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Painful swelling of the salivary glands (classically the parotid gland) and fever is the most typical presentation. Painful testicular swelling and rash may also occur. While symptoms are generally not severe in children, the symptoms in teenagers and adults can be more severe and complications such as infertility or subfertility are relatively common, although still rare in absolute terms.,, The disease is generally self-limited, running its course before waning, with no specific treatment apart from controlling the symptoms with painkillers.
Causes and risks
The mumps are caused by a paramyxovirus, and are spread from person to person by saliva droplets or direct contact with articles that have been contaminated with infected saliva. The parotid glands (the salivary glands between the ear and the jaw) are usually involved. Unvaccinated children between the ages of 2 and 12 are most commonly infected, but the infection can occur in other age groups. Orchitis (swelling of the testes) occurs in 10–20% of infected males, but sterility only rarely ensues; a viral meningitis occurs in about 5% of those infected. In older people, the central nervous system, the pancreas, the prostate, the breasts, and other organs may be involved.
The incubation period is usually 18 to 21 days, but may range from as few as 12 to as many as 35 days. Mumps is generally a mild illness in children in developed countries. After adolescence, mumps tends to affect the ovary, causing oophoritis, and the testes, causing orchitis. The mature testis is particularly susceptible to damage from mumps which can lead to infertility. Adults infected with mumps are more likely to develop severe symptoms and complications.
The more common symptoms of mumps are:
Other symptoms of mumps can include sore face and/or ears and occasionally in more serious cases, loss of voice.
Signs and tests
A physical examination confirms the presence of the swollen glands. Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, a test of saliva, urine, or blood may be carried out; a newer diagnostic confirmation, using real-time nested polymerase chain reaction (PCR) technology, has also been developed . An estimated 20%-30% of cases are asymptomatic. 
There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck area and by Acetaminophen/Paracetamol (Tylenol) for pain relief. Aspirin use is discouraged in young children because of studies showing an increased risk of Reye's syndrome. Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms.
Patients are advised to avoid fruit juice or any acidic foods, since these stimulate the salivary glands, which can be painful.
Death is very unusual. The disease is self-limiting, and general outcome is good, even if other organs are involved. Sterility in men from involvement of the testes is very rare. After the illness, life-long immunity to mumps generally occurs.
Known complications of mumps include:
The most common preventative measure against mumps is immunization with a mumps vaccine. The vaccine may be given separately or as part of the MMR immunization vaccine which also protects against measles and rubella. In the US, MMR is now being supplanted by MMRV, which adds protection against Chickenpox. The WHO recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 15 months. The American Academy of Pediatrics recommends the routine administration of MMR vaccine at ages 12-15 months and at 4-6 years. In some locations, the vaccine is given again between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. Efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%., The Jeryl Lynn strain is most commonly used in developed countries, but has been shown to have reduced efficacy in epidemic situations. The Leningrad-Zagreb strain is commonly used in developing countries, but appears to have superior efficacy in epidemic situations.
Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. Disagreeing, the WHO, the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the British Medical Association and the Royal Pharmaceutical Society of Great Britain currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.
Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000). In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%). The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968; in 1998 there were only 666 cases reported.
Canada (April 2007)
Dalhousie University, Halifax, Nova Scotia. Dalhousie University was struck with an outbreak of the mumps confirmed in many students with suspected cases in dozens of others. The main causes of the large outbreak include students being unaware of being infected, and other students who knowingly ignored quarantine restrictions. The outbreak began after St. Patrick's Day, and has spread beyond the university community, with confirmed cases reaching 350 cases of mumps since February, including about 24 new cases that have surfaced during the week ending June 9, 2007. The end of the university year in May meant that many students travelled to their homes across the country carrying the infection, leading to a large scale spread, the extent of which is still not clear, although the prevalence of the disease lay in people aged 17 to 24. Roughly 50 personnel of the Halifax-based navy ship HMCS Glace Bay were sent home as a precaution. Reported outbreaks have begun in New Brunswick (Approximately 100 cases), Prince Edward Island (2 cases), Ontario (3 cases confirmed, 5 suspected), West Coast of Newfoundland (2 cases), and Toronto (3 cases). On October 3rd 2007, a new case was reported at Nipissing University/Canadore College, in North Bay, Ontario. On October 26th, four additional cases were reported in Alberta at the University of Lethbridge and Lethbridge College; By October 30th, this had expanded to 5 confirmed.. As of Nov. 16 there have been a total of 54 cases in Alberta. As of Nov. 29 there have been 57 confirmed cases in Calgary Alberta, six at the University of Calgary as well as outbreaks at SAIT Polytechnic and Mount Royal College. A vaccination program is currently being undertaken to re-immunize all students in post-secondary by the Calgary Health Region. Vaccinations are also occurring at universities in Edmonton. As of December 11, 2007 the Alberta government has suspended its inoculation program after several people suffered severe allergic reactions.
United Kingdom (2004–2007)
In the United Kingdom over the last two years, a mumps outbreak has involved more than 70,000 patients. The cause of the outbreak is low immunity in those too old to have received MMR, but young enough to have not developed natural immunity through exposure. A catch-up programme of immunisation of under twenty five year olds, particularly in university towns such as Exeter was implemented.
United States (2005-2006)
Although there may not be a direct link with the mumps outbreak in Ireland, United States CDC Director Dr. Julie Gerberding has been quoted stating that the genotype from the U.S. outbreak, "in the early cases of this outbreak, was the same genotype of virus that was associated with the United Kingdom outbreak."  Entrez Gene contains a placeholder database record for a new Mumps gene; the record is dated 23 Feb 2006.
In early 2006, for reasons still not fully understood, the state of Iowa experienced a large surge in the number of reported mumps infections. According to the New York Times, college students accounted for about a quarter of the 245 cases , while about half of the cases are people aged seventeen to twenty five. Doctors are attributing the rise in mumps case frequency to low vaccination rates in Iowa's youth, coupled with the close quarters in dormitories, classrooms and cafeterias.
According to Canadian media reports , there may be something novel about this mumps strain which indicates a standard MMR-series vaccination is not 95% effective, as was thought.
There have been three confirmed cases of the mumps at Southern Illinois University-Carbondale, Two cases at Loyola University Chicago, and has spread to three other neighboring counties in the Southern Illinois area. There has also been one confirmed case at Knox College, in Galesburg (Western Illinois). Wheaton College has also been affected by 93 cases since early September (as of Jan 9).
North Carolina (2006)
South Dakota (2006)
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Mumps". A list of authors is available in Wikipedia.|