Mumps Virus

The mumps virus is an RNA paramyxovirus.10 The primary sites of infection are the parotids. The virus is spread, before parotitis and for 5 days after the parotid(s) begins to swell, primarily by airborne droplets of saliva and mucus from the mouth, nose, and throat of infected persons generated during speaking, breathing, coughing, or sneezing; by direct contact with saliva and mucus; and less frequently by touching freshly contaminated articles and environmental surfaces.

Clinical Features

Signs and symptoms of mumps usually begin 12 to 25 days after a person is exposed to the mumps virus. Fifteen to 20% of the patients with mumps infection are asymptomatic. The remainder experience nonspecific flu-like illness consisting of myalgia, anorexia, malaise, headache, and low-grade fever. Parotitis is characterized by acute onset tender swelling of the parotid(s) in approximately 50% of the patients.

In 25% of patients, only one parotid is involved and one parotid may swell before the other. Parotitis, which usually peaks in 1 to 3 days, may be associated with an outward lifting of the ear lobe, obscuration of the angle of the mandible, and erythema affecting Stensen’s ducts. Parotitis, lasts at least 2 days, but may persist longer than 10 days. The sublingual and submandibular glands are affected in about 10% of cases.

Prevention

Mumps is a vaccine-preventable disease and mumps infection confers life-long immunity. In the absence of acceptable presumptive evidence of immunity, active immunization is highly recommended. Prevaccination antibody testing before vaccination of HCP is not necessary. While separate monovalent formulation vaccines for measles, mumps, and rubella are available, the trivalent MMR vaccine is the vaccine of choice for routine adult vaccination.

Medical Management

There is no specific antiviral therapy for mumps. Medical care is supportive to help relieve symptoms and to address complications such as bacterial infections. HCP without evidence of immunity should be offered the first dose of MMR vaccine as soon as possible following exposure. However, antibodies develop slowly to the mumps component of MMR to provide effective prophylaxis after exposure and immunoglobulin is not routinely used for PEP.