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Mumps

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Mumps in Arizona

Mumps is uncommon in Arizona.  As of October 1, 2006, only three confirmed cases have been reported in the state for 2006.

December 2005 saw the beginning of a mumps outbreak in Iowa that soon spread to multiple other states. As of October 2006, over 5,783 confirmed and probable cases of mumps have been detected across 45 states in conjunction with the outbreak. Arizona was not part of this outbreak. Mumps cases peaked in late April and the number of reported cases per week decreased from that point through September. With the return of students to college, however, new clusters were reported at three campuses in the Midwest.

What is mumps?

Mumps is an infection caused by the mumps virus. 

Who can get mumps?

Anyone who is not immune from either previous mumps infection or from vaccination can get mumps. Before the routine vaccination program was introduced in the United States, mumps was a common illness in infants, children and young adults. Because most people have been vaccinated, mumps is now a rare disease in the United States. Of those people who do get mumps, up to half have very mild or even no symptoms.

How is mumps spread?

Mumps is spread by mucus or droplets from the nose or throat of an infected person, usually when a person coughs or sneezes. Surfaces of items can also spread the virus if someone who is sick touches the item without washing their hands and then someone else touches the same surface before rubbing their eyes, mouth, or nose.

What are the symptoms of mumps?

The most common symptoms are fever, headache, muscle aches, tiredness and loss of appetite followed by onset of parotitis (swollen and tender salivary glands under the ears-on one or both sides).

How soon after infection do symptoms appear?

Symptoms typically appear 16-18 days after infection, but this period can range from 12-25 days after infection.

How long can someone spread mumps?

Mumps virus has been isolated from the respiratory secretions of infected individuals from 3 days before the start of symptoms until 9 days after onset.

What are the complications associated with mumps?

The most common complication is the inflammation of the testicles (orchitis) in males who have reached puberty, but this rarely leads to fertility problems.

Other rare complications include:

  • Inflammation of the brain and/or tissue covering the brain and spinal cord (encephalitis/meningitis)
  • Inflammation of the ovaries (oophoritis) and/or breasts (mastitis) in females who have reached puberty
  • Spontaneous abortion particularly in early pregnancy (miscarriage)
  • Deafness, usually permanent

What is the treatment for mumps?

There is no specific treatment. Supportive care should be given as needed. If someone becomes very ill, they should seek medical attention. If someone seeks medical attention, they should call their doctor in advance so that they don't have to sit in the waiting room for a long time and possibly infect other patients.

What can be done to prevent the spread of mumps?

Mumps vaccine (usually MMR), is the best way to prevent mumps. Other things people can do to prevent mumps and other infections is to wash hands well and often with soap, and to teach children to wash their hands too. Eating utensils should not be shared, and surfaces that are frequently touched (toys, doorknobs, tables, counters, etc.) should also be regularly cleaned with soap and water, or with cleaning wipes.

Technical Information

Characteristics

  • Infectious Agent: The mumps virus is a paramyxovirus in the same group as influenza.
  • Mode of Transmission: Direct or droplet contact with respiratory secretions of an infected person.
  • Communicability:  The infectious period is considered to be from 2 days before parotitis onset to 9 days after parotitis onset.
  • Incubation Period:  12-25 days, though symptoms typically appear 16-18 days after infection 
  • Clinical Features
    • Subclinical Infection:
      • Up to 20% of persons infected with mumps are asymptomatic.  An additional 40-50% may have only nonspecific or mild respiratory problems.
    • Prodrome:
      • Prodromal symptoms are nonspecific and include myalgia, anorexia, malaise, headache, and low-grade fever.
    • Parotitis:
      • A swelling of the parotid glands, which may be noted as earache or tenderness on touching the angle of the jaw.  Unilateral or bilateral, affecting any combination or single or multiple salivary glands, occurs in 30-40% of infected persons.  Symptoms tend to decrease after one week and are usually gone by 10 days.

Arizona Administrative Code: R9-6-349

  1. Case control measures
    1. An administrator of a school or child care establishment, either personally or through a representative, shall exclude a mumps case from the school or child care establishment for nine days after the onset of glandular swelling.
    2. A health care provider shall use droplet precautions with a mumps case for nine days after the onset of glandular swelling.
    3. A local health agency shall conduct an epidemiologic investigation of each reported mumps case or suspect case. For each mumps case, a local health agency shall complete and submit to the Department within 10 working days after completing an epidemiologic investigation:
      1. A Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, "Mumps Surveillance Worksheet" (May 1998), which is incorporated by reference, on file with the Department, and available from the Centers for Disease Control and Prevention, Division of Viral and Rickettsial Diseases, 1600 Clifton Rd., NE, Mailstop A-30, Atlanta, GA 30333, including no future editions or amendments; or
      2. An electronic equivalent to the Mumps Surveillance Worksheet PDF provided by the Department.
  2. Contact control measures: When a mumps case has been at a school or child care establishment, the administrator of the school or child care establishment, either personally or through a representative, shall:
    1. Consult with the local health agency to determine who shall be excluded and how long each individual shall be excluded from the school or child care establishment, and
    2. Comply with the local health agency's recommendations for exclusion.

Lab Tests

Lab Criteria for Diagnosis

  • Isolation of mumps virus from a clinical specimen (buccal swab or urine).
  • Detection of viral RNA by reverse transcription polymerase chain reaction (RT-PCR)
    • Note: The interpretation of a positive RT- PCR result without demonstration of mumps growth in tissue culture must be interpreted carefully, particularly among persons whose symptoms do not meet the clinical definition of mumps.
  • A four-fold rise between acute- and convalescent-phase titers in serum mumps immunoglobulin G (IgG) antibody level by standard serologic assay.
    • Note: This rise may be undetected by this method in infected individuals who have previously been vaccinated against mumps.
  • Positive serological test for mumps IgM antibody.

Specimens to Collect

  • Acute and convalescent sera
    • Collect acute serum ASAP after parotitis onset and no later than 7 days post parotitis onset.
    • Collect convalescent serum >= 3 weeks after the acute serum was collected.
  • Buccal swab
    • For the mumps viral specimen a parotid gland/buccal swab is the preferred specimen.
    • Collect buccal swabs no later than 9 days post parotitis onset.
    • Massage the parotid gland area (the space between the cheek and teeth just below the ear) for about 30 seconds prior to collection of the buccal secretions. The parotid duct (Stensen's duct) drains in this space near the upper rear molars. A throat swab (oropharyngeal or nasopharyngeal swab) can also be collected and added together with the buccal swab.
    • Place the swab in a tube containing 2-3 mls of viral transport medium (i.e., Hank's Buffered Saline Solution) or other sterile isotonic solution (phosphate buffered saline or cell culture medium).
  • Urine
    • Collect 5-10 mls from clean catch urine and store in a screw top sterile container, preferably a 15 ml centrifuge tube.
  • Parotid gland location
  • Specimens should be shipped refrigerated (i.e. on wet ice) but not frozen.
  • Forward all specimens to the Arizona State Laboratory, 250 N. 17th Avenue, Phoenix, AZ, 85007.

Additional Resources