I recently saw a patient in the ED with fever, bilateral parotitis and trismus with inability to open mouth
greater than 1 finger width, concerning for mumps. I thought this would be a great opportunity to review this disease and recent epidemiology data from the US
MUMPS!
–viral illness
—symptoms appear 14-18 days s/p infection. however, may be as short as 12 or as long as 25 days
–those infected are contagious 2 days before sx onset and 5 days after sx onset
—symptoms:
- parotitis (95% of cases),
- low-grade fever,
- HA and stiff neck,
- malaise,
- loss of appetite,
- hoarse voice,
- orchitis (s/p puberty, may experience testicular atrophy, but rarely aspermia),
- oophoritis (7% of post-pubertal females),
- breast inflammation,
- deafness u/l or b/l (1 in 20k cases).
- infrequently causes aseptic meningitis.
—ASYMPTOMATIC INFECTION OCCURS IN 15-20% OF CASES
–prevention: need 2 dose MMR. 80-90% effective
—treatment: supportive care. NSAIDs, antipyretics, IVF, isolation. in patients with orchitis, also supportive care (bed rest, NSAIDs, testicle supports, ice packs)
–testing: IgG and IgM at UVa (PCR and viral cx available elsewhere)
| Mumps exposure history | IgM | IgG | Comments | References |
| Unvaccinated; no history of mumps | + | + or − | IgM may be detected for weeks to months; low levels of IgG may be present at symptom onset | Meurman et al. 1982; Sakata et al. 1985 |
| 1–dose vaccine history | + or − | Likely + | 50% of serum samples collected 1–10 days after symptom onset were IgM-positive; 50%–80% of serum samples collected >10 days after symptom onset were IgM-positive | Narita et al. 1998; Jin et al. 2004; Krause et al. 2007 |
| 2–dose vaccine history | + or − | Likely + | 13%–15% of serum samples collected 1–3 days after symptom onset were IgM-positive* | Bitsko et al. 2008; Rota et al. 2009 |
*30%–35% of buccal samples collected 1–3 days after symptom onset were positive by real-time RT-PCR among persons with 2 doses of MMR (Bitsko et al. 2008; Rota et al. 2009)
epidemiology in the US
–reported US cases in 2014 from 1/1 to 8/15: 965 (438 reported in 2013)
US outbreaks in 2014:
–central Ohio/ Columbus: 8/3-9/20. 484 cases. highest case report since 1979 outbreak (930)
–U of W-Madison: 25 confirmed cases as of 8/8/14
–U of I-Urbana-Champaign: 14 confirmed cases in 2014
Submitted by Paddy Fannon.
SOURCES:
The Centers for Disease Control and Prevention. Website: Fast Facts About Mumps (24 March 2010). Retrieved 24 November 2014. http://www.cdc.gov/mumps/about/mumps-facts.html
The Centers for Disease Control and Prevention. Website: 2014 Mumps Cases and Outbreaks (18 August 2014). Retrieved 24 November 2014. http://www.cdc.gov/mumps/outbreaks.html#outbreaks-2014
The Centers for Disease Control and Prevention . Graph: Overview of Laboratory Confirmation by IgM Serology (13 April 2010). Retrieved 24 November 2014. http://www.cdc.gov/mumps/lab/overview-serology.html
Wharton M, Cochi SL, Williams WW. Measles, mumps and rubella vaccines. Infect Dis North Am. 1990; 4(1):47
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