CHENNAI: Mumps is a vaccine-preventable disease found in children and adults. Mumps virus, present throughout the world, spreads by droplet infection like a cough, sneeze or direct contact. It affects the salivary glands, primarily called ‘Parotitis’.
Although the disease is usually a self-limiting clinical condition mainly affecting children between 5 to 10 years of age, it can lead to serious complications such as meningitis (15%), pancreatitis (4%), and orchitis (20–30%) in post-pubertal males, and encephalitis and abortions in pregnant women. It also results in a significant loss of school days/working days. Hence, its prevention becomes imperative.
Though 120 countries (62%) have included mumps vaccine in their national immunisation schedule, India is still not a member of this group. In India, outbreaks and sporadic cases have been reported throughout the year. Mumps is a prevalent viral disease with more than 90% cases going unreported. The ‘classic’ mumps illness is characterised by fever and swelling of the parotid gland(s) that affects children and adolescents and may lead to serious complications. However, only half of the infected subjects develop a classical disease. About 30% of the infections are asymptomatic, and a significant number of infections are atypical (without parotitis).
Mumps, without associated major complications, can be managed on an outpatient basis with supportive health guidance and care. Patients diagnosed with mumps should be isolated for five days from the onset of symptoms to minimise the risk of infecting others. Most cases see full recovery. About one in 1,000 people with mumps meningitis develop encephalitis, of whom 1.5% of cases are fatal.
The strategy for controlling a mumps outbreak is to define the population(s) at risk and transmission setting(s), and to rapidly identify and vaccinate persons without presumptive evidence of immunity. In an outbreak setting, persons previously vaccinated with one or two doses of mumps-containing vaccine and are identified by public health facilities at an increased risk for mumps because of the outbreak should receive a dose of a mumps-containing vaccine (second dose for persons previously vaccinated with one dose or a third dose for persons previously vaccinated with two doses) to improve protection against mumps and its complications.
From the prevention aspect, normal hygiene measures to prevent droplet infection should be followed in the household of a mumps patient. Children should be excluded from school for five days following the onset of parotid swelling.
The Centre for disease control recommends two doses of mumps vaccine — one at 12-15 months and other between 4-6 years of age. The Indian Academy Of Pediatrics in 2018 based on WHO (World Health Organisation) recommends administration of three MMR (Measles, Munpa, Rubella) Vaccine doses — one in 9 months, one in 15 months and one in between four to five years of age.
MMR vaccine is safe and effective. Mumps component of the MMR vaccine is about 88% (range: 31%−95%) effective when a person gets two doses, and one dose is about 78% (range: 49%−92%) effective.
Health guidance, continuous care
Mumps, without associated major complications, can be managed on an outpatient basis with supportive health guidance and continuous care. Patients diagnosed with mumps should be isolated for five days from the onset of symptoms to minimise the risk of infecting others. Most cases see full recovery. About one in 1,000 people with mumps meningitis develop encephalitis, of whom 1.5% of cases are fatal.
(The writer is a Consultant Pediatrics at Motherhood Hospitals MBBS, MRPCH (UK), MD (Ped), FPEM (Emergency Pead))