Description

Mumps is a viral illness characterized by swelling of the salivary glands (parotitis). The incubation period from exposure to onset of symptoms is generally 16-18 days (range 12-25) (1). Transmission is by respiratory droplets, saliva or contact with contaminated fomites. Patients are usually contagious from 1 to 2 days (occasionally as long as 7 days) before symptom onset until 9 days after the onset of symptoms.

Occurrence

Following licensure of mumps vaccine in 1967, the recommendation for its routine use in 1977 and the subsequent expanded recommendation for a two-dose measles-mumps-rubella (MMR) vaccine schedule for measles control in 1989 (2), the reported incidence of mumps declined steadily. The number of mumps cases reported annually in the United States remained below 300 during 2001-2005 (3, CDC unpublished data). However, a multistate outbreak with more than 4,000 reported cases, involving mainly Midwest states, occurred in 2006 (4, 5, CDC unpublished data). The source of the outbreak was unknown; however, the United Kingdom (U.K.) experienced a mumps epidemic that peaked in 2005 (6), and the mumps strain identified in the U.K. epidemic was the same as the one isolated in the U.S. outbreak. Mumps virus remains endemic in many countries throughout the world, and mumps vaccine is used in only 57% of World Health Organization member-countries (7).

Risk for Travelers

The risk of exposure to mumps among travelers can be high; thus all travelers leaving the United States should be immune to mumps. According to the current Advisory Committee on Immunization Practices recommendations (8), acceptable presumptive evidence of immunity to mumps for international travelers includes:

1. documented administration of two doses of live mumps virus vaccine, or
2. laboratory evidence of immunity, or
3. birth before 1957, or
4. documentation of physician-diagnosed mumps.

Clinical Presentation

Onset of illness is usually nonspecific: fever, headache, malaise, myalgia, and anorexia. In unvaccinated populations, an estimated 30%-40% of mumps infections produce typical parotitis, as many as 20% of infections are asymptomatic, and up to 50% are associated with nonspecific or primarily respiratory symptoms. Although mumps is generally a mild and self-limited disease, complications of mumps infection can include deafness; orchitis, oophoritis, or mastitis (inflammation of the testicles, ovaries or breasts, respectively); pancreatitis; meningitis/encephalitis; and spontaneous abortion. With the exception of deafness, these complications are more frequent in adults than in children (9, 10).

Prevention

Although vaccination against mumps is not a requirement for entry into any country (including the United States), travelers leaving the United States or living abroad should ensure they are immune to mumps.

VACCINATION

Mumps vaccine contains live, attenuated mumps virus. It is available as a monovalent formulation and in combination formulations, such as MMR and measles-mumps-rubella-varicella (MMRV). Combined MMR or MMRV vaccines are recommended whenever one or more of the individual components are indicated to provide optimal protection against measles, rubella, and varicella. Postlicensure studies in the United States demonstrated that one dose of mumps vaccine was 78%-91% effective in preventing clinical mumps with parotitis (9). Studies of vaccine effectiveness during outbreaks suggest substantially higher levels of protection with a second dose of MMR (11, 12). Vaccine effectiveness of approximately 90% has been reported for two doses of mumps-containing vaccine (12).

Mumps vaccine has not been demonstrated to be effective in preventing infection after exposure; however, it can be administered postexposure to provide protection against subsequent exposures. Immune globulin is not effective in prevent-ing mumps infection following an exposure and is not recommended.

Adverse Reactions, Precautions and Contrainidications to Mumps Vaccine

Refer to the Measles (Rubeola) section of this chapter for information on reactions following MMR or MMRV vaccine and additional precautions and contraindications.

General Vaccine Recommendations, Pediatric and Catch-Up Schedules, and Recommendations for Special Populations

Refer to Chapters 1, 8 and 9.

Treatment

There is no specific antiviral therapy for mumps, and the basic treatment consists of supportive therapy.

References

1. American Academy of Pediatrics. Mumps. In: Pickering LK, editor. Red book: 2006 report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003. p. 464-68.  
2. CDC. Measles prevention: recommendations of the Immunization Practices Advisory Committee on Infectious Diseases (ACIP). MMWR Morbid Mortal Wkly Rep. 1989;38(No. S-9):1-18.
3. CDC. Summary of notifiable diseases – United States, 2004. MMWR Morbid Mortal Wkly Rep. 2006:53:1-79.  
4. CDC. Mumps epidemic – Iowa, 2006. MMWR Morbid Mortal Wkly Rep. 2006;55:366-8.
5. CDC. Update: multistate outbreak of mumps – United States, January 1-May 2, 2006. MMWR Morbid Mortal Wkly Rep. 2006;55:559-63.
6. CDC. Mumps epidemic – United Kingdom, 2004-2005. MMWR Morbid Mortal Wkly Rep. 2006;55:173-5.  
7. World Health Organization. Global status of mumps immunization and surveillance. Wkly Epidemiol Rec. 2005;80:418-24.
8. CDC. Notice to readers: Updated recommendations of the Advisory Committee on Immunization Practices (ACIP) for the Control and Elimination of Mumps. MMWR Morbid Mortal Wkly Rep. 2006;55:629-630.
9. Plotkin SA. Mumps Vaccine. In: Plotkin SA, Orenstein WA, eds. Vaccines. 4th ed. Philadelphia, PA: WB Saunders;2003:441-69.
10. Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L. Measles, mumps and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 1998;47(RR-8):1-57.
11. Briss PA, Fehrs LH, Parker RA, Wright PF, Sannella EC, Hutcheson RH, et al. Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity. J Infect Dis. 1994;169:77-82.
12. Harling R, White JM, Ramsay ME, Macsween KF, van den Bosch C. The effectiveness of the mumps component of the MMR vaccine: a case control study. Vaccine. 2005;23:4070-4.