Mumps Treatment & Management

Updated: Jan 17, 2019
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Treatment

Approach Considerations

Mumps without associated major complications can be managed on an outpatient basis with supportive health guidance and continuity of care. Patients diagnosed with mumps should be isolated for 5 days from the onset of symptoms to minimize the risk of infecting others.

Also see Management of Acute Presentation of Mumps.

Medical care

Conservative, supportive medical care is indicated for patients with mumps. No antiviral agent is indicated for treatment of this viral illness, as mumps is a self-limited disease.

Encouraging oral fluid intake is essential, as maintenance of adequate hydration and alimentation of patients is important. Refrain from acidic foods and liquids as they may cause swallowing difficulty, as well as gastric irritation.

Prescribe analgesics (acetaminophen, ibuprofen) for headaches or discomfort due to parotitis. Topical application of warm or cold packs to the swollen parotid area may soothe the region.

Stronger analgesics may be required for patients with orchitis. Bed rest, scrotal support, and ice packs are recommended.

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Inpatient Care

Patients with specific complications may require inpatient care for intravenous fluid stabilization, pain management and continuous close observation.

Patients with meningitis, encephalitis, myocarditis, nephritis, or severe pancreatitis require a higher level of inpatient supportive care.

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Consultations and Transfer

Consultation may be considered in complicated cases involving multiple organ systems. Medical and treatment guidance from specialists in critical care, infectious disease, neurology, cardiology, gastroenterology and urology may be indicated.

Transfer to a medical facility with a higher level of care is rarely indicated. This action is warranted, if major complications are present and the current medical facility cannot properly support the patient's treatment needs.

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Diet and Activity

A light diet with generous fluid intake is recommended and best tolerated.

Avoidance of acidic foods (eg, tomato, vinegar-containing food additives) and liquids (eg, orange juice) is beneficial to lessen oral pain and discomfort.

Bed rest is recommended to foster a speedy recovery and is indicated for patients with complicated cases.

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Deterrence and Prevention

The principal strategy to prevent mumps is to achieve and maintain high immunization levels, primarily in infants and young children. Universal immunization, as part of preventative good health care, should be routinely carried out in physicians' offices and public health clinics. Programs aimed to vaccine children with MMR should be established and maintained in all communities. In addition, all other persons thought to be susceptible should be vaccinated, unless otherwise contraindicated. Reaching adolescents and young adults is especially important, due to the past observed increased risk of disease in these populations.

If a case of mumps occurs in a childcare facility, immediately notify the local health department and parents/caregivers. Make sure all children and adults continue to follow good handwashing practices. In large facilities, follow appropriate group separation guidelines. Review the immunization records of all children in the facility to assure that they have received their first mumps vaccination. Those not adequately vaccinated should be referred to their health care provider. Continue to closely observe all children for symptoms and refer anyone developing symptoms to his or her primary care provider.

Initially, children with mumps were excluded from school and childcare centers for 9 days following the onset of parotid gland swelling. However in 2007, the American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) modified their recommendation from 9-day isolation guidance (standard precautions and droplets precautions) to 5 days after the onset of clinical symptoms (eg, parotitis) based on current medical evidence. [22] . Children who have not been vaccinated due to medical or religious reasons should be excluded from school or daycare for at least 26 days after the onset of parotitis, beginning from the date of the last person with mumps in the affected facility.

Despite these isolation guidelines, spread of the infection can be difficult to control as the virus is present in saliva days prior to the onset of parotid swelling, and viral shedding does occur in asymptomatic persons.

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Vaccination

Susceptible children, adolescents, and adults should be vaccinated against mumps, unless vaccination is contraindicated. Mumps vaccine is important for children approaching puberty and for adolescents and, adults who have not had mumps. The MMR vaccine is the vaccine of choice for routine administration and should be used in all situations in which recipients are also likely to be susceptible to measles, rubella, or both. A favorable benefit-to-cost ratio for routine mumps immunization is better achieved when the MMR vaccine or the MMRV vaccine is given.

Persons are susceptible to mumps, unless they have documentation of the following:

  • Physician-diagnosed mumps

  • Adequate immunization with live attenuated mumps virus vaccine on or after their first birthday

  • Laboratory evidence of immunity

Prior to 1977 in the US, the live attenuated mumps vaccine was not used routinely and the peak age incidence of disease in children was age 5-9 years; as such, most persons born before 1957 are likely to have been naturally infected with the mumps virus between 1957 and 1977. Therefore, most are considered to be immune, even in cases without clinically recognizable mumps disease. However, this cutoff date for susceptibility is arbitrary. Although outbreak control efforts should be focused on persons born after 1956, these recommendations do not preclude vaccination of possibly susceptible persons born before 1957, who currently may be exposed in outbreak settings.

