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MUMPS

Tim Jones, MD Tennessee Department of Health

Mumps--United States, 1968-2005*

160

Cases (thousands)

140 120 100 80 60 40 20 0 1970 1975 1980 1985 1990 1995 2000 2005

*2005 provisional total

Year

Mumps--United States, 1980-2005*

14000 12000 10000

Cases

8000 6000 4000 2000 0 1980

1985

1990

1995

2000

2005

*2005 provisional total

Year

Mumps

· Acute viral illness · Parotitis and orchitis described by

Hippocrates in 5th century BCE

· Viral etiology described by

Johnson and Goodpasture in 1934

· Frequent cause of outbreaks

among military personnel in prevaccine era

Mumps Virus

· Paramyxovirus · RNA virus · One antigenic type · Rapidly inactivated by chemical

agents, heat, and ultraviolet light

Mumps Pathogenesis

· Respiratory transmission of virus · Replication in nasopharynx and

regional lymph nodes

· Viremia 12-25 days after exposure

with spread to tissues

· Multiple tissues infected during

viremia

Mumps Clinical Features

· Incubation period 14-18 days · Nonspecific prodrome of myalgia,

malaise, headache, low-grade fever

· Parotitis in 30%-40% · Up to 20% of infections

asymptomatic

Mumps Complications

CNS involvement Orchitis 15% of clinical cases 20%-50% in post- pubertal males 2%-5% 1/20,000 Average 1 per year (1980 ­ 1999)

Pancreatitis Deafness Death

Mumps Epidemiology

· · · ·

Reservoir Human Asymptomatic infections may transmit Respiratory drop nuclei

Transmission

Temporal pattern Peak in late winter and spring Communicability Three days before to four days after onset of active disease

Mumps Clinical Case Definition

· Acute onset of unilateral or bilateral

tender, self-limited swelling of the parotid or other salivary gland lasting >2 days without other apparent cause

Mumps Vaccine

· · · ·

Composition Efficacy Duration of Immunity Schedule Live virus (Jeryl Lynn strain) 95% (Range, 90%-97%)

Lifelong >1 Dose

Mumps (MMR) Vaccine Indications

· All infants >12 months of age · Susceptible adolescents and adults

without documented evidence of immunity

Mumps Immunity

· Born before 1957 · Serologic evidence of mumps

immunity

· Documentation of physiciandiagnosed mumps

· Documentation of adequate

vaccination

Mumps Laboratory Diagnosis

· Isolation of mumps virus · Detection of mumps antigen by PCR · Serologic testing ­positive IgM antibody ­significant increase in IgG antibody

between acute and convalescent specimens

Lab Testing

· Buccal swab culture · Urine culture · Serum for IgM (+/- IgG)

Recommendations

· Isolate suspects · No quarantine · Active surveillance of contacts · Vaccinate susceptibles

Recommendations

· HCW and college students · Document immunity

­ 2 doses vaccine ­ IgG ­ Physician documented mumps ­ Born <1957 (?)

Reporting

· Confirmed cases · Call CEDS for questions

Case 1

· 44 yo female · 15 days right side jaw swelling · No fever

Case 2

· 35 yo Hispanic female · No h/o vaccination · 2 days tender parotid

Case 3

· 2 adults · Undervaccinated · Asymptomatic · Exposed to suspects in IA

Case 4

· 2 patients of Dr. Gomer · Vaccinated · Told "mumps" and sent home

Case 5

· Traveled to IA · Son has strep · Symptomatic · IgG= 3.19 > 2.66

Mumps

Timothy Jones, M.D.

Tennessee Department of Health

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