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JAMA Patient Page
September 10, 2019

Mumps

JAMA. 2019;322(10):1022. doi:10.1001/jama.2019.10982

Outbreaks of mumps in the United States have increased since 2006.

Mumps is caused by a paramyxovirus and is characterized by facial swelling. Until the mumps vaccine was introduced in 1967, most individuals in the United States had mumps during childhood.

Symptoms

The illness starts with the general malaise and discomfort common to other childhood viral illnesses: headache, fever, body aches, poor appetite, and fatigue. Symptoms usually start 2 to 3 weeks after exposure to the virus, which spreads easily through contact with infected persons’ respiratory secretions.

The symptoms that distinguish mumps from other infections are painful swollen salivary glands, particularly the parotid glands in front of the ears on both sides of the face. Mumps is also known as infectious parotitis or epidemic parotitis. Although patients’ typical facial appearance gave mumps its name, not all patients have swollen parotid glands. Some have minimal or no symptoms.

Orchitis (pain and swelling of the testicles) is seen frequently in mumps and can on rare occasion lead to low fertility. Less common complications include inflammation of the ovaries (oophoritis), breast tissue (mastitis), pancreas (pancreatitis), heart (myocarditis), and joints (arthritis). Serious complications of mumps are involvement of the lining of the brain and spinal cord (meningitis) or the brain (encephalitis). Hearing loss is an infrequent complication. Deaths due to myocarditis and encephalitis are very rare.

Diagnosis and Treatment

Mumps is the most common cause of parotitis, but parotitis can be due to bacteria, other viruses, or noninfectious causes. Mumps is diagnosed with a swab inside the cheek and a blood sample. There is no drug that eradicates the mumps virus. Treatment is mostly aimed at alleviating symptoms and includes anti-inflammatory medications like ibuprofen and cold packs over swollen parotids or testicles.

Prevention

The best way to prevent mumps is for most of a population to be vaccinated. The mumps vaccine is part of the combined measles-mumps-rubella (MMR) vaccine, 2 doses of which are recommended in early childhood. The efficacy of mumps vaccine is relatively low: a single dose is about 80% effective and 2 doses increase the efficacy to almost 90%. Also, the immunity induced by the mumps vaccine is known to weaken as people age. Vaccinated individuals can get mumps, although symptoms are generally milder, and rare complications like low fertility and hearing loss are even less likely. You should avoid being near anyone who has mumps even if you have been vaccinated.

Outbreaks

Because the efficacy of the mumps vaccine is not perfect and immunity can weaken with age, mumps outbreaks can occur among vaccinated populations. Outbreaks are more likely when people live or work together in close quarters: recent US outbreaks have occurred in colleges, religious communities, and the National Hockey League. Between 2015 and 2017, there were about 150 outbreaks and 9000 cases in the United States. In some outbreaks, public health departments recommend a third dose of mumps vaccine.

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Article Information

Conflict of Interest Disclosures: None reported.

Sources: Hviid JA, Rubin S, Mühlemann K. Mumps. Lancet. 2008;371(9616):932-944.

Centers for Disease Control and Prevention. Mumps cases and outbreaks. https://www.cdc.gov/mumps/outbreaks.html.

Centers for Disease Control and Prevention. Mumps: for healthcare providers. https://www.cdc.gov/mumps/hcp.html.

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