11 - Mumps

Summary

INTRODUCTION

Once considered a common childhood illness, mumps has dramatically declined in incidence with the widespread usage of the mumps vaccine, though there have been significant sporadic outbreaks in the United States recently. Mumps is still a common disease in countries without widespread vaccination programs.

EPIDEMIOLOGY

Mumps is an enveloped negative-sense RNA virus belonging to the Paramyxovirus family. In the United States between 2001 and 2005, only 200–300 cases of mumps were diagnosed annually. Between January and May, 2006, however, there were more than 2,500 outbreaks in 11 states. Unvaccinated individuals are particularly at risk for infection, though the majority of outbreak cases have occurred among those who have been vaccinated and have not achieved immunity.

Current recommendations are that children receive a first dose of MMR vaccine at ages 12 to 15 months and a second dose at ages 4 to 6 years. Two doses of MMR vaccine are also recommended for students attending colleges and other post–high school institutions and who do not have proof of two prior doses or other evidence of immunity.

CLINICAL FEATURES

Patients with mumps commonly present with painful, bilateral parotid swelling (Figure 11.1). They may also have fevers, dry mucous membranes, dysphagia, and trismus (Table 11.1). On questioning, the patient may describe prodromal symptoms including malaise, fevers, and a sore throat. Milking of saliva along Stenson's duct should reveal clear saliva (purulent saliva suggests a bacterial etiology).