Mumps Causes, Symptoms, Diagnosis, Treatment, Prevention, Vaccine

Mumps Causes, Symptoms, Diagnosis, Treatment, Prevention, Vaccine

What is mumps?

Mumps is a viral infection that causes fever, headache, and swelling and tenderness of the salivary glands (below the ear).

Most adults born before 1957 have been infected naturally and are probably immune. Mumps can occur in unimmunized children, or adolescents and young adults who graduated from school prior to the law requiring mumps immunization.

  • Mumps is a highly contagious viral infection with an incubation period of 14-18 days from exposure to onset of symptoms. The duration of the disease is approximately 10 days.
  • The initial symptoms of mumps infection are nonspecific (low-grade fever, malaise, headache, muscle aches, and loss of appetite). The classic finding of parotid gland tenderness and swelling generally develops the third day of illness. The diagnosis is generally made without the need for laboratory tests.
  • Serious complications of mumps include meningitis, encephalitis, deafness, and orchitis.
  • The MMR vaccine provides 80% effective immunity against mumps following a two-dosage schedule (12-15 months with booster at 4-6 years of age).
  • No specific therapy exists for mumps. Warm or cold packs for the parotid gland tenderness and swelling is helpful. Pain relievers (acetaminophen [Tylenol] and ibuprofen [Advil]) are also helpful.

What causes mumps? How is mumps transmitted?

Mumps virus is a single strand of RNA housed inside a two-layered envelope that provides the virus its characteristic immune signature. Only one type of mumps virus has been demonstrated to exist (in contrast to the many virus types that can cause the common cold).

Mumps is highly contagious and has a rapid spread among members living in close quarters. The virus most commonly is spread directly from one person to another via respiratory droplets. Less frequently, the respiratory droplets may land on fomites (sheets, pillows, clothing) and then be transmitted via hand-to-mouth contact after touching such items. The incubation period from exposure to the virus and onset of symptoms is approximately 14-18 days. Viral shedding is short lived and a patient should be isolated from other susceptible individuals for the first five days following the onset of swelling of the salivary (parotid) glands.

What are risk factors for contracting mumps?

Failure to be immunized completely (two separate doses) with exposure to those with mumps

Age: The highest risk of contracting mumps is to children between 2-12 years of age

Season: epidemics of mumps were most likely during the winter/spring seasons

Travel to high-risk regions of the world: Africa, general Indian subcontinent region, and Southeast Asia. These areas have a very low rate of vaccination.

Weakening immune system: either due to diseases (for example, HIV/AIDS, cancer) or medication (oral steroid use for more than two weeks, chemotherapy)

Born before 1956: Generally, these individuals are believed to have experienced mumps infection in childhood. However, if they did not, they are at risk for adult mumps disease. A blood test may be obtained to determine immunity and is worthwhile if any doubt exists regarding prior mumps infection.

What are the signs and symptoms of mumps in children and adults?

Your symptoms will usually start two to three weeks after you have come into contact with someone who has the virus. This time is called the incubation period. About one in three people with mumps don't get any symptoms.

  • Swelling and pain of one or both parotid glands are the usual main symptoms. The parotid glands are the main salivary glands. They are just below the ears and you cannot normally see or feel them. The salivary glands make saliva which drains into the mouth.
  • The mouth may feel dry.
  • Chewing and swallowing may be sore.
  • Fever (high temperature), headache, feeling tired and being off food may develop for a few days. These symptoms may occur before you develop swelling of your parotid gland.
  • Mild abdominal (tummy) pain may occur.
The swelling of the parotid glands usually lasts for 4-8 days. Mumps is normally a mild illness, but complications sometimes occur. This is why immunisation is important.

There may be no symptoms, or only very minor ones. It is thought that about 3 in 10 people who contract the mumps virus have no symptoms. Rarely, complications alone occur without the usual symptoms occurring first.

The immune system makes antibodies during the infection. These clear the virus and then provide lifelong immunity. It is therefore very rare to have more than one episode of mumps.

Complications of mumps

Mumps usually gets better on its own without causing any other problems. However, a small number of people who have mumps go on to develop more serious health problems. Some of the main ones are listed below.

  • If you're a man, inflammation of your testicles and epididymis (the place where sperm are stored in your testicles) can occur. This is known as epididymo-orchitis and happens to around four in 10 men who get mumps. This can lead to sperm problems in a small number of men, for example, producing fewer or less active sperm. However, it's rare for mumps to affect your fertility.
  • Inflamed ovaries (oophoritis). This can develop in about five in 100 women who have mumps. However, it’s unlikely to affect your fertility.
  • Inflammation of the covering of your brain (viral meningitis). This develops in about one in 10 people who have mumps. Meningitis can also lead to encephalitis, which is inflammation of your brain. This is a more serious health problem and can be life-threatening. However, this is rare.
  • Loss of hearing happens to about four in 100 people with mumps – but this is usually temporary.
  • Inflamed pancreas (pancreatitis). Your pancreas is an organ in your abdomen that produces digestive juices, which break down the food you eat. About four in 100 people with mumps develop pancreatitis, but it's usually mild.
If you, or your child, develop any of the following symptoms, you should see your GP.

