps.
Management consists of supportive care and may include use of an
analgesic/antipyretic agent such as acetaminophen. Parotid discomfort may be
managed by application of warm or cold packs. Orchitis may be managed with
nonsteroidal anti-inflammatory agents, support of the inflamed testis, and cold
packs. (See 'Treatment' above.)
● Prevention

• Mumps infection is largely preventable via immunization prior to exposure.

Following mumps exposure, neither postexposure vaccination nor immune
globulin has been shown to prevent disease or lessen disease severity. (See
'Prevention' above.)

• For individuals who are part of a group identified by public health authorities as
being at increased risk for mumps because of an outbreak and who previously
completed a two-dose series of mumps virus-containing vaccine prior to outbreak
onset, we suggest a third MMR dose (Grade 2C). Incompletely immunized
individuals should receive the standard two-dose MMR series. (See 'Outbreak
settings' above and "Measles, mumps, and rubella immunization in adults".)

REFERENCES

1. Hviid A, Rubin S, Mühlemann K. Mumps. Lancet 2008; 371:932.

2. Centers for Disease Control and Prevention. Mumps Cases and Outbreaks. https://ww
w.cdc.gov/mumps/outbreaks.html (Accessed on June 21, 2023).
3. Dayan GH, Quinlisk MP, Parker AA, et al. Recent resurgence of mumps in the United
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States. N Engl J Med 2008; 358:1580.

4. Anderson LJ, Seward JF. Mumps epidemiology and immunity: the anatomy of a
modern epidemic. Pediatr Infect Dis J 2008; 27:S75.

5. 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 Recomm Rep 1998; 47:1.

6. Marin M, Marlow M, Moore KL, Patel M. Recommendation of the Advisory Committee

on Immunization Practices for Use of a Third Dose of Mumps Virus-Containing Vaccine
in Persons at Increased Risk for Mumps During an Outbreak. MMWR Morb Mortal
Wkly Rep 2018; 67:33.

7. Gupta RK, Best J, MacMahon E. Mumps and the UK epidemic 2005. BMJ 2005;
330:1132.

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