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Mumps: On the move

Snow, Michelle MSPH, MSHR, BSN, RN

doi: 10.1097/01.NURSE.0000369874.30585.20
Department: COMBATING INFECTION
Free

Michelle Snow is working on her PhD dissertation.

CAUSED BY A PARAMYXOVIRUS, mumps is spread via respiratory secretions, saliva, or fomites. In 1964, an estimated 212,000 cases of mumps were reported in the United States; in 2004, only 258 cases were reported. In 2006, an outbreak of mumps occurred in 45 states, mostly on college campuses, resulting in over 6,000 reported cases.1 Recently, another mumps outbreak was reported in New York and New Jersey, resulting in 1,521 lab-confirmed cases as of February 12, 2010.2 The United States isn't the only country facing a resurgence of mumps; the United Kingdom had 5,683 confirmed cases and an estimated 100,000 cases reported from 2003 to 2006.3

The resurgence of mumps can be attributed to poor adherence with recommended immunization schedules for the mumps, measles, and rubella (MMR) vaccine; delayed diagnosis and isolation of mumps-infected individuals from the community; and susceptible individuals living or spending time in close quarters such as schools and dormitories.1

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Signs and symptoms

Common signs and symptoms of mumps include fever, headache, myalgia, fatigue, and anorexia, typically followed by parotid gland swelling (parotitis). The painful swelling can be unilateral or bilateral. Up to half of patients with mumps have only mild or no parotitis. Severe complications, although rare, include sensorineural hearing loss, meningitis/encephalitis, orchitis, mastitis, oophoritis, spontaneous abortion, and pancreatitis.1

Someone with mumps can transmit the virus 3 days before signs and symptoms appear and for 9 days afterward. The incubation period ranges from 12 to 25 days.1

Mumps is diagnosed from patient history, physical exam, and buccal or serum lab tests. A buccal swab between days 1 and 3 of parotitis is the preferred viral test. Serum samples are collected between days 1 and 3 and repeated if the test result is negative between days 5 and 7.1 If lab test results confirm mumps, follow facility policy to report the case to the local health department. Mumps is a CDC Nationally Notifiable Infectious Disease Surveillance System reportable infection.1

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Treatment and prevention

Mumps is a self-limiting infection that normally requires only rest, fluids, and antipyretic and anti-inflammatory medication. To prevent disease spread, patients with a suspected or confirmed case of mumps should be kept in isolation for 5 days.1

Use meticulous hand hygiene and follow droplet precautions when treating a patient who has or may have mumps. Keep the patient at least 3 feet away from others and provide a mask.4 Instruct the patient and family about stringent hand hygiene; teach them to sanitize shared objects and personal items, such as doorknobs, toys, and food utensils.

The MMR and MMRV (mumps, measles, rubella, and varicella) vaccines are given in two doses: one at age 12 to 15 months and another at age 4 to 6 years. Children can be given the second dose of the MMR vaccine before age 4 as long as it's given at least 28 days after the first dose. The MMRV vaccine can be administered only through age 12.1

The MMR vaccine doesn't provide 100% immunity against mumps, but the first dose provides approximately 80% protection with an increase to 90% after the second dose.1 Individuals who experience a severe allergic reaction to the first dose shouldn't receive the second dose. Advise women who are considering getting pregnant to use birth control for at least 4 weeks after receiving the second dose. Adults don't need to be vaccinated if they have serology tests that confirm they're immune to measles, mumps, and rubella, or if they were born before 1957. Pregnant women and individuals with life-threatening allergic reactions to gelatin or neomycin shouldn't receive the vaccines.1

Breastfeeding isn't a contraindication for either the mother or the infant, but an immunocompromised person shouldn't receive either vaccine. Caregivers and family members of patients with compromised immunity can be given the MMR or MMRV vaccines with no added risk to the immunocompromised family member.1

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REFERENCES

1. Centers for Disease Control and Prevention. Mumps .
2. Mumps outbreak continues in New York and New Jersey: February 12, 2010 .
3. Jick H, Chamberlin DP, Hagberg KW. The origin and spread of a mumps epidemic: United Kingdom, 2003–2006. Epidemiology. 2009;20(5):656–661.
4. Updated recommendations for isolation of persons with mumps. MMWR. 2008;57(40):1103–1105.
© 2010 Lippincott Williams & Wilkins, Inc.