Mumps: A-to-Z Guide from Diagnosis to Treatment to Prevention

Young boy making a face while bending his arm to make a muscle. Mumps was a common childhood illness until the vaccine became common.Introduction to mumps:

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.

What is it?

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).

Who gets it?

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?

You decide.

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.

What are the symptoms?

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.

Is it contagious?

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.

How long does it last?

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.

How is it diagnosed?

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.

How is it treated?

Treatment is aimed at relieving the symptoms. Anti-inflammatory medicines can reduce the pain and fever.

How can it be prevented?

The mumps vaccine gives lasting immunity to more than 95 percent of the people who get it after the first dose.

Related concepts:

Epidemic parotitis.

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched DrGreene.com, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of DrGreene.com, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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