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'{{For|other uses of the word Mumps or MUMPS|Mumps (disambiguation)}} {{DiseaseDisorder infobox | Name = Mumps | ICD10 = {{ICD10|B|26||b|25}} | ICD9 = {{ICD9|072}} | <br> <br> <br> <br> ICDO = | Image = Mumps PHIL 130 lores.jpg | Caption = Child with mumps. | OMIM = | MedlinePlus = 001557 | eMedicineSubj = emerg | eMedicineTopic = 324 | eMedicine_mult = {{eMedicine2|emerg|391}} {{eMedicine2|ped|1503}} | DiseasesDB = 8449 | MeshID = D009107 | }} '''Mumps''' and '''epidemic [[parotitis]]''' is a [[viral disease]] of the [[human]] species, caused by the [[mumps virus]]. Before the development of [[vaccination]] and the introduction of a [[mumps vaccine|vaccine]], it was a common [[childhood disease]] worldwide, and is still a significant threat to health in the [[third world]].<ref name=Harrison>{{cite book | author = Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ, Eds. | title = Harrison's Principles of Internal Medicine | edition = 16th | publisher = McGraw-Hill Professional | year = 2004 | isbn = 0-07-140235-7 }}</ref> Painful swelling of the [[salivary gland]]s (classically the [[parotid gland]]) is the most typical presentation.<ref name=Hviid/> Painful testicular swelling ([[orchitis]]) and [[rash]] may also occur. The symptoms are generally not severe in children. In teenage males and men, complications such as [[infertility]] or [[subfertility]] are more common, although still rare in absolute terms.<ref>{{cite journal | author=Preveden T, Jovanovic J, Ristic D | title=[Fertility in men after mumps infection without manifestations of orchitis] | journal=Med Pregl | year=1996 | pages=99–102 | volume=49 | issue=3-4 | pmid=8692089 }}</ref><ref>{{cite journal | author=Shakhov EV, Krupin VN | title=[The clinico-statistical characteristics of the testicular generative function in male subfertility following mumps] | journal=Urol Nefrol (Mosk) | year=1990 | pages=46–50 | volume= | issue=2 | pmid=2368216 }}</ref><ref>{{cite journal | author=Tsvetkov D | title=[Spermatological disorders in patients with postmumps orchitis] | journal=Akush Ginekol (Sofiia) | year=1990 | pages=46–9 | volume=29 | issue=6 | pmid=2100952 }}</ref> The disease is generally [[Self-limiting (biology)|self-limited]], running its course before receding, with no specific treatment apart from controlling the symptoms with [[painkiller]]s. ==Signs and symptoms== [[Image:Mumps comparison.jpg|thumb|Comparison of a person before and after contracting mumps]] The more common symptoms of mumps are: * [[Parotid gland|Parotid]] [[inflammation]] (or [[parotitis]]) in 60–70% of infections and 95% of patients with symptoms.<ref name=Hviid> {{cite journal | author = Hviid A, Rubin S, Mühlemann K | title = Mumps | journal = [[The Lancet]] | volume = 371 | issue = 9616 | pages = 932–44 | year = 2008 | month = March | pmid = 18342688 | doi = 10.1016/S0140-6736(08)60419-5 | accessdate = 2009-11-13 }}</ref> [[Parotitis]] causes swelling and local pain, particularly when chewing. It can occur on one side (unilateral) but is more common on both sides (bilateral) in about 90% of cases.<ref>{{cite journal |author=Bedford H |title=Mumps: current outbreaks and vaccination recommendations |journal=Nurs Times |volume=101 |issue=39 |pages=53–4, 56 |year=2005 |pmid=16218124 |doi= |url=}}</ref> * [[Fever]] * [[Headache]] * [[Orchitis]], referring to painful inflammation of the testicle.<ref>{{cite journal | author=Manson AL | title=Mumps orchitis | journal=Urology | year=1990 | pages=355–8 | volume=36 | issue=4 | pmid=2219620 | doi = 10.1016/0090-4295(90)80248-L}}</ref> Males past puberty who develop mumps have a 30 percent risk of [[orchitis]].