With the focus on measles in the recent months, less attention has been given to the outbreaks of mumps described in the press at several universities in UK.
Mumps and Measles usually go ‘hand in hand’ when people talk about the Measles-Mumps-Rubella vaccine/MMR.
What is Mumps?
Mumps is a viral infection cause by a paramyxovirus. It is highly contagious. It is more common in the winter months and spring, although can occur throughout the year.
It is generally a childhood illness peaking at ages 5-9. However it can affect adults and when it does, the complications are more likely to be serious.
How It Spreads
The virus replicates in the passages of the upper airways (nostrils/mouth/throat/voicebox) and passes from person to person through direct contact with saliva or infected airway droplets by:
- Sharing food and cutlery
- Coughing
- Sneezing
- Kissing
- Contaminated surfaces
Mumps has an incubation time (the length of time from coming in to contact with the virus and the illness) of 2-3 weeks with the average being 18 days.
Symptoms
50% of infections are very mild and can cause:
- Pain and swelling of the salivary glands (parotitis) which can affect one or both cheeks*. The swollen gland pushes the ear lobe up and out. As swelling worsens, the angle of the jaw is often no longer visible.
- Low grade fever
- Headache
- Aching muscles
- Feeling sick, no appetite
- Generally feeling unwell
Approximately 1 in 3 people infected with the mumps virus don’t get any symptoms at all!
*Don’t forget that parotitis can occur with other infections, not just mumps, such as the ‘flu, highlighting the need for laboratory confirmation if the diagnosis is in doubt. In fact in the last quarter of 2018 in England, of the 1241 suspected cases tested for mumps, only 170 cases were confirmed1.
Diagnosis / Testing
A diagnosis of mumps is usually clinical meaning the doctor makes the diagnosis following examination of the patient without laboratory testing. However if testing is required, it is usually done by an ‘oral fluid swab’ – a saliva swab checked for the virus’ DNA or antibodies against the virus. The sample is taken by gently brushing the teeth and gums with a sponge swab and is therefore painless. Mumps can also be tested for in blood samples, as well as urine samples and spinal fluid in specific situations.
Severe complications
Some complications of mumps are known to occur more frequently among adults than children, and complications occur less frequently in vaccinated patients.
- Pancreatitis (inflammation of the pancreas)
- Orchitis (testicular swelling in men) and oophoritis (ovarian swelling in women)
- Meningitis (infection of the brain lining)
- Deafness
- Very rarely encephalitis (brain tissue infection causing permanent nerve damage in the rest of the body)
- Infection in the first trimester may lead to miscarriage
Treatment
Treatment is simply supportive, such as rest, drink plenty of fluids and over-the-counter medicines to reduce any fever and discomfort. As mumps is caused by a virus and not by bacteria, antibiotics are not used as a treatment.
Prevention
There has been a mumps vaccine available since the late 1960’s and immunisation against mumps in the UK became routine in 1988 as a combined measles-mumps-rubella/MMR vaccine.
MMR is a live vaccine meaning it contains measles, mumps and rubella viruses but they are weakened and therefore should not be given to anyone who has a low immune system (either due to drug treatment e.g. chemo or an underlying illness e.g. HIV). A single dose of the MMR used in the UK gives between 61-91% protection against mumps, so two doses of MMR are required to produce long-term mumps protection and this became routine in 1996.
The second MMR vaccine can be given at any time after the first MMR vaccine, as long as at least three months have elapsed between doses.
The current UK MMR vaccination schedule is given at age 1, and then at age 3 years and 4 months.
It is worth noting that mumps may still occur in fully vaccinated individuals, and if it does, it is less likely to lead to serious complications requiring hospitalisation as mentioned above.
Who is at risk?
- Anyone without full vaccination (2 doses) of MMR
- College students
- International travellers
- Anyone born before the 1960’s
Notifiable disease
Mumps is a notifiable disease meaning when it is suspected, the healthcare professional is legally required to inform their local Health Protection Team/HPT. The HPT then usually arrange testing of oral fluid by a saliva pack.
There was a slight decrease in number of mumps cases in England in 2018 was 1024 compared to 2017 was 1796. Mumps cases were reported in all regions of England, but highest number of cases (almost 3 times as much) was seen in the North West of England, with highest numbers seen in young adults aged 15 to 34 years1. More than a half of the cases this quarter were unvaccinated.
Work/school exclusion
When a person is ill with mumps, they should avoid contact with others from the time of diagnosis until 5 days after the start of the swollen cheek glands by staying home from work/school and staying in a separate room if possible.
If you are concerned about Mumps or Measles, you wish to discuss your immunity, be tested or vaccinated get in touch.
