AUTHOR AND EDITOR INFORMATION

Section 1 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

INTRODUCTION

Section 2 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Background

Mumps is a single-stranded RNA virus and a member of the family Paramyxoviridae, genus Paramyxovirus. It has 2 major surface glycoproteins: the hemagglutinin-neuraminidase and the fusion protein. Mumps virus is sensitive to heat and ultraviolet light.

Mumps vaccine was licensed in the United States in December 1967, and the Advisory Committee on Immunization Practices (ACIP) recommended that its use be considered for children approaching puberty, for adolescents, and for adults. At that time, the public health community considered mumps control a low priority, and the ACIP stated that mumps immunization should not compromise the effectiveness of established public health programs. In 1972, however, the ACIP recommendations were strengthened to indicate that mumps vaccination was particularly important for the initially targeted age groups; in 1977, the ACIP recommended the routine vaccination of all children aged 12 months or older.

The use of mumps vaccine in young children was facilitated by the introduction (in 1977) and extensive use of the measles-mumps-rubella (MMR) vaccine. In 1980, stronger recommendations called for the vaccination of susceptible children, adolescents, and adults, unless such vaccination was contraindicated. Following these increasingly comprehensive recommendations and the enactment of state laws requiring mumps vaccination for school entry and attendance, the reported incidence of mumps declined steadily. However, during 1986 and 1987, large outbreaks occurred among underimmunized cohorts of persons born during 1967-1977, resulting in a shift in peak incidence from persons aged 5-9 years to persons aged 10-19 years. In 1989, the ACIP recommended that a second dose of measles-containing vaccine be administered to children aged 4-6 years (at time of entry to kindergarten or first grade) and designated MMR as the vaccine of choice.

The incidence of mumps during 1988-1998 decreased among all age groups. The greatest decrease occurred among persons aged 10-19 years—the same age group in which the greatest increases had occurred during 1986 and 1987, when a resurgence of outbreaks occurred among susceptible adolescents and young adults. Subsequent outbreaks have occurred among highly vaccinated populations. During 1989-1990, a large outbreak occurred among students in a primary and a secondary school; most of the students in these schools had been vaccinated, suggesting that vaccination failure, in addition to failure to vaccinate, might have contributed to the outbreak. In 1991, another outbreak occurred in a secondary school where most of the students had been vaccinated; this outbreak was also mostly attributed to primary vaccination failure.

The shift in higher risk for mumps to these other age groups (ie, from younger children of school ages to older children, adolescents, and young adults), which occurred after the routine use of the mumps vaccine was initiated, has persisted despite minimal fluctuations in disease incidence that occurred in recent years among the various age groups.

Pathophysiology

Mumps virus produces a generalized infection. After entry into the oropharynx, viral replication occurs, causing subsequent viremia and involving glands or nervous tissue. The virus may be isolated from saliva, blood, urine, and cerebrospinal fluid (CSF). Affected glands show edema and lymphocyte infiltration.

Frequency

United States

After the licensure of the mumps vaccine in the United States in December 1967 and the subsequent introduction of state immunization laws in an increasing number of states, reported incidence of mumps decreased substantially. The 666 cases of mumps reported for 1998 reflect a 99% decrease from the 152,209 cases reported for 1968. Although incidence decreased in all age groups, the largest decreases (>50% reduction in incidence rate per 100,000 population) occurred in persons aged 10 years or older. Overall, the incidence of mumps was lowest in states with comprehensive school immunization laws requiring mumps vaccination and was highest in states without such requirements.

The prevalence of mumps is at record low levels because of the recommendation of 2 doses of MMR vaccine and its high coverage rate in the United States. During the 1990s, mumps cases declined substantially, from 5,292 reported cases in 1990 to 266 reported cases in 2001, meeting the Healthy People 2000 objective of less than 500 cases per year. In 2003, the Centers for Disease Control and Prevention (CDC) reported a total of 231 cases.

