mumps: out and about with epidemic parotitis

25 Nov

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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