Mumps

(Infectious parotitis)
 Objective …
• Mode of transmission, risk factors,
and the skills required for the
prevention and control of infectious
diseases
 Mumps
Acute viral diseases..
RNA virus.
The name comes from the British word
"to mump", that is grimace or grin.
The appearance of the patient as a result
of parotid gland swelling seems to be in
grin.
• Acute viral disease characterized by fever,
swelling and tenderness of one or more of
salivary glands usually the parotid and
sometimes the sublingual or submaxillary
glands
• Not all cases of parotitis are caused by mumps
infection but the other parotitis causing
agents don t produce parotitis on epidemic
scale
 Courtesey: This media comes from the Centers for Disease Control and
Prevention's Public Health Image Library (PHIL), with identification
number #130 Content Providers: CDC/NIP/Barbara Rice
 Clinical features

• Fever
• Swelling & tenderness of one
or more salivary glands,
usually parotid.
• Orchitis most commonly
unilateral (postpubertal males)
• The orchitis most commonly unilateral,
occurs in 20%- 30% of affected postpubertal
males
• Testicular atrophy occurs in one third of the
patient but the infertility is extremely rare …
• Mumps orchitis has been reported to be
a risk factor for testicular cancer…!
 Complications
• Orchitis
• Oophoiritis
• Spontaneous abortion.
• Mild form of meningitis.
• Encephalitis.
• Pancreatitis usually mild , 4% of cases
• Symptomatic aseptic meningitis up to 10 % of
cases
Courtesy : Adapted from Mims et al.
Medical Microbiology, 1993, Mosby
 • Epidemiology:
• Immunity - life long
• Environmental factor – winter and
spring are peak seasons.
• Reservoir : Humans.
• Mode of transmission – airborne
transmission, droplet spread , direct
contact with salivary of infected
person.
• I.P. - 16-18 days.
• Period of communicability: Virus has
been isolated from saliva (7 days before
to 9 days after the onset of parotitis ) and
from urine (6 days before to 15 days after
the onset parotitis). Maximum
infectiousness occurs between 2 days
before, 4 days after onset of illness.
• Acute mumps infection can be confirmed
by :
- A positive serological test for specific-
mumps IgM.
- A significant ( at least 4 folds ) rise in
serum mumps IgG.
- Isolation of mumps virus from (throat
swab, urine, CSF).
 Prevention !!
• Public education by health
departments and private physicians
should encourage immunization…
• Live attentuated mumps virus
vaacines
• MMR ….
 Control of patients and contacts
- Steps for outbreak measures ..!!!
- Report to local health authority..
- Respiratory Isolation for known cases
for 9 days from onset of parotitis,
exclusion from school or workplace
until 9 days after onset of parotitis if
susceptible contacts (those not
immunized ) are presents..
- Concurrent disinfection of articles
soiled with throat secretion.
- Investigation of contacts and source
of infection
- Immunization of susceptible
contacts.
Rubella (German measles)
AGENT – RNA VIRUS (TOGO
VIRUS FAMILY), GENUS
RUBIVIRUS.
• Rubella is a mild febrile viral disease with
diffuse punctate and maculopapular
rash…
• Clinically is usually indistinguishable from
febrile rash illness due measles,
echovirus, human herpesvirus 6, and
scarlet fever
Clinical feature:
•Low-grade fever
•Headache
•Conjunctivitis ( in adults)
•Mild coryza ( in adults)
•Tender lymphadenopathy (particularly
posterior auricular and ooccipital , posterior
cervical lymph nodes) the most characteristic
clinical feature !
•Leukopenia is common .
•Body rashes, Maculo-papular rashes
• WHO: case definition of suspected
Rubella case:
“any person with fever maculopapular rash
and adenopathy (cervical, subocciptal or
post- auricle !!.. Lab. Diagnosis is reguired”
• Lab. Confirmation is based on positive
rubella- specific IgM.
Image in a 4-year-old girl with a 4-day history of low-grade fever,
symptoms of an upper respiratory tract infection, and rash.
Courtesy of Pamela L. Dyne, MD.
Complications
• Encephalitis
• Intrauterine death
• Spontaneous abortion
• Congenital rubella syndrome (CRS) up to
90% of infants born to infected mothers who
infected in first trimester …fall to 10-20% by
16th … defects are rare when maternal
infection occurs after 20th week of gestation .
 Congenital rubella syndrome
(CRS)
• Include :
- Deafness , cataract , congenital
glaucoma, microcephaly,
meningoencephalitis, mental
retardation, patent ductus arteriosis,
arterial septal defect,
hepatosplenomegaly.
 Salt and pepper retinopathy
http://www.kellogg.umich.edu/theeyeshave
it/congenital/retinopathy.html
Courtesy Courtesy: Jonathan Trobe, M.D. - University
http://phil.cdc.gov/phil_images/2003072 of Michigan Kellogg Eye Center
4/28/PHIL_4284_lores.jpg

Content Providers(s): CDC Creation

Date: 1976
• Source of infection – Respiratory secretion
• Reservoir : Human
• Immunity –life long
• Infants born to immune mothers are protected for 6-9
months !
• Environmental factors –winter and spring season
• Transmission – droplet, direct contact with patient,
vertical transmission
• I.P 14-17 days.
• Period of communicability 1 week before and at least
4 days after onset of rashes.
• Infants with CRS may shed virus for months after
birth
 Prevention
• Public education by health
departments and physicians for
encouraging immunization.
• MMR vaccine: Live attenuated virus
vaccine helps prevent measles,
mumps, and rubella. Children 1 year of
age and older get dose given between
ages 15 and 18 months and again
between ages 4 and 6 years…
U.S. Dept. of Health & Human Services, Wikimedia Commons 28
Two approaches to prevent CRS:
A) Prevention CRS only through
immunization of girls or women of
childbearing age … or
B) Elimination of Rubella as well as CRS
through universal immunization of
infants and ensuring immunity in
women of childbearing age ….
 Vaccines and pregnancy
• The Rubella vaccines should be avoided
in pregnancy due to theoretical but never
demonstrated, teratogenic risk …!

• IG given after exposure early in

pregnancy may not prevent infection or
viraemia
Age Vaccines Note
Deep subcutaneous injection
9 months Measles into the upper arm.

12-15 Deep subcutaneous injection

months MMR -1 into the upper arm.

Deep subcutaneous injection

5 years MMR -2 into the upper arm.
 Contraindication for live virus
vaccine
- Patient with primary immune deficiency: e.g.
lymphoma, leukemia..
- Patient with sever acute illness: e.g. upper
respiratory disease.
- Patient with anaphylactic hypersensitivity.
- Vaccine should be given at least 14 days
before IG or blood transfusion.
Control of patients and contacts
 Control of patients and contacts
-Report to local health authority..
- Isolation In hospitals, patients suspected of having
rubella ..attempt to prevent exposure of nonimmune
pregnant women …!
-Exclude children from schools and adults from work
for 7 days after onset of rash.
-Infants with CRS may shed virus for prolonged periods
of time. All person having contact with infants with CRS
should be immune to rubella, also contact between
these infants and pregnant women should avoided!!!
- Investigation of contacts and source of
infection… such contacts should be tested
serologically ( IgM ) !
- Immunization of contacts will not necessary
prevent infection or illness, passive
immunization with IG not indicated