However, on July 26, 2005, an epidemic occurred in Sullivan County, New York at a summer camp. An investigation conducted by the New York State Department of Health (NYSDOH) identified 31 cases of mumps, likely introduced by a camp counselor who had traveled from the United Kingdom and had not been vaccinated for mumps. Even in a population with 96% vaccination coverage, as was the case with participants in the summer camp, a mumps outbreak can result from exposure to virus imported from a country with an ongoing mumps epidemic. The likelihood of disease in US residents caused by imported virus from areas with mumps epidemics remains high.

International

Because the virus is present throughout the world, risk of exposure to mumps outside the United States may be high. Mumps remains endemic in many countries throughout the world, and mumps vaccine is used in only 57% of countries that belong to the World Health Organization, predominantly in countries with more developed economies. In England and Wales, an epidemic of mumps was ongoing during 2005, with 56,390 notified cases reported.

Mortality/Morbidity

• Death due to mumps is rare; more than half of the fatalities occur in persons older than 19 years.
• Mumps encephalitis occurrence ranges as high as 5 cases per 1000 reported mumps cases, and males are affected 3-5 times more frequently than females. Permanent sequelae are rare, but the reported encephalitis case-fatality rate has averaged 1.4%.
• Approximately 10% of all infected patients develop a mild form of meningitis, which could be confused with bacterial meningitis.
• Encephalitis, transient myelitis, or polyneuritis is rare.
• Unilateral hearing loss is associated with mumps infection but also is rare.
• Orchitis occurs in 10-20% of patients; subsequent sterility is rare. Oophoritis is quite rare and usually is a benign inflammation of the ovaries.
• Other rare complications include myocarditis, nephritis, arthritis, thyroiditis, pancreatitis, thrombocytopenia purpura, mastitis, and pneumonia. These usually resolve within 2-3 weeks without sequelae.

Race

• During 1990-1998, race and ethnicity were reported for approximately two thirds of cases in each of 28 states and the District of Columbia. Mumps incidence decreased for people of all races during this 4-year period. For each year, incidence was highest among black persons, ranging from 1.2-8.2 times the incidence of any other racial group. In people of every age group, incidence rates for black persons exceeded rates for people of other racial groups; this relationship was most notable for persons aged 5-19 years.
• Although incidence rates for Hispanics exceeded the rates for non-Hispanics in every age group, differences in rates were minimal for children younger than 5 years and for persons aged 20 years or older. The greatest difference in incidence rates between Hispanics and non-Hispanics was for persons aged 5-19 years.

Sex

No sexual predilection exists.

Age

• As in the prevaccine era, most reported mumps cases still occur in school-aged children (aged 5-14 y). Almost 60% of reported cases occurred in this population from 1985-1987, compared with an average of 75% of reported cases from 1967-1971, the first 5-year period postlicensure. However, for the first time since mumps became a reportable disease, the reported peak incidence rate shifted from children aged 5-9 years to older age groups for 2 consecutive years (ie, 1986, 1987).
• Persons aged 15 years or older accounted for more than one third of the reported total from 1985-1987, whereas during the period 1967-1971, an average of only 8% of reported cases occurred among this population. Although reported mumps incidence increased in all age groups from 1985-1987, the most dramatic increases were among adolescents aged 10-14 years (almost a 7-fold increase) and young adults aged 15-19 years (more than an 8-fold increase).
• Increased occurrence of mumps in susceptible adolescents and young adults has been demonstrated in several recent outbreaks in high schools, on college campuses, and in occupational settings. Nonetheless, despite this age shift in reported mumps, the overall reported risk of disease in persons aged 10-14 and those aged 15 years or older is still lower than that in the prevaccine and early postvaccine era.

CLINICAL

Section 3 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

History

The incubation period is 14-21 days, and mumps is communicable from 6 days before to 9 days after facial swelling is apparent. However, 30% of infections are subclinical.

