PEDI | Mumps

Mumps is an acute, contagious viral illness characterized by the swelling of salivary glands (parotitis). Historically a leading cause of aseptic meningitis and hearing loss in children, widespread vaccination has reduced cases by over 99%, though outbreaks continue to occur in close-contact settings.Clinical Presentation and Transmission• Symptoms: The hallmark symptom is parotitis (swelling of the parotid glands at the jaw), which lasts about 5 days. Prodromal symptoms are nonspecific, including low-grade fever, headache, myalgia (muscle pain), anorexia, and malaise. Approximately 15–24% of infections are asymptomatic.• Transmission: The virus spreads via respiratory droplets and saliva.• Contagiousness: Patients are infectious from 2 days before to 5 days after the onset of parotitis. It is considered as contagious as influenza but less so than measles.• Incubation: Symptoms typically appear 16 to 18 days after exposure.ComplicationsWhile usually mild in children, mumps can cause serious complications, which are more common in adults and unvaccinated individuals.• Orchitis: The most common complication in post-pubertal males (inflammation of the testicles), occurring in up to 30% of unvaccinated men. It involves abrupt onset of pain and swelling and can lead to testicular atrophy.• Other Inflammations: Oophoritis (ovaries), mastitis (breasts), and pancreatitis.• Neurological: Meningitis and encephalitis occur but are rare (≤1%) in the post-vaccine era.• Hearing Loss: Sensorineural hearing loss can occur and may be permanent.Vaccination and PreventionVaccination is the primary preventive measure. The U.S. uses the MMR (measles, mumps, rubella) or MMRV (includes varicella) vaccines, which contain live, attenuated virus.• Efficacy: One dose is approximately 78% effective; two doses are 88% effective.• Standard Schedule: ◦ Dose 1: Age 12–15 months. ◦ Dose 2: Age 4–6 years.• Contraindications: Pregnancy and severe immunocompromise are major contraindications.• Safety: The vaccine is safe. Fever and rash may occur. There is no causal link between the vaccine and autism.• Outbreaks: Since 2006, cases have risen, often in close-contact environments like colleges. During outbreaks, public health authorities may recommend a third dose of MMR for high-risk groups.Diagnosis and Management• Diagnosis: Clinical suspicion (parotitis) should be confirmed via RT-PCR (buccal or urine swab). Serology (IgM) is less reliable due to false negatives in vaccinated individuals.• Treatment: There is no specific antiviral treatment. Management is supportive care involving fluids, bed rest, and analgesics (acetaminophen or ibuprofen). Aspirin must be avoided in children due to the risk of Reye syndrome