  • Swollen, painful testicles which may be accompanied by a fever and chills.
  • Pain in your abdomen.
  • Stiffness in your neck.
  • Sensitivity to light and vomiting.
You should also see your GP if you have symptoms of mumps and are in the early part of your pregnancy. If you're in the first three months of pregnancy and catch mumps, there may be an increased risk of having a miscarriage.

How is mumps diagnosed?

The diagnosis of mumps is primarily one of clinical acumen. Supportive laboratory studies are generally done to support the clinical impression. The purpose of these laboratory studies is to exclude other viruses that may give a similar clinical presentation as well as exclude very infrequent similarly presenting parotid gland enlargement (for examples, salivary gland cancer, Sjögren's syndrome, IgG-4 related disease, sarcoidosis, side effects of thiazide diuretics, etc.).

Mumps is a notifiable disease. This means that if your GP thinks you have mumps, by law he or she has to report it. Your GP will contact your local Health Protection Unit, and they will arrange a testing kit to confirm that you have mumps. This usually means taking a swab from your mouth and having it tested for the virus. You may also have a blood test.

What is the treatment for mumps in adults and in children?

There is no specific treatment for mumps. Mumps usually gets better on its own about a week after your symptoms start. However, you can treat the symptoms of mumps, which will make you feel more comfortable.

You do not usually need any treatment if your symptoms are mild.

If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You should rest and drink enough fluids to prevent you from becoming dehydrated – usually six to eight glasses of water a day. Don't drink fruit juice made from citrus fruits, such as oranges or grapefruits, as this can make the pain in your salivary glands worse. 

Give children lots to drink, particularly if they have a fever. Fruit juice may stimulate the parotid gland to make more saliva, and cause more pain.

You may find that using an ice pack on your swollen salivary glands also helps. Don’t put ice directly onto your skin as this can damage your skin.

If your symptoms get worse, or haven't improved after a week, contact your GP.

Prevention of mumps

The best way to prevent mumps is to be vaccinated against it.

The mumps vaccine is given in one injection together with the measles and rubella vaccines, known as MMR vaccine.

The vaccine is given to toddlers at 12 to 15 months of age.

Most people who get the vaccine will not experience any side effects. In rare instances, some swelling of the glands in the cheeks and under the jaw may appear, lasting for a few days. This could happen from one to two weeks following the shot.

There is no upper age when the MMR vaccine can be given, so adults and older children can also have the vaccine. The two vaccinations must be given at least one month apart. However, you shouldn’t have the MMR vaccine if you’re pregnant. See out frequently asked questions for more information about this. If you have been in contact with someone who has mumps, being vaccinated afterwards won't prevent you from catching it.

Teenagers and adults who do not know if they are protected against mumps should ask their doctor, nurse or clinic about the MMR vaccine.

Is there a vaccine for mumps? Mumps immunisation

Prior the introduction of the mumps vaccine in 1948, epidemics during the winter/spring would commonly affect young schoolchildren with secondary spread to other family members not yet immune. Until an effective vaccine program was introduced, isolation of the infected individual was the only public-health control option. The current MMR strain used in the United States and other developed countries was licensed in 1967. Another strain is more commonly used in developing countries. Both strains provide approximately 80% immunity following the two-vaccination schedule detailed below.

The Centers for Disease Control and Prevention (CDC) recommends a combination vaccine (MMR) to children at 12 to 15 months of age with a booster dose at 4 to 6 years of age. During periods of possible epidemics, the booster dose may be administered after a minimum of 28 days following the initial vaccination. The MMR vaccination is designed to prevent measles, mumps, and rubella (German measles). Adults born after 1956 should receive at least one MMR vaccination. Those born prior to 1956 are generally found to have acquired natural immunity and no vaccination is necessary.

More common side effects of the MMR vaccine include stinging/burning at the injection site, mild temperature, and mild skin rash. The temperature and skin rash most commonly develop five to 12 days postvaccination and occur more commonly after the first vaccination. Some recipients of the vaccine will note mild enlargement and tenderness of local (for example, neck) lymph nodes. It should be noted that these relatively common side effects are considerably less severe than acquiring any of the three illnesses the MMR vaccine is designed to prevent. In extremely rare situations, more severe reactions affecting the nervous system, gastrointestinal system, and digestive organs, the skin, and others may occur.

A very small population should not receive the MMR vaccine. These include those with a compromised immune system (HIV/AIDS, cancer, those receiving more than two continuous weeks of steroids) or who are allergic to any component of the vaccine, including gelatin or neomycin. MMR vaccines are very unlikely to produce a severe reaction to those who are egg white allergic. Daily use of inhaled steroids (such as those used to control certain pulmonary diseases such as asthma, COPD, etc.) is not a contraindication to the MMR vaccine. Patients with a mild illness (for example, the common cold) may safely receive the MMR vaccine. Conception should be avoided until at least 28 days following vaccination.

Multiple international studies have not demonstrated any causative relationship between administration of the MMR vaccine and the development of autism.