Understanding Mumps Outbreaks: Why They Occur and How to Stay Safe

Mumps is a contagious viral infection caused by paramyxovirus in childhood. Headache, fever, weakness, appetite loss, and the classic symptoms of parotid gland infection are the symptoms of mumps infection. Mumps commonly affects children between 2 and 12 years of age but can also affect adults.  

Mumps complications include inflammation of internal organs such as the testes, ovaries, breasts, pancreas, and brain. The mumps vaccine is part of the routine childhood vaccines to protect children from mumps attacks.  

How does mumps replication occur:

The virus enters the body using specific proteins. These form a protective shell surrounded by a fat layer through which the virus enters the body and becomes the target for various antibodies.  

Mumps transmission:

Mumps transmission occurs from infected to uninfected individuals when they are in close contact with the affected individuals.  

• Sharing the same house as the affected individuals  
• Face-to-face contact with the affected individuals  
• Sharing food or things that lead to salivary contact  
• Physical contact like kissing and dancing
• Sneezing, coughing, talking, playing, and participating in other activities  

Risk factors for mumps:

Some of the risk factors for mumps include:

• Individuals with a weaker immunity
• Individuals who travel internationally very frequently  
• Unvaccinated individuals  
• Individuals who stay in close contact, such as on college campuses  

What are mumps outbreaks:

Mumps is an endemic infection. However, sometimes unexpected increases occur due to epidemic outbreaks. Mumps outbreaks are three or more cases detected by time and place. Mumps outbreaks occur every 5 years as they are highly infectious and transmissible through direct contact, especially in unvaccinated areas and those closely staying, such as colleges. The leading causes of mumps outbreaks include:

• Reduced vaccine coverage  
• Inability to take the two doses of vaccines  
• Use of less effective vaccine strains  
• Withdrawal of mumps vaccine from the routine schedule  
• Waning of immunity to mumps vaccine over a period  

Mumps symptoms:

The symptoms of mumps include the following:

• Fever
• Weakness
• Headache
• Muscle soreness
• Appetite loss,  
• Parotid infection is one of the classic symptoms of mumps, which can occur on one or both sides. It causes severe pain between the earlobe and the lower jaw. Salivary ducts in the mouth will be red, and swollen glands will also be seen that reduce in a week. Chipmunk cheeks are characteristic features of mumps.  
• Testes swelling is another symptom of mumps that causes pain, tenderness, and swelling on one or both sides of the testes.  
• Some individuals may develop atrophy of the testes, leading to infertility in males.  
• Ovary inflammation is seen in females.  
• Nervous system findings include inflammation of the meninges, encephalitis, facial palsy, swelling in the head called hydrocephalus, and Guillain barre syndrome.  
• Severe symptoms of mumps that need immediate attention include uncontrolled high fever, stiffness in the neck, severe headache, confusion, vomiting, and seizures.  

Complications of mumps:  

Mumps complications include infections and inflammation of internal organs such as the pancreas, heart, breast, thyroid, kidneys, liver, and knees, as well as decreased platelets. However, there is inconsistency regarding the impact of mumps on babies. Spontaneous abortion is seen in the first trimester. No spontaneous abortion or premature birth was seen for mumps in pregnancy.  

Mumps diagnosis:

Mumps diagnosis is done after a clinical examination followed by blood tests.  

• The reverse transcriptase-polymerase chain reaction (RT-PCR) test collects saliva from the mouth by massaging the parotid gland for 30 seconds before taking the swab. The swab collection should be done within 3 days of parotid swelling and no later than 8 days after the symptoms.  
• Acute phase serum tests include blood tests for IgM and IgG antibodies. These blood tests may not show any results at least 5 days after the symptoms start in those who are not vaccinated and may not be seen in vaccinated people.  

Mumps management:

Mumps is a benign and self-limiting disease, which means it runs its course and subsides on its own after a few days. Supportive care is the primary treatment option for mumps. The following are some of the treatment strategies for mumps:

• Drinking lots of fluids  
• Gargling with warm salt water  
• Having soft diet  
• Avoid acidic foods that increase salivation  
• Sucking ice lollies helps relieve sore throat symptoms  
• Swollen glands should be treated with ice packs  
• Medications such as acetaminophen and ibuprofen help to reduce the fever  
• Aspirin should be avoided in mumps patients due to the risk of developing Reye’s syndrome.  

Mumps outbreak control:

Mumps outbreaks are commonly seen despite the vaccination status of the population. The following care is generally taken in cases of mumps outbreaks.  

• Suspected individuals with mumps should be tested.  
• All individuals should be thoroughly tested, as mumps can occur at any age.  
• All individuals with salivary gland swelling should be suspected of mumps.  
• Investigations for mumps should be carried out regardless of age, vaccination status, and travel history.  
• Mumps should also be suspected in individuals who have developed complications.
• All individuals with suspected mumps from an endemic area should be tested.  
• Laboratory tests should do confirmation of suspected cases.  
• False-negative results may be seen in vaccinated individuals, which does not rule out mumps diagnosis.
• For infected individuals who have developed parotid swelling in less than 3 days, a salivary swab can be collected by milking the parotid gland for RT-PCR tests.
• For individuals with parotid swelling that has lasted more than 3 days, salivary swabs and blood should be collected for IgM antibody detection.  
• For individuals who have developed mumps complications, a salivary swab, blood test for IgM, and an additional urine sample must also be collected.  
• The suspected mumps patients should be isolated for at least 5 days, even if the lab tests are negative or have not yet been revealed.  
• Confirmed cases of mumps outbreaks should also isolate themselves for at least 5 days.  
• Identification of the source of the mumps outbreak is necessary to control the mumps outbreak.
• All close contact individuals with the infected should be assessed for mumps immunity.  
• Close contact individuals should be advised to monitor symptoms if they may develop later.  
• Individuals who do not have immunity to mumps should be tested for IgG antibodies in their blood, as this may suggest a recent acute infection.  
• All close-contact individuals should be monitored for at least 25 days after mumps exposure and avoid large gatherings.  

Mumps vaccine:

The mumps vaccine is called the MMR vaccine, a combination of vaccination against measles, mumps, and rubella. Children are given two doses of this vaccine at ages 12-15 months and 4-6 years of age. The second dose can be given at least 28 days after the first dose.  

Adults who need the mumps vaccine include students after high school, healthcare professionals, and all international travelers. Women of reproductive age should get at least one dose of the mumps vaccine before getting pregnant. The mumps vaccine is safe in breastfeeding.  

Mumps vaccine is not advised for the following:

• Severe life-threatening allergies
• Pregnancy  
• Recent blood transfusion
• Tuberculosis  
• Recent vaccination  

Mumps prevention:

We present some mumps prevention tips if you have ever wondered how to stay safe from mumps. These include:

• getting a mumps vaccine  
• isolating yourself from infected individuals.  

Mumps is a self-limiting infectious disease caused by paramyxovirus infection. A mumps vaccine and isolation help control the symptoms. Fortis Hospital has expert clinicians who can identify mumps in its early stages and provide necessary treatment.