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In this issue Sonia Hall of the Practice Nurse Association begins a series of articles covering the common childhood illnesses.

It is widely known that mumps is an acute viral infection caused by Paramyxovirus. In mumps the salivary or parotid glands typically swell and become painful. It can either be unilateral or bilateral. This creates the characteristic 'hamster' appearance of a swollen face, particularly just below and in front of the ear. The glands continue to swell over two to three days, and the swelling gradually decreases as the temperature falls. It is not unusual for swelling to last for around eight days.

The incubation period for mumps is generally accepted as being between 14 and 21 days. However, a person who has mumps is contagious from about six days before their glands swell, until about five days afterwards. Mumps is spread by airborne or droplet transmission.

The mumps virus frequently affects the nervous system and maybe symptomatic or asymptomatic. Meningism (headache, photophobia, neck stiffness) occurs in up to 15% of cases and mumps viruses are often identified in the cerebrospinal fluid. Neurological complications, including meningitis and encephalitis, may precede or follow parotitis and can also occur in its absence.

Other common complications include pancreatitis, oophoritis and orchitis (around 25% of post pubertal men). Sub-fertility following bilateral orchitis has rarely been reported. Sensorineural deafness is a well recognised complication of mumps, with estimates of its frequency varying from one in 3400 cases to one in 20,000. Nephritis, arthropathy, cardiac abnormalities and rarely, death have been reported. Other symptoms of mumps may include:

• Pain when chewing and swallowing
• Sore throat
• Fever
• Feeling tired
• Loss of appetite
• Mild abdominal pain
• Dry mouth
• Headache

There may be swelling around the ovaries (in girls) or testes (in boys after puberty).

Around a third of people with the mumps virus develop no symptoms and, in most other people, the symptoms are fairly mild.

Most cases of mumps may be diagnosed on clinical grounds alone, but if in doubt the diagnosis is typically confirmed by the demonstration of specific antibodies, a virus culture from the saliva or from the cerebrospinal fluid in meningitis.

Prompt notification of mumps to the local health protection unit (HPU) is normally required to ensure that public health action can be taken promptly. Notification is usually based on clinical suspicion and should not await laboratory confirmation. Since 1994, few clinically diagnosed cases have been subsequently confirmed to be true mumps. Confirmation rates do increase, however, during outbreaks and epidemics. Typically, oral fluid samples would be obtained from all notified cases, other than in a large epidemic. Advice on this procedure can be obtained from the local HPU.

Once infected, the management of mumps is primarily concerned with relief of the symptoms so it is generally accepted best practice to offer antipyretics and to take care with oral hygiene, as the mouth will become very dry due to lack of saliva. Orchitis might be relieved by a corticosteroid such as prednisolone.

Before the introduction of the MMR vaccination in 1988, mumps occurred commonly in school-age children, and more than 85% of adults had evidence of previous mumps infection. Mumps was the cause of 1200 hospital admissions per year in England and Wales and was the commonest cause of viral meningitis in children.

Today, the NHS National Immunisation Programme predominantly uses the MMR vaccination at 13 months followed by a pre-school booster. , There is currently a worldwide shortage of single mumps vaccine so this is typically not a realistic option for parents.

Antibody response to the mumps component of the MMR vaccine is widely known to develop soon enough to provide a normally effective prophylaxis after exposure to suspected mumps. Where it is too late to provide effective post-exposure prophylaxis with MMR, the vaccine should work against future exposure to measles, mumps, and rubella. If the individual is already incubating any of these diseases, the MMR vaccine is unlikely to exacerbate the symptoms. Of course, as with any vaccine, MMR doesn’t guarantee immunity and may carry the risk of side effects.

 

References

1. http://www.statistics.gov.uk/cci/nugget.asp?id=1334
2. www.nhs.uk/MMR
3. http://www.immunisation.nhs.uk/Vaccines/MMR/The_vaccine/mmr_vaccine
 

This article is the sole work of the author and does not necessarily reflect the views of Johnson & Johnson Medical Limited or any of its affiliated business or companies, nor does the publication of this article on the CareMail website comprise an endorsement of its contents, for which Johnson & Johnson Medical Limited and its affiliated businesses and companies accept no responsibility. In particular no such Johnson & Johnson entity shall be liable for any damages or injury resulting from any reliance placed on any information provided in this article or for any possible inaccurate or misleading data or statements contained therein.

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