• Symptoms in the history mostly consist of fever, headache, and malaise. Within 24 hours, patients report an ear pain localized near the lobe of the ear and aggravated by a chewing movement of the jaw. The fever usually subsides after a variable period of up to 1 week, well before the salivary gland edema disappears.
• Older children may describe a sensation of swelling at the angle of the jaw in the early stage, especially with a sour taste.

Physical

After the prodromal period, 1 or both parotid glands begin to enlarge; 70-80% of cases are bilateral. Edema over the parotid gland typically occurs with nondiscrete borders, pain with pressure, and obscured angle of the mandible.

• Parotitis: The classic illness of mumps consists of swelling of the parotid gland (ie, parotitis, parotiditis). Systemic symptoms include low-grade fever, headache, malaise, anorexia, and abdominal pain. Acid-containing foods may aggravate discomfort of the parotid gland. Ordinarily, the parotid gland is not palpable, but in patients with mumps, it rapidly progresses to maximum swelling over several days. Unilateral swelling usually occurs first, followed by bilateral parotid involvement. Occasionally, simultaneous involvement of both parotid glands occurs. Unilateral parotid disease occurs in fewer than 25% of patients. Fever subsides within 1 week and disappears before swelling of the parotid gland resolves, which may require as long as 10 days. Other salivary glands may be involved, including both submaxillary glands and sublingual glands, and orifices of the ducts may be erythematous and edematous.
• Orchitis: Approximately one third of postpubertal male patients develop unilateral orchitis. It usually follows parotitis, but it may precede parotitis or occur in the absence of parotitis. Usually, it appears in the first week of parotitis, but it can occur in the second or third week. Bilateral orchitis occurs much less frequently, and although gonadal atrophy may follow orchitis, sterility is rare even with bilateral involvement. Prepubertal boys may develop orchitis, but it is uncommon in those younger than 10 years. Orchitis is accompanied by high fever, severe pain, and swelling. Nausea, vomiting, and abdominal pain are not uncommon. Fever and gonadal swelling usually resolve in 1 week, but tenderness may persist.
• Meningoencephalitis
• • Central nervous system involvement with mumps is not uncommon, and it more often occurs as meningitis rather than true encephalitis. It may precede parotitis or appear in the absence of parotitis, but it usually occurs in the first week after parotitis. Headache, fever, nausea, vomiting, and meningismus are common. Marked changes in sensorium and convulsions are not usual. Pleocytosis of the cerebral spinal fluid (CSF) occurs in a high percentage of persons without clinical evidence of central nervous system involvement.
  • In clinically diagnosed meningoencephalitis, a CSF mononuclear pleocytosis occurs, as does normal glucose, although hypoglycorrhachia has been reported. The mumps virus may be isolated from CSF early in the illness. Mumps meningoencephalitis carries a good prognosis and is usually associated with an uneventful recovery. Other clinical manifestations of mumps include pancreatitis accompanied by severe abdominal pain, chills, fever, and persistent vomiting. Thyroiditis, oophoritis, and mastitis occasionally occur.
• Deafness: Neuritis of the auditory nerve may result in deafness. Sudden onset of tinnitus, ataxia, and vomiting is followed by permanent deafness. Other neurologic complications include facial nerve neuritis and myelitis.
• Less common complications include arthritis, myocarditis, and hematologic complications.

Causes

Lack of immunization, international travel, and immune deficiencies can make a child more prone to infection by Paramyxovirus mumps virus.

