History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors are unvaccinated status, international travel, and potential exposure to a known case or outbreak setting.
parotitis
Parotid swelling is present in 95% of people with symptomatic mumps. It is caused by direct infection of the ductal epithelium and a local inflammatory response.[32]
history of missed or no vaccination or possible vaccine failure (primary or secondary)
Before vaccinations and in countries where there is no vaccination against mumps, children aged 5-9 years were the most commonly affected age group.[3] In the post-vaccine era, most mumps cases occur in young adults and college students. During the US mumps epidemic in 2006, 48% of cases occurred in people aged 17-25 years and 30% were college students.[39] In England and Wales in 2005, over 56,000 notifications of mumps were reported and over 80% of these were in people over 15-years-of-age.[40] Many other European countries, including the Netherlands, have had similar outbreaks.[41]
Other diagnostic factors
common
constitutional symptoms
Mumps infection usually begins with a prodrome of low-grade fever, malaise, headache, myalgias, and anorexia.[2]
orchitis
Epididymo-orchitis is the most common symptomatic extra-salivary mumps complication in adult males and may develop in as many as 38% of infected post-pubertal males.[42] It manifests as pain and swelling of one or both testicles.
oophoritis
Occurs in approximately 5% of post-pubertal females. Infertility and premature menopause have been reported but are rare complications.[2] Oophoritis manifests as fever with loin, abdominal, or back pain.
aseptic meningitis
Symptoms include neck stiffness, photophobia, and vomiting. Reported rates vary widely depending on assessment. Where CSF is routinely examined with lumbar puncture, the reported rate is over 50%; however the rate of clinical meningitis is between 1% and 10%.[2]
uncommon
mastitis
May occasionally occur in females and, rarely, in males.
encephalitis
deafness
In the pre-vaccine era, mumps infection was a common cause of sensorineural hearing loss, usually unilateral, in children. The onset may be acute or insidious. With the advent of the MMR vaccine, mumps has become an infrequent cause of deafness.[43]
Risk factors
strong
unvaccinated status
international traveller
The risk of exposure to travellers can be high. It is recommended that all travellers ensure they are fully immunised.
weak
immunosuppression
There are limited data about the risks of mumps in immunocompromised patients. It is generally thought that immunosuppression is not a significant risk factor for mumps infection. In one published series on mumps infection in children with acute lymphoblastic leukaemia, the infection was rarely severe and often remained subclinical, as in immunocompetent children.[15]
healthcare worker
close-contact living (college students, prisoners, military)
The US mumps outbreak in 2006, and a similar outbreak in the UK, affected a large number of college students. People who live in close contact with others, including college students, prisoners, and military personnel, are at increased risk of exposure to the disease.
vaccine failure
Mumps vaccine has yielded efficacy estimates as high as 95%.[2] However, a Cochrane review found that the effectiveness of Jeryl Lynn-containing MMR vaccine in preventing mumps was 72% after one dose and 86% after two doses.[14]
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There is also evidence of waning immunity, so secondary vaccine failure would also appear to be important.[19][20]
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