Chapter 318

Mumps is a communicable systemic viral illness usually characterized by parotitis. With the widespread use of mumps vaccine, the disease has become less common. A significant number of infections are asymptomatic.

### Epidemiology

Humans are the only known natural hosts of mumps virus. The virus can be recovered from patients with active disease from saliva, cerebrospinal fluid (CSF), urine, blood, breast milk, and infected tissue.1,2 Mumps virus infections are spread by respiratory droplet or by direct contact with infected saliva. Virus can be demonstrated in respiratory secretions up to 7 days before through 9 days after the onset of parotitis.2 Secondary attack rates of mumps among susceptible household contacts have been shown to be less than that of measles or varicella, suggesting a less efficient transmission of the mumps virus.3 The normal incubation period is from 16 to 18 days (range 12–25 days). In susceptible, unimmunized populations, 60% to 70% of infections are associated with parotitis.4 However, there is a substantial subclinical attack rate produced by the mumps virus. Approximately 20% of mumps infections may go unrecognized, especially in adults, because they do not have evidence of parotitis.2,5 Given the number of subclinical cases, information regarding a patient’s history of mumps infection is notoriously inaccurate. Mumps virus infection is most communicable from 1 to 2 days prior to parotid swelling until 5 days after parotid swelling begins.2 Introduction of infection onto a hospital ward in areas where vaccine is not routinely given may lead to widespread nosocomial transmission because some patients may develop subclinical infection, and patients are contagious prior to onset of parotid swelling, making it extremely difficult to prevent transmission.6

Introduction of an effective, live-attenuated virus vaccine (Jeryl Lynn strain) in 1967, combined with the introduction of school laws regarding mumps vaccination, led to a marked reduction in the number of reported cases of mumps in the United States, from more than 185,000 cases in 1968 to 2982 in 1985.7 Following a brief resurgence of disease, a revised recommendation for two doses of measles-mumps-rubella (MMR) vaccine in 19894 and subsequent changes in school laws requiring two doses of vaccine, the annual number of mumps cases further declined. From 2001 to 2005, fewer than 300 cases of mumps were reported annually in the United States.8 In 2006, a multistate mumps outbreak with more than 5700 cases, many involving older adolescents and young adults, demonstrated that although two doses of vaccine were more protective than a single dose, protection from infection, even with two doses of vaccine, was not 100%.5,9 Outside the United States, mumps remains endemic in many countries throughout the world.10,11 In 2005, only 57% of World Health Organization member-countries reportedly used mumps vaccine.11

A single attack of mumps is believed to confer permanent immunity against a subsequent attack, regardless of whether ...

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