Persons who are unsure of their mumps disease history, mumps vaccination history, or both should be vaccinated. Persons who have previously either received mumps vaccine or had mumps, do not have an increased risk of local or systemic reactions from receiving live attenuated mumps vaccine. Testing for susceptibility prior to vaccination, especially among adolescents and young adults, is not necessary. In addition to the expense, some tests (eg, mumps skin test, complement-fixation antibody test) may be unreliable, and tests with established reliability (eg, neutralization test, enzyme immunoassay, single-radial hemolysis antibody test) are not easily available.

A single dose of vaccine in the volume specified by the manufacturer (standardly 0.5 mL) should be administered subcutaneously (SC). Although not routinely recommended, intramuscular (IM) vaccination is effective and safe.

Administration of the live attenuated mumps virus vaccine as either MMR (measles-mumps-rubella) or MMRV (measles-mumps-rubella-varicella) is recommended at any age on or after the first birthday for all susceptible persons, unless a contraindication is present. It should not be administered to infants younger than 12 months because persisting maternal antibody might interfere with seroconversion. To ensure immunity, all infants vaccinated too early (before their first birthday), should be revaccinated on or after their first birthday. [23, 24]  This action properly covers them for their first dose. A second dose is then, administered at age 4-6 years, to serve as a safeguard to ensure immunity against possible initial vaccine failure.

ACIP recommends a third dose of MMR vaccine for those previously vaccinated with two doses and identified as being at higher risk for acquiring mumps because of an outbreak. [34, 35]

If the vaccine is administered after an exposure to the mumps virus, it may not provide adequate protection from disease development. However, if the exposure does not result in infection, vaccination should induce protection against infection from subsequent exposures. The risk of vaccine-associated adverse events does not increase, if the vaccine is administered to persons who are incubating disease at that time.

Immunoglobulin (IVIG) has not shown benefit to patients as treatment for post-exposure prophylaxis and hence, is not recommended. In the United States, mumps IVIG is no longer available or licensed for use. Vaccination post-exposure is not harmful and may possibly avert later disease.

A study published in 2011 evaluated MMR vaccine effectiveness in persons who received 1 or 2 doses of this vaccine during a mumps outbreak that occurred between September 1, 2009 and June 10, 2010 in Ontario, Canada. This study also aimed to estimate the coverage level required to achieve “herd” immunity and to interrupt community transmission. Using data from Ontario's Public Health Information System, 134 confirmed cases were identified; 114 of those reported receiving the MMR vaccine. Of those, 63 received 1 dose (49.2-81.6% effectiveness), while 32 received 2 doses (66.3-88% effectiveness). The authors concluded that if the assumed vaccine effectiveness after receiving 2 doses of MMR is 85%, then the populace vaccine coverage of 88.2% and 98% would be needed to interrupt community transmission of mumps. This study reemphasizes the need for routine vaccination and warns against complacency in vaccination programs. [25]

Cardemil et al evaluated the effectiveness of a third dose of the MMR vaccine in a study that included 20,496 university students, of which 259 were diagnosed with mumps during an outbreak. The study reported the attack rate was lower among the 4783 students that received the third dose than those who had received two (6.7 vs 14.5 cases per 1000 population, P< 0.001). The third dose was associated with a 78.1% lower risk of mumps compared to the second dose at 28 days post vaccination (adjusted hazard ratio, 0.22; 95% confidence interval, 0.12 to 0.39). [26]

Another mumps outbreak was reported in September 2011 on a university campus in California. The California Department of Public Health (CDPH) confirmed using PCR, 3 cases of mumps in college students who were recently evaluated at the university's student health services with symptoms suggestive of mumps. An investigation by CDPH, student health services, and the local health department identified a total of 29 mumps cases. The index patient was an unvaccinated student with history of recent travel to Western Europe, where mumps infection was circulating. Additional knowledge in regard to the date of onset of this index case, clarified that two generations of transmission had occurred before public health authorities were properly alerted. This mumps outbreak illustrates the value of requiring MMR vaccination (including documentation of immunization or other evidence of immunity) prior to college enrollment, the need for heightened clinical awareness, and timely reporting of suspected mumps cases to public health personnel. [27]

