Mumps is a viral infection caused by the mumps virus that primarily affects the salivary glands. It is most contagious a few days before and during the onset of parotid gland swelling. While it usually causes mild symptoms, complications can include aseptic meningitis, orchitis, and deafness. Prevention is through the live attenuated MMR vaccine, which is recommended as a single dose between 12-18 months of age.

1. MUMPS Dr. Sukhwant Singh

2. INTRODUCTION*The name comes from the British word “to mump”, that isgrimace or grin. *This results from the appearance of the patientas a result of parotid gland swelling. *Mumps is a viral infectionprimarily affecting the salivary glands.

3. AGENT“MYXOVIRUS PAROTIDITIS” *Belongs to genus- Rubulavirus, and family- paramyxoviridae.*It is an enveloped, non- segmented, negative – sense RNA virus with helical symmetry. *It has two major surface glycoproteins : the haemgglutinin –neuraminidase andthe fusion protein. *Mumps virus is sensitiveto heat and ultraviolet light. *Only one serotype is known

4. SOURCE OF INFECTION* Both clinical and subclinical cases.* Subclinical cases ( 30-40% ), appear to be responsible for maintaining the cycle of infection.* The virus can be isolated from saliva, surface of stenson’s duct, blood, urine, human milk and occasionally in the CSF.

5. PERIOD OF COMMUNICABILITY* Usually 4-6 days before the onset of symptoms and a week thereafter.* The maximum infectivity is just before and at the onset of parotitis.* Once the swelling of the gland has subsided, the case is no longer infectious.* SAR – 85 Percent.

6. HOST FACTORS* Humans are the only natural hosts.* Peak incidence is among 5-9 years.* No age is exempt if there is no previous immunity.* The disease is more severe in adults.* One attack confers life long immunity.* Infants below 6 months are immune because of maternal antibodies.

7. ENVIRONMENT* In hot climates, the disease is endemic throughout the year.* In temperate climates, incidence peaks in winter and spring.* Epidemics are associated with overcrowding.

8. TRANSMISSION* Droplet infection.* Direct contact with infected person.INCUBATION PERIOD* Ranges from 2-3 weeks.Usually 18 days

9. CLINICAL FEATURES*prodromal illness of headache,malaise,myalgia and low gradefever occurs for 1-2 days before the onset of parotid enlargement. *Cases of classic mumps develop enlargement ofone parotid gland, followed a few days later by enlargementof the contralateral gland. *The patient complains of pain and tenderness in the area of the gland.

10. * The sub – mandibularand sublingual glands may occasionally be involved. * Parotidswelling develops in 95% of those with clinical illness. * Up to 30%of patients may have no or very mild symptoms (sub – clinical cases). * Most infections in children below two years of age aresubclinical.* The swelling subsides in 1-2 weeks.

11. COMPLICATIONS* Aseptic meningitis ( occurs in 10 % of patients )* Epididymo-orchitisoccurs in about 25% ofpostpubertal men .Testicular atrophyoccurs in about one - third of patients with mumps orchitis, butsterility is rare. Mumps orchitis appears to be a risk factor fortesticular cancer, though not a major one*Oophoritiscan occur in postpubertal women.* Spontaneous abortionAmong women who acquire mumps during the first 12 weeks of pregnancy

12. * Pancreatitismumps virus can infect human pancreatic beta cells, and may trigger the onset of insulin - dependent diabetes mellitus in some individuals.* Deafness Mumps is one of the main infectious causes of sensori neural deafness.* Hepatitis* Myocarditis* Thyroiditis* Encephalitis

13. MANAGEMENT* Mumps is a mild, self limited disease. * No specific anti – viral therapy is indicated. * Treatment is conservative.* Analgesics may be given for severe headaches or discomfort due to parotitis. * In orchitis, stronger analgesics may be needed.* Bed rest is recommended for a faster recovery.

14. PREVENTION* The first vaccinedeveloped against mumps was a killed vaccine which wasusedin the United States between 1950 and 1978.* live attenuated mumps virus vaccines have been developed based on several different strains. * The common ones are the Jeryl - Lynn strains, RIT 4385 strains, Leningrad - 3 strains, L - Zagreb strains, Urabe strains & the Rubini strains .* The recommended use is the form of a single dose schedule, given at age 12 - 18 months.

15. * MMR vaccine is manufactured by The Serum Institute of India. The strains used are * L - Zagreb for mumps, *Edmonston Zagreb for measles and *Plotkins RA 27/3 for rubella