Mumps (parotitis)

Mumps (parotitis)

Acute viral illness

Parotitis and orchitis described by Hippocrates
in 5th century BC
Viral etiology described by Johnson and
Goodpasture in 1934
Frequent cause of outbreaks among military
personnel in prevaccine era
Viral etiology

Caused by mumps virus.

Family: paramyxoviridae.
Genus: parainfluenza virus.
Pleomorphic, enveloped with helical nucleocapsid.
The viral genome is ss-RNA, with negative polarity.
The viral envelope is covered with two glycoprotein spikes,
the HN which posses both hemagglutinine and
neuraminidase activities , and the fusion glycoprotein.
Viral etiology

The fusion protein enables the virus to form

multinucleated giant cell by fusing infected cells together.
Mumps (parotitis)

Inflammation of the salivary glands.

Mainly the parotid glands are affected.
There are three pairs of salivary glands.
Two parotid glands, the largest, one in each cheek, over the
angle of the jaw , in front of the ear.
Two sub mandibular glands at the back of the mouth.
Two sub-lingual glands, under the floor of the mouth.
Salivary glands .
 Mumps Pathogenesis

Respiratory transmission of virus

Replication in nasopharynx and regional lymph
nodes
Viremia 12-25 days after exposure with spread to
tissues
Multiple tissues infected during viremia
 Mumps Clinical Features

Incubation period 14-18 days

Nonspecific prodrome of myalgia, malaise,
headache, low-grade fever
Parotitis in 30%-40%
Up to 20% of infections asymptomatic
Transmission

By inhalation of respiratory droplets, during sneezing and

coughing.
The virus sheds in saliva.
Also, the virus can be transmitted by direct contact with
saliva.
Clinical Features

Mumps is a highly infectious child-hood disease.

Mumps starts with moderate fever, malaise, pain on
chewing or swallowing, particularly acidic liquids.
Followed by inflammation of the salivary glands,
particularly the parotid glands. (parotid swelling)
The swelling appears in front of the ear. (ear ache)
Parotitis .
Parotitis .
Complications

CNS of clinical cases 15%

involvement

Orchitis in post- pubertal male 50%-20%

Pancreatitis 5%-2%

Deafness 1/20,000

Death Average 1 per year (1980 1999)

Prognosis & lab diagnosis

In the absence of complications recovery is usual.

Lab. Diagnosis, by detection of IgM antibody to mumps

virus.
Prevention

A live attenuated vaccine is available (MMR).

It contains mumps, measles and rubella attenuated
virus strains.
Administered in one dose, intramuscularly or
subcutaneously.
The vaccine is protective.
Passive immunization against mumps

Immune globulin ineffective for

postexposure prophylaxis
does not prevent disease or reduce
complications

Transplacental maternal antibody appears

to protect infants for first year of life
 Mumps Vaccine

Composition Live virus (Jeryl Lynn strain)

Efficacy 95% (Range, 90%-97%)

Duration of
Immunity Lifelong

Schedule >1 Dose

Should be administered with measles and rubella (MMR) or with

measles, rubella and varicella (MMRV)
MMR Vaccines
treatment

There is no specific anti-viral drug therapy.

Treatment is supportive by treating symptoms, using
antipyretics and analgesics.
Child care

The child must rest in bed until the fever goes away.
Isolate the child, to prevent spreading the disease to
other.
Use analgesics and anti-pyretic to ease symptoms.
Avoid food that require chewing.
Avoid sour foods that stimulate saliva production.
Drink plenty of water.
Use cold compress to ease the pain of swelling
glands.
 Mumps Outbreak, 2006
Source of the initial cases unknown
Outbreak peaked in mid-April
Median age of persons reported with mumps was 22
years
Highest incidence was among young adults 18-24 years
of age, many of whom were college students
Transmission of mumps virus occurred in many
settings, including college dormitories and healthcare
facilities

MMWR 2006;55(42):1152-3
 Factors Contributing To Mumps
Outbreak, 2006
College campus environment
Lack of a 2-dose MMR college entry requirement or lack
of enforcement of a requirement
Delayed recognition and diagnosis of mumps
Mumps vaccine failure
Vaccine might be less effective in preventing
asymptomatic infection or atypical mumps than in
preventing parotitis
Waning immunity