RISK FACTORS: Highly contagious, 90% transmission rate for non-immune household contacts, Urban epidemics, non-vaccinated population, Usual communicable period is 24 hrs before to 72 hrs after onset of parotitis, Incubation period usual
RISK FACTORS
• Highly contagious, 90% transmission rate for non-immune household contacts
• Urban epidemics, non-vaccinated population
• Usual communicable period is 24 hours before to 72 hours after onset of parotitis
• Incubation period usually 18 days
• Rubini strain mumps vaccine previously used in some areas of Europe and Asia is ineffective
GENERAL MEASURES
• Supportive and symptomatic care
• For patients with orchitis, ice packs to scrotum can help relieve pain
• Scrotal support with adhesive bridge while recumbent and/or athletic supporter while ambulatory
• Use IV fluids if severe nausea or vomiting accompanies pancreatitis
SURGICAL MEASURES N/A
ACTIVITY Mumps orchitis - bedrest and local supportive clothing, such as wearing 2 pairs of briefs, or adhesive-tape bridge
DIET Liquids if cannot chew
PATIENT EDUCATION: 9 days after onset of pain
• Orchitis is common in older children but rarely results in sterility
• Immunization of family may protect against later exposures but not the present one
DRUG(S) OF CHOICE Corticosteroids or a non-steroidal anti-infl ammatory may diminish pain and swelling in acute orchitis and arthritis mumps, but usually not necessary. May use acetaminophen for fever and/or pain.
ALTERNATIVE DRUGS
• Mumps arthritis may improve with corticosteroids or a non-steroidal anti-inflammatory
• Interferon-alpha 2b for 7 days may be used in severe bilateral orchitis to prevent infertility
PATIENT MONITORING Most cases will be mild. Monitor hydration status.
PREVENTION/AVOIDANCE
• 2 doses of live mumps vaccine or MMR recommended at 12-15 and 4-6 years of age. Vaccine is 95% effective.
Adverse effects of vaccine: most common proven effect is ITP at an incidence of 3.3 per 100,000 doses.
• Immune globulin is not effective in preventing mumps
• Postexposure vaccination does not protect from recent exposure
• Isolate hospitalized patients until 9 days past onset
POSSIBLE COMPLICATIONS
• May precede, accompany, or follow salivary gland involvement and may occur (rarely) without primary
involvement of the parotid gland
• Meningitis or encephalitis may present 10 days after first symptoms of illness. Aseptic meningitis is typically
mild, but meningo-encephalitis may lead to seizures, paralysis, hydrocephalus or, in 2% of cases, death.
• Acute cerebellar ataxia has been reported after mumps infections; self-resolving in 2-3 weeks
• Cerebrospinal fl uid (CSF) pleocytosis , usually lymphocytes found in 65% of cases with parotitis
• Orchitis common (30%) in postpubertal boys, starts within 8 days after parotitis, fever, swollen testis of 4 day duration, fertility impaired in 13% but absolute sterility is rare
• Oophoritis in 7% of postpubertal females, no decreased fertility
• Pancreatitis, usually mild
• Nephritis, thyroiditis, or arthralgias are rare
• Myocarditis - usually mild, but may depress ST segment, may be linked to endocardial fibroelastosis
• Deafness - 1/15,000 unilateral nerve deafness, may not be permanent
• Infl ammation about the eye (rare)
• Dacryoadenitis, optic neuritis
EXPECTED COURSE/PROGNOSIS
• Complete recovery is usual, immunity is permanent
• Sensorineural hearing loss in 4% of adults - transient
• Rare recurrence after 2 weeks may be recurrent nonepidemic parotitis