<ref>[http://www.uchc.edu/ocomm/features/stories/stories06/feature_mumps.html]{{Dead link|date=March 2008}}</ref> Other symptoms of mumps can include dry mouth, sore face and/or ears and occasionally in more serious cases, loss of voice. In addition, up to 20% of persons infected with the mumps virus do not show symptoms, so it is possible to be infected and spread the virus without knowing it.<ref>[http://www.health.gov.on.ca/cs/mumps/english/faq/ Mumps], FAQ For Young Adults, Ministry of Health and Long-Term Care, Ontario.ca</ref> ===Prodrome=== Fever and headache are [[prodromal symptoms]] of mumps, together with [[malaise]] and [[anorexia (symptom)|anorexia]]. == Cause== Mumps is a contagious disease that is spread from person-to-person through contact with respiratory secretions such as saliva from an infected person. When an infected person coughs or sneezes, the droplets aerosolize and can enter the eyes, nose, or mouth of another person. Mumps can also be spread by sharing food, sharing drinks, and kissing. The virus can also survive on surfaces and then be spread after contact in a similar manner. A person infected with mumps is contagious from approximately 6 days before the onset of symptoms until about 9 days after symptoms start.<ref>[http://www.nhs.uk/Conditions/Mumps/Pages/Symptoms.aspx?url=Pages/What-is-it.aspx Symptoms of mumps]</ref><ref>[http://www.cdc.gov/eid/content/13/10/1617.htm Letter:Compliance with Exclusion Requirements to Prevent Mumps Transmission], By Stephanie M. Borchardt, Preethi Rao, and Mark S. Dworkin, Volume 13, Number 10–October 2007</ref> The [[incubation period]] (time until symptoms begin) can be from 14–25 days but is more typically 16–18 days.<ref>{{cite journal |author=Conly J, Johnston B |title=Is mumps making a comeback? |journal=Can J Infect Dis Med Microbiol |volume=18 |issue=1 |pages=7–9 |year=2007 |month=January |pmid=18923686 |pmc=2542890 |doi= |url=}}</ref> ==Diagnosis== A physical examination confirms the presence of the swollen glands. Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, a test of saliva, or [[serology|blood]] may be carried out; a newer diagnostic confirmation, using real-time [[nested polymerase chain reaction]] (PCR) technology, has also been developed.<ref> {{cite journal | author = Krause CH, Eastick K, Ogilvie MM | title = Real-time PCR for mumps diagnosis on clinical specimens--comparison with results of conventional methods of virus detection and nested PCR | journal = J. Clin. Virol. | volume = 37 | issue = 3 | pages = 184–9 | year = 2006 | month = November | pmid = 16971175 | doi = 10.1016/j.jcv.2006.07.009 | accessdate = 2009-11-13 }}</ref> An estimated 20%-30% of cases are asymptomatic.<ref> {{cite journal | author = | title = Mumps epidemic--Iowa, 2006 | journal = [[Morbidity and Mortality Weekly Report|MMWR Morb. Mortal. Wkly. Rep.]] | volume = 55 | issue = 13 | pages = 366–8 | year = 2006 | month = April | pmid = 16601665 | doi = | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a3.htm | publisher= [[Centers for Disease Control and Prevention]] (CDC) | accessdate = 2009-11-13 | author1 = Centers for Disease Control and Prevention (CDC) }}</ref> As with any inflammation of the salivary glands, serum amylase is often elevated.