Feb 2, 2017
It's time for a mumps outbreak! Here is a basic primer on the
very basic basics.
How do you get mumps?
- Respiratory secretions, that
guy sitting next to you on the airplane with the huge parotid gland
and just sneeze in your eye. Not good.
- How long does this need to cook
before mumps is ready for full star spangled disease manifestation?
Somewhere between 2-3 weeks.
- The classic presentation is a
swollen parotid gland. Usually it’s both, but in a quarter of
patients, it’s unilateral parotitis, which can make things tricky
when you’re wondering if this patient has acute bacterial
parotitis, or mumps. The other salivary glands can swell as well,
but much less commonly than the parotid.
- All this salivary swelling
business may be preceded by a few days of viral syndrome fever ,
headache, body aches, feeling crappy. Patients
feel bad for a few days, the
parotids swell, stay swollen for anywhere from 2 to 10 days.
There may, however, be no parotid swelling as well, just a viral
syndrome and nothing else (there may also be no
The other issues with mumps
Orchitis. Can be one testicle, can be both
testicles. Females can also have reproductive organ
involvements- less than 1% with oophoritis and a similar
rate for mastitis. Non reprotrducgei or salivary gland involvement
include aseptic meningitis and pancreatitis.
But wait, I can’t get mumps, I’ve been
- Unfortunately that’s not 100%
protective and sadly, immunity can wane.
- There is no specific treatment, just supportive care.
- Your job now is to keep it from spreading. In the hospital,
droplet precautions. Mumps is most infectious from 2 days before
the parotid swelling to at least 5 days after. Hard to quarantine
when there's no parotid swelling, but once it starts, 5 days of no
school, no work, and separated from family members (not always
- We’re getting these
recommendations from the health department to collect samples from
almost every body fluid, but isn’t blood enough? It turns out that
it is not. Serum IGM, which you’d expect to see in an acute
infection, may be falsely negative, especially in someone who has
been vaccinated. Many different tissues are infected in mumps, so
to really figure out if it’s mumps or not, we’ve been advised to
get serum, urine, and buccal swabs. By the time the results come
back, your patient will probably be finished with quarantine, but
from a public health angle, you’re a hero.
Testing advanced level
- In unvaccinated patients, IgM
is present by day 5 post onset of symptoms. In a vaccinated person,
there might not be any IgM and it could have a very quick spike and
disappearance. When you get that IgM mumps test back negative 3
weeks after you’ve seen the patient, just know that that
doesn’t mean they don’t or didn't have mumps.
- Why buccal swabs? This
tests for the mumps virus itself and is very good in the early
stage of infection, especially in someone who has had vaccination,
which is hopefully everybody, but it’s not.
- Why urine testing? Not as
sensitive as buccal testing in early infection but currently
recommended in our region. I’m guessing to cast as wide a net
Call the health department
- Initiate patient tracking,
contact tracking, and have a public health expert take over with
following up on test results etc.
- If you see a patient with parotid swelling and there has been a
viral prodrome, or perhaps there’s been a mumps outbreak - think
mumps. If you have high suspicion, immediately
initiate droplet precautions, collect samples, call the
health department, quarantine (at home) and if possible separate
from family for 5 days following onset of parotid swelling.
Sometimes that last part is not possible, but have them do their
- Specimen Collection (what to order, exact way to collect
- Oregon Public Health Mumps Review (mumps
- Oregon Public Health Mumps Main Page (investigative guidelines,
case report form). Link
- CDC Mumps Pinkbook Review (mumps overview) Link
- CDC Mumps mainpage Link
- CDC Current Mumps Outbreaks Link