Mumps
Description
Mumps is a viral illness characterised by parotitis preceded by a prodrome that may include fever, headache, malaise, myalgia, and anorexia.
Occurrence
Following licensure of the vaccine in 1967, mumps cases in the United States have steadily decreased from an estimated 100,000 to 200,000 annually to fewer than 300 cases reported in 2003.
Risk for Travellers
The risk for exposure outside the United States remains high. The WHO reports that 102 (53%) of their member states include mumps in their routine vaccination programme; however, inclusion of mumps in the routine vaccination programme of a country should not be interpreted as lowered risk for the traveller. Although incidence data are not generally available, mumps remains common in many parts of the world, including Western Europe.
Clinical Presentation
Up to 50% of mumps infections may produce only nonspecific upper respiratory symptoms, 30%-40% result in parotitis, and 15%-20% are asymptomatic. Mild aseptic meningitis may affect 4%-6% persons infected, while more rare central nervous system complications can result in permanent sequelae, including deafness. Orchitis may occur in up to 50% of postpubertal males.
Prevention
Mumps vaccine contains live, attenuated mumps virus. In the United States, it is licensed as a single antigen preparation (Mumpsvax), combined with live attenuated measles vaccine (M-M-Vax), or combined with both live attenuated measles and rubella vaccine (M-M-R II or MMR). Currently, it is available only as single antigen mumps vaccine (Mumpsvax) or combined with both measles and rubella vaccine (MMR).
Although not required for entry into any country, persons travelling or living abroad should ensure that they are immune to mumps. Travellers should receive MMR vaccine, which would offer immunity not only against mumps but measles and rubella as well. Persons may be considered immune to mumps if they have a) documentation of one or more doses of mumps-containing vaccine on or after their first birthday; b) physician-diagnosed mumps; c) laboratory evidence of mumps immunity; or d) were born before 1957. Mumps vaccine or MMR may be administered to any person if there is reason to believe they may be susceptible. Immunity to mumps is of particular importance for adolescent and adult males because of the risk of orchitis.
In the United States, a dose of MMR is recommended at 12-15 months of age and a second dose at age 4-6 years. A single dose of mumps vaccine, either as single antigen or in combination, has a protective efficacy of 90%-96% and the second dose should provide protection to most people who do not respond to the first dose.
Mumps vaccine has not been demonstrated to be effective in preventing infection after exposure; however, it can be administered post-exposure to provide protection against subsequent exposures. Immune globulin is not effective in preventing mumps infection following an exposure and is not recommended.
The most common adverse reactions to mumps vaccine are parotitis and low-grade fever. Typically, mumps vaccine in the US is administered as MMR vaccine. Refer to the travellers' health information on Measles (Rubeola) for information on reactions following MMR vaccine and additional precautions and contraindications.
Treatment
No specific treatment is available for persons with mumps. Treatment is supportive.
Bibliography- American Academy of Paediatrics. Mumps. In: Pickering LK, editor. Red book: 2003 report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Paediatrics; 2003. p. 439-43.
- CDC. 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 Immunisation Practices (ACIP). MMWR. 1998;47(RR-8):1-57.
- CDC [homepage on the Internet]. Atlanta: National Immunisation Programme; [updated 2003 Sept 6; cited 2004 Oct 7]. Available from http://www.cdc.gov/nip/diseases/mumps/default.htm.
- Heymann DL, editor. Control of communicable diseases manual. 18th ed. Washington DC: American Public Health Association; 2004.
- World Health Organization. Mumps virus vaccine. Wkly Epidemiol Rec. 2001;76:346-55.
-Francisco Averhoff
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