<ref>[http://www.labtestsonline.org.uk/understanding/analytes/amylase/test.html Amylase: The Test], Lab Tests Online UK</ref><ref>{{cite journal |author=Skrha J, Stĕpán J, Sixtová E |title=Amylase isoenzymes in mumps |journal=Eur. J. Pediatr. |volume=132 |issue=2 |pages=99–105 |year=1979 |month=October |pmid=499265 |doi=10.1007/BF00447376 |url=}}</ref> ==Prevention== The most common preventative measure against mumps is immunization with a [[mumps vaccine]], invented by [[Maurice Hilleman]] at [[Merck]]<ref>{{cite book |author=Offit PA |title=Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases |location=Washington, DC |publisher=Smithsonian |isbn=0-06-122796-X |year=2007 }}</ref>. The vaccine may be given separately or as part of the [[MMR vaccine|MMR immunization]] vaccine which also protects against [[measles]] and [[rubella]]. In the US, MMR is now being supplanted by [[MMRV vaccine|MMRV]], which adds protection against [[chickenpox]]. The [[World Health Organization|WHO]] (World Health Organization) recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 15 months. The [[American Academy of Pediatrics]] recommends the routine administration of MMR vaccine at ages 12–15 months and at 4–6 years.<ref>{{PDFlink|[http://www.cispimmunize.org/IZSchedule.pdf]}}{{Dead link|date=September 2009}}</ref> In some locations, the vaccine is given again between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. The [[Vaccine#Effectiveness|efficacy of the vaccine]] depends on the strain of the vaccine, but is usually around 80%.<ref>{{cite journal |author=Schlegel M, Osterwalder JJ, Galeazzi RL, Vernazza PL |title=Comparative efficacy of three mumps vaccines during disease outbreak in Eastern Switzerland: cohort study |journal=BMJ |volume=319 |issue=7206 |pages=352 |year=1999 |pmid=10435956 |pmc=32261 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=10435956}}</ref>^,<ref>{{cite web | title=Summary | work=WHO: Mumps vaccine | url=http://www.who.int/vaccines/en/mumps.shtml#summary | accessdate=2006-04-18}}</ref> The Jeryl Lynn strain is most commonly used in developed countries but has been shown to have reduced efficacy in epidemic situations. The Leningrad-Zagreb strain commonly used in developing countries appears to have superior efficacy in epidemic situations.<ref>{{cite journal |author=Peltola H, Kulkarni PS, Kapre SV, Paunio M, Jadhav SS, Dhere RM |title=Mumps outbreaks in Canada and the United States: time for new thinking on mumps vaccines |journal=Clin. Infect. Dis. |volume=45 |issue=4 |pages=459–66 |year=2007 |month=August |pmid=17638194 |doi=10.1086/520028 |url=}}</ref> Due to the outbreaks within college and university settings, many governments have established vaccination programs to prevent large-scale outbreaks. In Canada, provincial governments and the Public Health Agency of Canada have all participated in awareness campaigns to encourage students ranging from grade 1 to college and university to get vaccinated.<ref>[http://www.phac-aspc.gc.ca/mumps-oreillons/prof-eng.php#t2 Table 2: Provincial and Territorial recommendations for mumps-containing immunization, 2007], Information on Outbreaks of Mumps In Canada - Information for Health Professionals, Public Health Agency Canada</ref> Some [[anti-vaccinationists|anti-vaccine activists]] protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. There is no evidence whatsoever that the wild disease is beneficial, or that the [[MMR]] vaccine is harmful. Claims have been made that the MMR vaccine is linked to autism and [[inflammatory bowel disease]], including one study by [[Andrew Wakefield]]{{Citation needed|date=April 2010}} (paper retracted in 2010) that indicated a link between [[gastrointestinal disease]], autism, and the MMR vaccine. However, all further studies{{Citation needed|date=April 2010}} since that time have indicated no link between vaccination with the MMR and autism or bowel disease. Furthermore, there is scant evidence to suggest that autism is linked to bowel disease, though several poorly-designed studies have indicated a weak link between the two disorders. Since the dangers of the disease are well known, while the dangers of the vaccine are quite minimal, most doctors recommend vaccination. The [[WHO]], the [[American Academy of Pediatrics]], the Advisory Committee on Immunization Practices of the [[Centers for Disease Control and Prevention]], the [[American Academy of Family Physicians]], the [[British Medical Association]] and the [[Royal Pharmaceutical Society of Great Britain]] currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.