Background

Mumps (epidemic parotitis) is an acute contagious disease caused by the mumps virus (paramyxovirus). It typically starts with a few days of fever, headache, muscle aches, tiredness, and so on, and is followed by swelling of salivary glands. Painful swelling of the salivary glands – classically the parotid gland – is the most typical presentation. Painful testicular swelling (orchitis) and rash may also occur. The symptoms are generally not severe in children. In teenage males and men, complications such as infertility or subfertility are more common, although still rare in absolute terms.

The disease is generally self-limiting, running its course before receding, with no specific treatment apart from controlling the symptoms with pain medication. In addition, up to one-third persons infected with the mumps virus do not show symptoms, so it is possible to be infected and spread the virus without knowing it. Males past puberty who develop mumps have a 20–30% risk of orchitis, painful inflammation of the testicles.

In the pre-vaccination era, it was an illness in infants worldwide. After implemention of vaccination, it’s still a significant threat to health in developing countries, and outbreaks still occur sporadically in developed countries. There is no specific treatment for mumps. Supportive care should be given as needed. If someone becomes very ill, they should seek medical attention.

Epidemiology

As international research shows that 80% of adults that without got MMR during childhood still have mumps specific-antibody. In addition, up to of one-third of persons infected with the mumps virus does not show symptoms. As many as child less than two-year age infected with the mumps virus are asymptomatic. An additional 40% to 50% may have only nonspecific or primarily respiratory symptoms.

Mumps occurs worldwide. Then the mumps incidence peaks predominantly in late winter and spring, but the disease has been reported throughout the year.  The largest percentage of cases occurred among persons aged 4–9years.

Between 2014 and 2016, there were 880, 772and 616 reported cases respectively in Taiwan. All reported cases should be collected and ship samples to Taiwan CDC Lab to test between years of 2006 to 2007.  The positive rates were below 1%.  Since 1st July 2008, the mumps sampling-related regulation has been revised as who meet sampling criteria, people with mumps clinical case definition and epidemiologic linkage to another probable or confirmed case or linkage to a group/community defined by public health during an outbreak of mumps, would be sampled by health worker of local health department or hospital.

Mumps Surveillance in Taiwan

Taiwan National Infectious Disease Statistics System

Prevention and Control

Vaccination

1. The first dose of mumps-containing vaccine should be given on or after the first birthday.  Susceptible individuals should receive vaccination before entering the teenage years.
2. In 1992, Taiwan ACIP recommended the first dose of mumps vaccine should be given at or after 15 months of age.
3. In 2001, Taiwan ACIP recommended the second dose of mumps vaccine for elementary school-age children.
4. Currently, two doses of MMR vaccine are recommended to children at or after 12 months of age and at the age of 5 before entering elementary school.

Management

1. Case report：

If healthcare providers or personnel at schools, childcare facilities, and other institutions responsible for reporting a suspected case identify someone who met the mumps case definition or criteria for laboratory testing should notify the local health department within one week.

2. Case Isolation：

Current evidence suggests that patients diagnosed with mumps should be isolated for 5 days from the onset of symptoms. Use droplet isolation precautions in addition to standard precautions in healthcare settings.

3. Quarantine： 

Suspectible people should avoid attending school or on duty from the 12th to 25th days after the first unprotected exposure to mumps.

4. Investigation：

(1)Identification of suspected or confirmed cases of mumps is important in the initiation of control measures to recognize if the spread of the disease among persons who do not have presumptive evidence of immunity.

(2) Person with mumps clinical case definition and epidemiologic linkage to another probable or confirmed case or linkage to a group/community defined by public health during an outbreak of mumps would meet sampling criteria. Please collect and ship samples to Taiwan CDC to identify scale of mumps epidemic.

5. Contact management：

Immunize susceptible contacts to reduce likelihood of infection upon future exposures. Immune globulin (IG) is not effective as a preventive measure or as postexposure prophylaxis, and not recommended.

6. Treatment: None.

FAQs

1. What is mumps?

Mumps is an acute viral infection that is spread from person to person. It is a potentially serious disease for children and young adults and is very common in young children not vaccinated against it.

2. What are the symptoms of infection?

Symptoms of mumps include fever, headache, malaise and swollen, tender salivary glands (usually the parotid gland which is located just below the front of the ear). Mumps often gives the appearance of swollen cheeks or jaw.

Symptoms of mumps begin to appear 12 to 25 days (usually 18 days) after exposure. Approximately one-third of infected individuals will have no symptoms. An additional 40%-50% may have only non-specific or primarily respiratory symptoms (particularly in children <5 years of age).

Symptoms tend to decrease after one week and have usually resolved after 10 days.

3. How is mumps spread?

Mumps is spread from person to person by coughing or sneezing and by direct contact with saliva or discharges from the nose and throat of infected individuals. People infected with mumps may spread the infection to others even when they do not have any symptoms. Mumps virus has been isolated from 7 days before onset of parotitis to 9 days after, but individuals with parotitis are most infectious in the 2-3 days before and the 4-5 days after onset of symptoms.

4. What complications have been associated with mumps?

Complications of mumps may occur and can include:

(1) Meningitis.

(2) Testicular inflammation (orchitis).

(3) Encephalitis (brain inflammation) is rare (reported in 0.02-0.3% of the cases).

(4) Deafness has been reported in approximately 1 in 20,000 patients.

(5) Other complications may include mastitis, arthritis, nephritis, pancreatitis, or myocarditis. Mumps fatality rate is reported at between 1-3 deaths per 10,000 cases.

5. Diagnosis of acute mumps infection:

Since 1st July 2008, the mumps sampling-related regulation has been revised as who meet sampling criteria, people with mumps clinical case definition and epidemiologic linkage to another probable or confirmed case or linkage to a group/community defined by public health during an outbreak of mumps, would be sampled by health worker of local health department or hospital. Sample collection items include 2ml serum specimens or parotid duct swabs (an oral fluid sample taken by a swab). Parotid duct swabs yield the best viral sample. This is particularly true when the salivary gland area is massaged approximately 30 seconds prior to swabbing the buccal/parotid duct, so that the specimen contains the secretions from the parotid or other salivary duct glands. Efforts should be made to obtain the specimen as soon as possible after onset of parotitis or meningitis.

6. Is there any treatment for mumps?

There is no specific treatment for mumps. Supportive care should be given as needed. If someone becomes very ill, they should seek medical attention.

7. What can be done to prevent mumps?

Vaccination is the best way to prevent you from ill. Mumps vaccine is given as part of the measles-mumps-rubella (MMR) vaccine. Since 2001, Taiwan ACIP has recommended two-dose of MMR vaccination schedule. MMR vaccine would be given routinely at or after 12 months of age and at the age of 5 before entering elementary school.

More Information

1. WHO|Mumps

2. USA CDC|Mumps