Mumps

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Organism, Causative Agent, or Etiologic Agent

Mumps virus is a Rubulavirus in the Paramyxovirus family.

Transmission
Mumps is spread by droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs, sneezes or talks. Items used by an infected person, such as cups or soft drink cans, can also be contaminated with the virus, which may spread to others if those items are shared.

Symptoms
Mumps is best known for the puffy cheek and swollen jaw which is the results of swollen or tender salivary glands (parotitis). This swelling may be on one or both sides and will usually resolve in about a week. Other common symptoms include:

• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite

Many people may have mild symptoms or not have any symptoms at all. Other glands can swell or become tender, most notably adult males may have swollen or tender testicles. Complications or other presentations are rare and usually mild, but include deafness, pancreatitis, oophoritis (swollen ovaries), meningitis, and encephalitis.

Incubation Period
Average of 16-18 days (range of 12-25 days).

Communicability
 A person is most infectious with mumps within the first 5 days after symptom onset. Mumps is most infectious in the several days before and after parotitis onset and thus the most likely time transmission occurs. Transmission also likely occurs from people who are not exhibiting any symptoms and from those with prodromal symptoms (i.e. muscle aches, loss of appetite, tiredness, headache, and low-grade fever). 

Prevention and Vaccination
Mumps can be prevented with the MMR (measles mumps rubella) vaccine and it is currently recommended for children to received two doses starting with the first dose at 12 through 15 months of age and the second dose at 4 to 6 years of age. Anyone who is not immune from either previous mumps infection or from vaccination can get mumps. A third dose of MMR has recently been recommended and approved by the Advisory Committee on Immunization Practices for public health authorities. A third dose would be recommended for “persons previously vaccinated with 2 doses of a mumps virus-containing vaccine who are identified…as being part of a group or population at increased risk for acquiring mumps because of an outbreak…to improve protection against mumps disease and related complications” (MMWR Morb Mortal Wkly Rep 2018;67:33–38). 

School Exclusion Policy
Children with suspected or confirmed mumps should be kept out of school or childcare for five days after the onset of swelling. Rules for exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically Rule 97.7 for schools.

Recent Texas Trends
Due to high vaccination rates in Texas, mumps incidence is traditionally low, however there has been a recent surge in mumps cases. In 2019, 783 cases of mumps were reported in Texas. This was the highest number of cases since 1990. There were 20 outbreaks in 2019 with the largest outbreak from March-May 2019 in Hidalgo County with cases ranging from 2 to 61 years old. Of the cases in the outbreaks, only 13% had a known 2 dose history of the mumps vaccine, and 72% in which vaccination history was unknown. Many of these outbreaks with high percentages of unknown vaccine history were associated with detention facilities, which was an issue across the U.S.