{{Citation needed|date=January 2010}} Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000). <ref name=PinkBook_2006>{{cite book | author = Atkinson W, Humiston S, Wolfe C, Nelson R (Editors). | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | edition = 9th | publisher = Centers for Disease Control and prevention | year = 2006 | id = [http://www.cdc.gov/nip/publications/pink/def_pink_full.htm Fulltext] }}</ref> In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%).<ref>{{cite journal | author=Kanra G, Isik P, Kara A, Cengiz AB, Secmeer G, Ceyhan M | title=Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination | journal=Pediatr Int | year=2004 | pages=663–8 | volume=46 | issue=6 | pmid=15660864 | doi = 10.1111/j.1442-200x.2004.01968.x}}</ref> The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968. Since 2001, the case average was only 265 per year, excluding an outbreak of >6000 cases in 2006 attributed largely to university contagion in young adults.<ref> {{cite journal | author = McNabb SJ, Jajosky RA, Hall-Baker PA, ''et al.'' | title = Summary of notifiable diseases--United States, 2006 | journal = [[Morbidity and Mortality Weekly Report|MMWR Morb. Mortal. Wkly. Rep.]] | volume = 55 | issue = 53 | pages = 1–92 | year = 2008 | month = March | id = PMID 18354375 | doi = | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5553a1.htm | accessdate = 2009-11-13 }}</ref><ref>[http://www.latimes.com/features/health/la-he-mumps14apr14,1,547450.story 2006 mumps outbreak occurred despite high vaccination rate - Los Angeles Times<!-- Bot generated title -->]{{Dead link|date=November 2009}}</ref> ==Treatment== There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck/testicular area and by [[acetaminophen]]/paracetamol (Tylenol) for pain relief. [[Aspirin]] is not used due to a hypothetical link with [[Reye's syndrome]]. Warm salt water [[gargle]]s, soft foods, and extra fluids may also help relieve symptoms. Patients are advised to avoid fruit juice or any acidic foods, since these stimulate the salivary glands, which can be painful. ==Prognosis== Death is very unusual. The disease is self-limiting, and general outcome is good, even if other organs are involved. Known complications of mumps include: *Infection of other organ systems *Mumps viral infections in adolescent and adult males carry an up to 30% risk that the testes may become infected ([[orchitis]] or [[epididymitis]]), which can be quite painful; about half of these infections result in [[testicular atrophy]], and in rare cases sterility can follow.<ref name=Senanayake/> *Spontaneous abortion in about 27% of cases during the first trimester of pregnancy.<ref name=Senanayake/> *Mild forms of [[meningitis]] in up to 10% of cases<ref name=Senanayake/> (40% of cases occur without parotid swelling) *[[Oophoritis]] (inflammation of ovaries) in about 5% of adolescent and adult females,<ref name=Senanayake/> but fertility is rarely affected. *[[Pancreatitis]] in about 4% of cases, manifesting as abdominal pain and vomiting *[[Encephalitis]] (very rare, and fatal in about 1% of the cases when it occurs)<ref name=Senanayake/> *Profound (91 dB or more) but rare sensorineural [[hearing loss]], uni- or bilateral. Acute unilateral deafness occurs in about 0.005% of cases.