Children age 12-23 months who are vaccinated with the combination MMRV vaccine have a slightly higher risk of febrile seizures, when compared to those children who are vaccinated separately, with the MMR and the VZV (varicella vaccine). The risk period for febrile seizures is 5-12 days after receipt of MMRV. However, the risk for febrile seizures is not increased among the older children aged 4-6 years receiving the MMRV. In response to this observation, the AAP has recommended that for the first dose given at age 12-48 months, the child can receive either MMR and VZV vaccines separately, or the MMRV. For children 48 months of age or older, both recommended vaccinations are for the inclusive MMVR. [28]

A published 2015 study by Siberry et al compared the immunity response to MMR vaccination of children who contracted perinatal HIV (PHIV), to those children who were perinatally HIV-exposed but uninfected (HEU). The children in the PHIV group lacked serologic evidence of immunity to MMR, despite proper documented immunization and current treatment with sustained combination antiretroviral therapy (cART). The study found that among 428 children with PHIV, and 221 children with HEU, the immunity protection of the participants was significantly lower in children who contracted perinatal HIV (PHIV), for measles seroprotection (57% vs 99%), rubella seroprotection (65% vs 98%), and mumps seropositivity (59% vs 97%). [29]

Adverse effects of vaccine use

Reports of adverse effects following mumps vaccination have cited low-grade fever and parotitis. Allergic reactions, presenting as a pruritic rash, have been temporally associated with mumps vaccination, but are uncommon. If allergic reactions occur, they are usually mild and of brief duration.

Encephalitis occurring within 30 days after receipt of a mumps-containing vaccine has been reported to be 0.4 cases per million doses. This incidence is not greater than the observed background incidence rate for encephalitis in healthy populations. Other indicators of CNS involvement, such as febrile seizures and sensorineural deafness, have been infrequently reported. [30]  Reports of CNS illness in patients following administration of the mumps vaccination, do not necessarily indicate an etiologic relationship between the CNS complication and the vaccine.

Contraindications to vaccine use in pregnancy

Although the live attenuated mumps vaccine does infect the placenta and fetus, no evidence indicates that this infection causes congenital malformations in the fetus. Due to the theoretical risk of fetal damage, avoiding administration of live virus vaccine to pregnant women is prudent. Women of child-bearing age are recommended to avoid pregnancy for 3 months postvaccination of the live attenuated mumps vaccine.

Routine precautions prior to vaccinating women of child-bearing age are to inquire if they are, or may be pregnant. Of those who say they are or may be, it is important to explain the theoretical risk to those women who plan to receive this vaccine.

Vaccination during pregnancy should not be considered an indication for termination of pregnancy. However, discussion to take this action rests between the patient and her physician.

Severe febrile illness

Vaccine administration should not be postponed due to a minor febrile illness, such as a mild upper respiratory infection. MMR vaccination scheduled for those persons who have a severe febrile illness should be deferred, until health is restored.

Allergies

The live attenuated mumps vaccine is produced in chick embryo cell culture; hence persons with a history of anaphylactic reactions (i.e., hives, swelling of the mouth and throat, difficulty breathing, hypotension, shock) after egg product ingestion should be vaccinated with caution, using published protocols. Evidence indicates that persons are not at increased risk, if their egg allergy response is not of an anaphylactic nature. Vaccination can proceed in the usual manner for these patients. As a precaution, patients with known egg allergy should be observed for a minimum of 20 minutes post receiving the vaccine, at the medical facility. 

No evidence indicates that persons with allergies to chickens or feathers are at increased risk of reaction to the vaccine.

Mumps vaccine does contain trace amounts of neomycin (25 mcg). As such, persons who have experienced anaphylactic reactions to topically or systemically administered neomycin should not receive the mumps vaccine. Patients who have a neomycin allergy presenting as a contact dermatitis without systemic involvement can receive the vaccine, as its administration is not contraindicated in this situation.

Recent immunoglobulin (IVIG) injection

Passively acquired antibody can interfere with the response to live attenuated virus vaccines because antibody in these products neutralizes the vaccine virus and interferes with successful immunization. Therefore, the MMR vaccine should be administered at least 2 weeks before, or deferred until 3 months after the administration of IVIG or blood product transfusion.

Exceptions

Recommendations for live attenuated vaccine administration differ for children with immunodeficiency diseases or for those receiving immunosuppressive therapy (e.g., patients with HIV or oncologic disease, or treatment with high dose corticosteroids). All HIV-infected patients who are not severely immune compromised (age-specific CD4+ T-lymphocyte counts of ≥15%) should receive MMR vaccination as scheduled.

Patients with leukemia in remission, whose chemotherapy ended at least 3 months earlier, can receive live attenuated mumps virus vaccine (as MMR). Vaccination of close susceptible contacts to immunocompromised patients is very important as to minimize risk of mumps exposure. Immunized patients cannot transmit the mumps vaccine virus to others.

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