DIFFERENTIALS

Section 4 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Other Problems to be Considered

Coxsackievirus parotitis
Influenza virus parotitis
Parainfluenza virus parotitis
Suppurative parotitis commonly caused by Staphylococcus aureus or other bacteria
Adenitis
Recurrent parotitis
Calculus of Stensen duct
Tumors of the parotid gland
Mikulicz syndrome
Meningoencephalitis

WORKUP

Section 5 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Lab Studies

• Diagnosis is clinical, and laboratory tests are unnecessary. The virus can be isolated from saliva or mouth washings in primary monkey kidney tissue culture.
• Diagnosis can also be made by significant rise between acute and convalescent phase titers in serum mumps immunoglobulin G (IgG) antibody level using any standard serologic assay or positive serologic test for mumps immunoglobulin M (IgM) antibody. Interpretation of titer rise may have limitations because of mumps cross-reaction with parainfluenza viruses.
• Serum amylase is elevated in mumps parotitis and pancreatitis. Serum lipase is elevated in pancreatitis.
• CBC indicates a normal or elevated WBC count with lymphocyte predominance.
• Viruria is common even in uncomplicated mumps.

Imaging Studies

• Imaging may only be needed for complicated cases involving certain organ systems.

Other Tests

• Complicated cases may need further testing, if a need exists to determine other organ system involvement.

Procedures

• Lumbar puncture may be needed to obtain cell profile and culture information if meningoencephalitis is the prominent presentation.

TREATMENT

Section 6 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Medical Care

• Conservative therapy is indicated.
• Generous offering of fluids is essential because adequate hydration and alimentation of patients is important.
• Foods and liquids containing acid may cause swallowing difficulty as well as gastric irritation.
• Prescribe analgesics for severe headaches or discomfort due to parotitis. In orchitis, stronger analgesics may be needed.
• No antiviral agent is indicated for mumps, which is a self-limited disease.

Consultations

Consultation may be considered in complicated cases with multiple organ system involvement.

Diet

A light diet with generous fluid intake is recommended. Avoiding acid-containing foods (eg, tomato, vinegar-containing food additives) and liquids (eg, orange juice) are beneficial to reduce pain.

Activity

Bed rest is recommended for a faster recovery and is needed for patients with complicated cases.

MEDICATION

Section 7 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Drug Category: Analgesics

These agents may be prescribed for severe headaches or discomfort due to parotitis. In orchitis, stronger analgesics may be needed.

Drug Name	Acetaminophen (Tylenol, Tempra)
Description	DOC for pain in patients with documented hypersensitivity to NSAIDs, with upper GI disease, or who are taking PO anticoagulants. Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.
Adult Dose	325-650 mg PO q4-6h or 1000 mg tid/qid; not to exceed 4 g/d
Pediatric Dose	15 mg/kg/dose q4-6h prn for relief of pain/fever; not to exceed 2.6 g/d
Contraindications	Documented hypersensitivity; known G-6-P deficiency
Interactions	Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Hepatotoxicity possible in people with long-term alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; APAP is contained in many OTC products, and combined use with these products may result in cumulative APAP doses exceeding recommended maximum dose

Drug Category: Vaccines (measles, mumps, rubella)

Prevention of mumps through immunization cannot be overemphasized. All children younger than 7 years should receive the mumps vaccine. In the United States, mumps vaccine is recommended and is usually combined with measles and rubella (MMR).

FOLLOW-UP

Section 8 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Deterrence/Prevention