<ref name=Senanayake/> After the illness, life-long [[immunity (medical)|immunity]] to mumps generally occurs; reinfection is possible but tends to be mild and atypical.<ref name=Senanayake>{{cite journal |author= Senanayake SN |title=Mumps: a resurgent disease with protean manifestations |journal= Med J Aust |volume=189 |issue=8 |pages=456–9 |year=2008 |pmid=18928441 |doi= |url=http://www.mja.com.au/public/issues/189_08_201008/sen10220_fm.html}}</ref> ==Epidemiology== {{See also|List of modern mumps outbreaks}} ==References== <!-- ---------------------------------------------------------- See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a discussion of different citation methods and how to generate footnotes using the <ref>, </ref> and <reference /> tags ----------------------------------------------------------- --> {{Reflist|2}} ==External links== {{Commons category|Mumps}} * ''Original version based on the [[National Library of Medicine]]'s [http://www.nlm.nih.gov/medlineplus/ency/article/001557.htm Medline Plus] website. Update Date: 08/15/01. Update date included for cross-reference against newer versions.'' * [http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=255 NHS.uk] &ndash; Encyclopedia &ndash; 'NHS Direct Online Health Encyclopaedia: Mumps', [[National Health Service]] (UK) * [http://www.who.int/immunization/topics/mumps/en/index.html WHO.int] &ndash; "Immunization, Vaccines and Biologicals: Mumps vaccine", [[World Health Organisation]] * [http://www.microbiologybytes.com/virology/Paramyxoviruses.html MicrobiologyBytes: Paramyxoviruses]" * [http://www.ncbi.nlm.nih.gov/entrez/viewer.fcgi?db=Nucleotide&dopt=GenBank&val=7592770 nih.gov] &ndash; "NIH database entry: complete genome of Miyahara strain of Mumps" * [http://www.cdc.gov/vaccines/vpd-vac/mumps/default.htm cdc.gov] &ndash; Collection of information from the [[Centers for Disease Control and Prevention|CDC]] concerning mumps * [http://www.ontario.ca/mumps ontario.ca] &ndash; Ontario Mumps Catch-Up Vaccination Campaign targeted at Students * [http://www.twu.ca/life/wellness/bulletin-boards/mumps-outbreak.html TWU.ca], [http://news.students.sfu.ca/2008/09/15/mumps-outbreak/ SFU.ca] &ndash; Information from 2008 Mumps Outbreak in British Columbia * [http://www.gnb.ca/cnb/news/he/2007e0881he.htm GNB.ca] &ndash; New Brunswick Vaccination Campaign * [http://www.gov.pe.ca/news/getrelease.php3?number=5308 gov.pe.ca] &ndash; P.E.I. Vaccination Campaign * [http://www.hss.gov.yk.ca/news/2006/id_51/ gov.yk.ca] &ndash; Yukon Vaccination Campaign * [http://www.phac-aspc.gc.ca/mumps-oreillons/prof-eng.php#t2 Public Health Agency of Canada] &ndash; Public Health Agency of Canada Vaccination Campaigns {{Viral diseases}} {{Oral pathology}} [[Category:Viral diseases]] [[Category:Pediatrics]] [[Category:Oral pathology]] [[Category:Mononegavirales]] [[Category:Microbiology]] [[Category:Mumps|*Main]] [[ar:نكاف]] [[az:Qulaqdibi xəstəliyi]] [[cs:Příušnice]] [[cy:Clwy'r pennau]] [[de:Mumps]] [[dv:ކޯފުއްޕި]] [[es:Parotiditis]] [[eu:Hazizurri]] [[fa:اوریون]] [[fr:Oreillons]] [[ga:Plucamas]] [[gd:A' Phloic]] [[hi:गलगंड]] [[id:Beguk]] [[it:Parotite epidemica]] [[he:חזרת (מחלה)]] [[la:Parotitis epidemica]] [[lb:Mumps]] [[mr:गालफुगी]] [[ms:Beguk]] [[mdf:Тоблок]] [[nl:Bof]] [[ja:流行性耳下腺炎]] [[no:Kusma]] [[pl:Nagminne zapalenie przyusznic]] [[pt:Parotidite infecciosa]] [[ro:Parotidită epidemică]] [[ru:Эпидемический паротит]] [[sco:Buffits]] [[simple:Mumps]] [[sk:Zápal príušných žliaz]] [[sl:Mumps]] [[fi:Sikotauti]] [[sv:Påssjuka]] [[tl:Beke]] [[tr:Kabakulak]] [[uk:Епідемічний паротит]] [[vi:Quai bị]] [[zh:腮腺炎]]'