Mumps has been a common disease for centuries. Hippocrates wrote about it almost 2500 years ago. It’s not all that serious an illness. It doesn’t even affect male fertility the way that most people think. So why was a vaccine developed? Well, about 1/3 of the men who get mumps develop exquisite pain and swelling in one or both testicles, which then shrivel up and remain permanently atrophied. Perhaps that had something to do with it! Less well known, mumps can affect the ovaries as well.
Mumps is a virus that classically causes painful swelling of the parotid glands (saliva glands). Before the vaccine became available, it was an extremely common childhood infection.
When adults or adolescents get mumps the infection is more serious, often with orchitis (inflammation of the testicles).
Mumps used to be predominately a disease of elementary school-aged children. It was also a significant problem in the military. The biggest known epidemic in history occurred during World War II.
Mumps was around all of the time, especially during the winter and spring. Every 4 years or so, there was a major epidemic.
When the vaccine became widespread in 1968, there were more than 152,000 reported cases of mumps in the US. By 1997, the number had dropped to about 680 cases per year (while the population had grown significantly).
Today the demographics of mumps have changed. In the US, the seasonal variation has disappeared. And now mumps is associated more with college campuses than with elementary schools.
Since the vaccine, the age curve for mumps has shifted. It is no longer primarily a disease of 5 to 9 year olds, but is more frequently a disease of young adults than ever before – the very ones who have the most to lose!
Is this a failure of vaccine policy?
Before the vaccine, only about 15 per cent of mumps occurred after puberty. In 1968, more than 22,000 of the reported mumps cases were adult cases.
Today, about half of the 680 cases are in adolescents and adults (more or less than half in different years). Even if all of the remaining cases were in adults, this would still represent a 97 percent decrease in mumps in adults since the vaccine was introduced.
The classic symptom of mumps is painful swelling of one or both parotid glands, often obscuring the angle of the jaw. The pain is especially intense when tasting sour liquids (lemon juice and vinegar have provoked many a muffled scream).
People with mumps often mumble (and medical historians argue over whether the name mumps comes from an old word for ‘lump’ or an old word for ‘mumble’. I disagree with everyone. As a fan of wordplay, I suspect that the clever namers had both in mind.)
(Note: other viruses such as influenza, parainfluenza, HIV, CMV, and coxsackieviruses can also cause parotitis. So can staph infections.)
Many people with mumps have no symptoms. Some have both the classic symptoms and complications. Some have only the complications. Boys have complications about 3 times as often as girls.
The list of possible complications is long. Fortunately, most of them are rare. The most common complication before puberty is meningitis/encephalitis. The spinal fluid is changed in most kids with mumps, but the full blown complication occurs in about ¼ of 1 percent.
After puberty, the most common complication is sharp testicular pain and swelling (often confused at first with appendicitis, if the person is in too much pain to speak or point clearly – at least until the person is undressed). This is usually accompanied by chills, high fever, nausea, and headache. This occurs in about 1/3 of postpubertal males with mumps. It rarely occurs before puberty, but has been reported down to age 3.
About 40 percent of the affected testicles atrophy – this is noticeable cosmetically, but is unlikely to cause infertility even if both testicles are involved (contrary to the popular myth).
Most people don’t know this, but mumps can affect the ovaries in much the same way. 5 to 10 percent of women who get mumps will have some ovarian involvement. Fertility is not thought to be affected.
Mumps during pregnancy has not been associated with birth defects, but it does double the early miscarriage rate.
Other complications of mumps, such as Bell palsy, deafness, arthritis, heart problems, eye problems, thyroiditis, or inflammation of the pancreas are quite rare.
Mumps is contagious. It is usually spread through direct contact with infected saliva. The saliva is contagious for a day or two before the swelling and up to three days after the swelling has subsided.
The virus silently multiplies for 12 to 25 (usually 16-18) days before symptoms appear, if they do. The salivary gland swelling can happen quickly – within hours – or gradually over several days. The swelling and symptoms usually decrease and disappear over another 3 to 7 days.
If complications arise, they usually come later. The testicular or ovarian symptoms appear about a week after the parotitis. They last about 4 days (the four longest days according to a college friend of mine).
Meningitis or encephalitis typically arrives about a week and a half after the parotitis.
Mumps is suggested by the history and physical exam. Because the mumps virus is so uncommon today, further testing to determine the cause of the parotitis is wise. This might be done with blood, urine, throat washings, or spinal fluid, depending on the symptoms.
Treatment is aimed at relieving the symptoms. Anti-inflammatory medicines can reduce the pain and fever.
The mumps vaccine gives immunity to most people who get it after the first dose. And even more after the second dose. But this protection can decrease over time. When and where there is a mumps outbreak, a third dose may be needed for prevention.