History and exam
Key diagnostic factors
common
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.[30]
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 ages 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 ages 17-25 years and 30% were college students.[37] Many European countries, including the Netherlands, have had similar outbreaks.[38]
Other diagnostic factors
common
constitutional symptoms
Mumps infection usually begins with a prodrome of low-grade fever, malaise, headache, myalgias, and anorexia.[2]
orchitis
Epididymoorchitis is the most common symptomatic extrasalivary mumps complication in adult males and may develop in as many as 38% of infected post-pubertal males.[39] 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.[40]
Risk factors
strong
unvaccinated status
international traveler
The risk of exposure to travelers can be high. It is recommended that all travelers ensure they are fully immunized.
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 leukemia, the infection was rarely severe and often remained subclinical, as in immunocompetent children.[13]
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.[12]
[ 
]
There is also evidence of waning immunity, so secondary vaccine failure would also appear to be important.[17][18]
Use of this content is subject to our disclaimer