Primary prevention
The mumps vaccine is a live-attenuated virus. In most countries, the Jeryl Lynn strain is used.
In the US, the mumps vaccine is available in combination with measles and rubella (MMR vaccine) and also in combination with measles, rubella, and varicella (MMRV). The first dose of vaccine is routinely given at age 12-15 months, and the second at age 4-6 years.[19] Since 1978, M-M-R II has been the sole MMR vaccine used in the United States; however, in June 2022, PRIORIX was licensed as an additional MMR vaccine option.[20]
During a mumps outbreak, the US Advisory Committee on Immunization Practices recommends that individuals ages ≥12 months who are at increased risk and have received 2 doses of a mumps-containing vaccine should receive a further dose to improve protection.[21]
If required, MMR vaccine can be given to individuals of any age. Generally, vaccination with attenuated mumps-containing vaccine is recommended for anyone who has not been vaccinated previously, or for those people who have only received 1 dose of the vaccine previously.[15][19][22]
Two post-licensure studies indicated that among children ages 12-23 months, one additional febrile seizure per 2300-2600 children occurred 5-12 days after the first dose of the MMRV vaccine compared to administration of the MMR and varicella vaccines as separate injections on the same day. Following guidance from the US, where the varicella vaccine is already in use, it is anticipated that the UK will incorporate the varicella vaccine into the universal immunization program as MMRV at 12 and 18 months. This introduction may be scheduled for the latter part of next year, allowing for careful planning and implementation. Consequently, the US guidelines suggest using the MMRV vaccine with caution in children with a personal or family (i.e., sibling or parent) history of seizure and, in children ages 12-47 months, the first dose of the MMR and varicella vaccines should be administered as separate injections. For the second dose of the measles, mumps, rubella, and varicella vaccines at any age (15 months-12 years) and for the first dose at age older than 48 months, the use of the combined MMRV vaccine is generally preferred.[14] One study showed that the risk of seizures after the first dose of MMR and MMRV vaccines was about twice that when given at 16-23 months, as opposed to 12-15 months.[23]
In a comparison study of people with mumps immunity secondary to vaccination versus naturally acquired immunity to mumps, levels of detectable IgG antibodies were lower in the vaccinated group. However, mumps antigen-specific lymphoproliferative responses were detected in 98% of all patients, suggesting a long persistence of cellular immunity against the mumps virus.[24] The field experience of mumps vaccines shows them to be less efficacious than prelicensure studies suggested. This discrepancy may partially relate to primary vaccine failure and the lack of concordance between some measures of seroconversion and clinical protection. There is also evidence of waning immunity, so secondary vaccine failure would also appear to be important.[17][18]
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]
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MMR vaccine is not recommended in pregnancy, in patients receiving pharmacological doses of glucocorticoids, or in immunocompromised individuals. However, MMR vaccination may be considered for patients with HIV who have moderate (but not severe) immunosuppression, although local protocols should be followed.[15] The MMRV vaccine is contraindicated in the US for children with HIV.[25]
Adverse reactions to the vaccines are infrequent. The most common adverse reactions include local reactions, low-grade fever, and rash. Parotitis can also occur. In 1998, an article was published which led to a false suggestion of a link between the MMR vaccine and autism. Since then, a retraction of the initial article was submitted, and numerous studies have found no evidence of a connection between MMR and autism.[12][26][27]
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Secondary prevention
People with mumps should be isolated to prevent the spread of the infection. The American Academy of Pediatrics (AAP), Centers for Disease Control and Prevention (CDC), and Healthcare Infection Control Practices Advisory Committee (HICPAC) all recommend a 5-day period of isolation after onset of parotitis, both for people with mumps in either community or healthcare settings and for use of standard precautions and droplet precautions.[43] Exclusion for 5 days is also recommended in the UK.[44] Postexposure immunization has not demonstrated efficacy in preventing disease spread. However, the CDC recommends that people previously vaccinated with two doses of a mumps virus-containing vaccine and are deemed at increased risk due to an outbreak should receive a third dose to improve protection against mumps disease and related complications.[21] Local guidelines should be consulted.
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