• Droplet precautions are recommended until 9 days after the onset of parotid swelling. Children should be excluded for 9 days from the onset of parotid gland swelling from going to school and child care centers. If outbreaks occur, all children should be vaccinated.
• Susceptible children, adolescents, and adults should be vaccinated against mumps, unless vaccination is contraindicated. Mumps vaccine is of particular value for children approaching puberty and for adolescents and adults who have not had mumps. MMR vaccine is the vaccine of choice for routine administration and should be used in all situations where recipients are also likely to be susceptible to measles, rubella, or both. The favorable benefit-to-cost ratio for routine mumps immunization is more marked when vaccine is administered as MMR. Persons should be considered susceptible to mumps unless they have documentation of (1) physician-diagnosed mumps, (2) adequate immunization with live mumps virus vaccine on or after their first birthday, or (3) laboratory evidence of immunity.
• Because live mumps vaccine was not used routinely before 1977 and because the peak age-specific incidence was in children aged 5-9 years before the vaccine was introduced, most persons born before 1957 are likely to have been infected naturally from 1957-1977. Therefore, they may generally be considered to be immune, even if they may not have had 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 may be exposed in outbreak settings.
• Persons who are unsure of their mumps disease history, mumps vaccination history, or both should be vaccinated. No evidence indicates that persons who have previously either received mumps vaccine or had mumps are at any increased risk of local or systemic reactions from receiving live mumps vaccine. Testing for susceptibility before 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, radial hemolysis antibody test) are not readily available.
• A single dose of vaccine in the volume specified by the manufacturer should be administered subcutaneously. While not recommended routinely, intramuscular vaccination is effective and safe.
• Administration of the live mumps virus vaccine is recommended at any age on or after the first birthday for all susceptible persons, unless a contraindication exists. Under routine circumstances, mumps vaccine should be administered in combination with measles and rubella vaccines as MMR, following the currently recommended schedule for administration of measles vaccine. It should not be administered to infants younger than 12 months because persisting maternal antibody might interfere with seroconversion. To insure immunity, all persons vaccinated before the first birthday should be revaccinated on or after the first birthday.
• When administered after exposure to mumps, live mumps virus vaccine may not provide protection. However, if the exposure did not result in infection, vaccine should induce protection against infection from subsequent exposures. No evidence indicates that the risk of vaccine-associated adverse events increases if vaccine is administered to persons incubating disease.
• Immunoglobulin has not been demonstrated to be of established value in postexposure prophylaxis and is not recommended. Mumps immunoglobulin has not been shown to be effective and is no longer available or licensed for use in the United States.

Complications

• Hearing loss
• Meningitis or encephalitis
• Orchitis
• Oophoritis
• Pancreatitis
• Transient myelitis
• Polyneuritis
• Myocarditis
• Nephritis
• Arthritis
• Thyroiditis
• Thrombocytopenia purpura
• Mastitis
• Pneumonia
• Sensorineural deafness

Prognosis

• Overall prognosis in uncomplicated mumps is excellent.
• Prognosis of patients with meningoencephalitis generally is favorable; however, neurologic damage and death can occur. Reported rates of mumps encephalitis range as high as 5 cases per 1000 reported mumps cases. Permanent sequelae are rare, but the reported encephalitis case-fatality rate has averaged 1.4%.
• Sensorineural deafness is 1 of the most serious of the rare complications involving the central nervous system. It occurs with an estimated frequency of 0.5-5.0 cases per 100,000 reported mumps cases. Minor degrees of hearing loss or impairment are likely to occur with higher incidence and are probably reversible. Deafness after mumps is rare, mostly unilateral (20% bilateral), and often permanent.
• Orchitis (usually unilateral) has been reported as a complication in 20-30% of clinical mumps cases in postpubertal males. Some testicular atrophy occurs in about 35% of cases of mumps orchitis, but sterility rarely occurs.
• Symptomatic involvement of other organs has been observed less frequently. Limited experimental, clinical, and epidemiologic data suggest permanent pancreatic damage may result from injury caused by direct viral invasion. Further research is needed to determine whether mumps infection contributes to the pathogenesis of diabetes mellitus.
• Mumps infection in pregnant women seems to increase the risk of embryonic and fetal death and spontaneous abortions, especially during the first trimester of pregnancy (reported to be as high as 27%). No association was found between mumps and congenital anomalies, and the studies relating maternal mumps infection to endocardial fibroelastosis in the fetus are inconclusive. Mumps during pregnancy was rare even before immunization and is even rarer with the widespread use of mumps immunization in childhood.

