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NCID > For Healthcare Professionals > Diseases and Conditions > Mumps

Mumps

Mumps

Causative Agent

Mumps virus

Incubation Period

12 to 25 days (median 18 days).

Infectious Period

One week before and up to 9 days after the onset of parotitis.

Transmission

Respiratory droplets and direct salivary contact with an infected person.

Epidemiology

In January 1990, vaccination against mumps was introduced in the national childhood immunisation programme when the monovalent measles vaccine was replaced by the trivalent measles, mumps, rubella (MMR) vaccine. Since January 1990, 3 mumps-virus strains have been used in the MMR vaccine: Urabe strain, Jerryl-Lynn strain and Rubini strain. The Urabe strain was substituted by the Rubini strain during 1993-1995. Although the incidence of measles and rubella had declined, that of mumps increased significantly in 1999 and 2000 due to primary vaccine failure (lack of protection by the Rubini strain vaccine). In view of this, the Ministry of Health deregistered the MMR vaccine containing the Rubini strain in May 1999. The current vaccine contains the Jerryl-Lynn strain.

Since 2000, the incidence of mumps has decreased dramatically from 5981 cases in 2000 to 631 cases in 2009 (12.7 cases per 100,000 population).


  • About 30% of cases may just have mild respiratory tract infection with no apparent salivary gland swelling or have subclinical infection.
  • Prodrome with malaise, headache, fever and anorexia lasting 2-3 days.
  • Pain and swelling in one or both parotid glands (or other salivary glands), increasing for 2-3 days, then resolving over 1 week.
  • Complications:
    • Neurological: meningoencephalitis, facial palsy, cerebellar ataxia, transverse myelitis and sensorineural hearing loss
    • Gonadal: epididymo-orchitis occurs in approx. 20% of post-pubertal males; usually unilateral so sterility is rare. Oophoritis also occurs, causing pelvic pain and tenderness.
    • Pancreatitis: occurs in less than 10%. Usually presents after parotitis.
    • Arthritis/ arthralgia: usually in adults


Bacterial parotitis or epididymo-orchitis; parainfluenza/ influenza/ coxsackievirus parotitis, viral lymphadenitis; parotid calculus or tumour. Bilateral parotid swelling can be seen in children with HIV infection.



  • Serological confirmation by detection of mumps IgM antibody or a significant rise in mumps IgG antibody titres between acute and convalescent serum samples.
  • Mumps virus culture from saliva, blood, urine and CSF.

A legally notifiable disease in Singapore. Notify Ministry of Health (Form MD 131 or electronically via CD-LENS) not later than 72 hours from the time of diagnosis.



Symptomatic treatment.



  • Combined measles/mumps/rubella (MMR) vaccination at age 15 months is given as part of the national childhood immunisation programme in Singapore (see Appendix 2). A combined measles/mumps/rubella/varicella (MMRV) vaccine is also available.
  • Infected children should stay away from school for 9 days from the onset of parotid swelling.
  • All childhood vaccinations should be notified to the National Immunisation Registry, Health Promotion Board. All post-vaccination adverse reactions should also be notified to the Pharmacovigilance Branch, Health Sciences Authority.








References

  1. Goh KT. Resurgence of mumps in Singapore caused by the Rubini mumps virus vaccine strain. Lancet 1999; 354:1355-6
  2. Ong G,Goh KT, Ma S et al. Comparative efficacy of Rubini, Jeryl-Lynn and Urabe mumps vaccine in an Asian population. J Infect 2005;51: 294-8.
  3. American Academy of Pediatrics. Report of the Committee on Infectious Diseases (28th edition).Red Book 2009: 464-8





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