Mumps

Definition
Mumps is a systemic viral disease (one that affects the body as a whole) characterized by swelling and tenderness of the salivary glands. The prevalence of mumps has dropped significantly since the mumps vaccine came into widespread use in 1967.

Causes/associated factors
Mumps is caused by a paramyxovirus, a group of viruses that also causes measles and certain types of respiratory infections, such as croup. Once the virus is established within the respiratory system, it enters the bloodstream and travels through the body, often to the salivary glands. Mumps can occur at any time, but the condition is more prevalent in late winter and spring.
Before widespread use of the vaccine, mumps was most common during childhood. Today, it's most prevalent in young adults who have not been immunized. About 10 percent of adults are at risk for contracting mumps. Once you've had mumps, you're considered immune to repeat infections. Blood tests can verify immunity. Children born to women who are immune to mumps are usually protected by their mother's antibodies for the first six to nine months of life.


Transmission
Mumps is spread by inhaling or having direct contact with infected respiratory secretions, including saliva. The incubation period (time from exposure until symptoms appear, if they appear at all) is from 12 to 25 days, usually 14 to 18 days. You may be contagious from six to seven days before until nine days after the development of swollen glands. However, you're most contagious from three days before through four days after the swollen glands develop. Those with few or no symptoms are still considered contagious. Anyone with mumps should avoid susceptible people to help prevent spreading the infection.

Signs/symptoms
About one-fifth of all people who develop mumps have no symptoms, including most children under age 2. Those who do develop symptoms may notice:
low-grade fever
headache
fatigue
appetite loss
earache
sore throat
painful chewing and swallowing, especially with sour or acidic foods which stimulate saliva production
swollen glands just below and in front of the ears on one or both sides
rarely, swelling under the jaw when other salivary glands are affected

Diagnosis
If you suspect mumps, consult your doctor right away. Diagnosis is typically based on symptoms. If the diagnosis is in question, blood tests can provide confirmation. Less commonly, the virus may be detected through samples of saliva, urine or spinal fluid.

Treatment
Treatment is based on symptoms. If chewing is painful, stick to a soft or liquid diet. Drink lots of fluids, but avoid citrus juices if they irritate inflamed glands. The doctor may recommend acetaminophen to treat fever and muscle aches. Finally, get plenty of rest and be alert to possible complications.

Complications
Mumps is generally considered a mild disease. However, serious complications can develop, especially for adults. Complications may include:
deafness
myocarditis (inflammation of the lining of the heart)
nephritis (inflammation of the kidney)
pancreatitis (inflammation of the pancreas)
thyroiditis (inflammation of the thyroid, the gland that helps, in part, regulate the body's metabolism)
arthritis (inflammation of a joint)
for women, infections of the ovaries or breasts
for men, infections of the testicles (Although complete sterility is rare, up to 13 percent of males past puberty may experience impaired fertility related to a bout with mumps.)
meningitis (inflammation of the membranes covering the brain and spinal cord)
encephalitis (inflammation of the brain, which typically affects people over age 19 and may be fatal for up to 2 percent of those who develop it)

Pregnancy-specific information
Contracting mumps during the first trimester of pregnancy increases the risk of miscarriage. It does not increase the risk of birth defects.

Senior-specific information
The risk of mumps is low for people over age 65 because most people in this age group have had the mumps, usually as children.

Prevention
If you have mumps, do everything possible to stay away from others who may not be immune to the mumps virus for nine days after the gland swelling begins.
The most effective way to prevent mumps is to be immunized. The mumps vaccine is a live vaccine made of the weakened mumps virus. Children routinely receive the mumps vaccine in combination with the measles and rubella vaccines (known as MMR for measles, mumps and rubella). The first dose is given between ages 12 and 15 months, and a booster shot is given between ages 4 and 6.

For adults who were born in 1957 or later and haven't had the mumps or were never vaccinated, at least one dose of the vaccine is recommended. For those who have a high risk of exposure to the virus, a second dose should be given at least one month after the first. The vaccine is especially important for health care workers, international travelers and students. The mumps vaccine can be given by itself or in combination with the measles and rubella vaccines.

The mumps vaccine is injected in the front of the upper leg in infants and in the upper arm in older children and adults.

The mumps vaccine should not be given if you're pregnant or had a severe allergic reaction to gelatin, neomycin or a prior dose of the vaccine. Your doctor may also not recommended the vaccine if your immune system is not functioning properly (due to cancer, severe HIV infection or long-term treatment with steroid medication, for example).

Immunization may be delayed if you:

have received a blood product containing an antibody (such as platelets, a blood transfusion or an immune globulin) within the last three to 11 months (depending on the product), or will receive such a product in the next two weeks
have had thrombocytopenia (a decrease in the number of platelets, substances that help blood clot)
are currently ill