Patient Education

• The principal strategy to prevent mumps is to achieve and maintain high immunization levels, primarily in infants and young children. Universal immunization as a part of good health care should be routinely carried out in physicians' offices and public health clinics. Programs aimed at vaccinating 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. This is especially important for adolescents and young adults in light of the recently observed increase in risk of disease in these populations.
• Advise parents and educators to exclude the infected child from large-population facilities until 9 days after the swelling begins or until the swelling subsides.
• Advise all children and adults to follow good handwashing practices.
• For excellent patient education resources, visit eMedicine's Common Childhood Illnesses Center, Children's Health Center, and Bacterial and Viral Infections Center. Also, see eMedicine's patient education articles Mumps and Immunization Schedule, Children.

MISCELLANEOUS

Section 9 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Medical/Legal Pitfalls

• Failure to advise isolation for the duration of the contamination period
• Failure to check for complicated cases involving certain organ systems
• Failure to check for pregnancy in postpubertal women, including asking if they are or may be pregnant, excluding those who say they are, and explaining the theoretical risk to those who plan to receive the vaccine

Special Concerns

• Mumps in a childcare facility: If a case of mumps occurs in a childcare facility, notify the local health department. Notify parents. Exclude the infected child from the facility until 9 days after the swelling begins or until the swelling subsides. Make sure all children and adults follow good handwashing practices. In large facilities, follow appropriate group separation practices. Review the immunization records of all children in the facility to assure they have received their first mumps vaccination. Those not adequately vaccinated should be referred to their physicians. Closely observe all children for symptoms and refer anyone developing symptoms to his or her physician.
• Adverse effects of vaccine use: In field trials before licensure, illnesses did not occur more often in vaccinees than in unvaccinated controls. Reports of illnesses following mumps vaccination have mainly involved episodes of parotitis and low-grade fever. Allergic reactions, including rash, pruritus, and purpura, have been temporally associated with mumps vaccination but are uncommon, are usually mild, and are of brief duration. The reported occurrence of encephalitis within 30 days of receipt of a mumps-containing vaccine (0.4 cases per million doses) is not greater than the observed background incidence rate of CNS dysfunction in the healthy population. Other manifestations of CNS involvement, such as febrile seizures and deafness, have also been infrequently reported. Complete recovery is usual. Reports of nervous system illness following mumps vaccination do not necessarily denote an etiologic relationship between the illness and the vaccine.
• Contraindications to vaccine use in pregnancy: Although mumps vaccine virus has been shown to infect the placenta and fetus, no evidence indicates that it causes congenital malformations in humans. However, because of the theoretical risk of fetal damage, avoiding administration of live virus vaccine to pregnant women is prudent. Vaccinated women should avoid pregnancy for 3 months after vaccination. Routine precautions for vaccinating postpubertal women include asking if they are or may be pregnant, excluding those who say they are, and explaining the theoretical risk to those who plan to receive the vaccine. Vaccination during pregnancy should not be considered an indication for termination of pregnancy. However, the final decision about interruption of pregnancy must rest with the individual patient and her physician.
• Severe febrile illness: Vaccine administration should not be postponed because of minor or intercurrent febrile illnesses, such as mild upper respiratory infections. However, vaccination of persons with severe febrile illnesses should generally be deferred until they have recovered.
• Allergies: Because live mumps vaccine is produced in chick embryo cell culture, persons with a history of anaphylactic reactions (ie, hives, swelling of the mouth and throat, difficulty breathing, hypotension, shock) after egg ingestion should only be vaccinated with caution using published protocols. Children with known allergy should not leave the vaccination site for 20 minutes. Evidence indicates that persons are not at increased risk if they have egg allergies that are not anaphylactic in nature. Such persons may be vaccinated in the usual manner. No evidence indicates that persons with allergies to chickens or feathers are at increased risk of reaction to the vaccine. Because mumps vaccine contains trace amounts of neomycin (25 mcg), persons who have experienced anaphylactic reactions to topically or systemically administered neomycin should not receive mumps vaccine.
• Recent immunoglobulin injection: Passively acquired antibody can interfere with the response to live attenuated-virus vaccines. Therefore, mumps vaccine should be administered at least 2 weeks before the administration of immunoglobulin or deferred until approximately 3 months after the administration of immunoglobulin.
• Exceptions: An exception to these general recommendations is in children infected with human immunodeficiency virus (HIV); all asymptomatic HIV-infected children should receive MMR vaccination at 15 months of age. Patients with leukemia in remission whose chemotherapy has been terminated for at least 3 months may also receive live mumps virus vaccine.

REFERENCES

Section 10 of 10

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

• AAP. Mumps. In: Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, Ill:. American Academy of Pediatrics;2003:439-443.
• CDC. Status report on the Childhood Immunization Initiative: reported cases of selected vaccine-preventable diseases--United States, 1996. MMWR Morb Mortal Wkly Rep. Jul 25 1997;46(29):665-71. [Medline].
• CDC. Update: childhood vaccine-preventable diseases--United States, 1994. MMWR Morb Mortal Wkly Rep. Oct 7 1994;43(39):718-20. [Medline].
• CDC. Mumps prevention. MMWR Morb Mortal Wkly Rep. Jun 9 1989;38(22):388-92, 397-400. [Medline].
• CDC. Mumps--United States, 1985-1988. MMWR Morb Mortal Wkly Rep. Feb 24 1989;38(7):101-5. [Medline].
• CDC. Mumps outbreak at a summer camp--New York, 2005. MMWR Morb Mortal Wkly Rep. Feb 24 2006;55(7):175-7. [Medline]. [Full Text].
• CDC. Mumps epidemic--United kingdom, 2004-2005. MMWR Morb Mortal Wkly Rep. Feb 24 2006;55(7):173-5. [Medline]. [Full Text].
• Chaiken BP, Williams NM, Preblud SR, et al. The effect of a school entry law on mumps activity in a school district. JAMA. May 8 1987;257(18):2455-8. [Medline].
• Cherry JD. Mumps Virus. In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Disease. 2nd ed. Philadelphia, Pa:. WB Saunders;1998:2075-2083.
• Hopkins RS, Jajosky RA, Hall PA, et al. Summary of notifiable diseases--United States, 2003. MMWR Morb Mortal Wkly Rep. Apr 22 2005;52(54):1-85. [Medline].
• Maldonado Y, Phillips C. Mumps. In: Behrman RE, ed. Nelson Textbook of Pediatrics. Philadelphia, Pa:. WB Saunders;1996:873-875.
• McQuone SJ. Acute viral and bacterial infections of the salivary glands. Otolaryngologic Clinics of North America. Oct. 1999;32(5):793-811. [Medline].
• Ornoy A, Tenenbaum A. Pregnancy outcome following infections by coxsackie, echo, measles, mumps, hepatitis, polio and encephalitis viruses. Reprod Toxicol. May 2006;21(4):446-57. [Medline].
• Sosin DM, Cochi SL, Gunn RA, et al. Changing epidemiology of mumps and its impact on university campuses. Pediatrics. Nov 1989;84(5):779-84. [Medline].
• Taber LH, Demmler GJ. Mumps. In: McMillan JA, DeAngelis CD, Feigin R, Warshaw JB, eds. Oski's Pediatrics. Philadelphia, Pa:. Lippincott Williams & Wilkins;1999:1141-1142.
• WHO. Global status of mumps immunization and surveillance. Wkly Epidemiol Rec. Dec 2 2005;80(48):418-24. [Medline].
• Watson JC, Hadler SC, Dykewicz CA, et al. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR - Morbidity & Mortality Weekly Report. May 22 1998;47(RR-8):1-57. [Medline].
• Wharton M, Cochi SL, Williams WW. Measles, mumps, and rubella vaccines. Infect Dis Clin North Am. Mar 1990;4(1):47-73. [Medline].
• van Loon FPL, Holmes SJ, Sirotkin BI. Mumps Surveillance -- United States, 1988-1993. MMWR. August 11, 1995;44(SS-3):1-14.

Article Last Updated: May 18, 2006