Material for this Seminar was primarily based on journal publications identified through a comprehensive search of the PubMed database. Search terms included “mumps”, “pathogenesis”, “diagnosis”, “epidemiology”, and “vaccination”. The searches were inclusive of all languages and article types (eg, reviews, case reports, and editorials). The publication dates covered were 1957 to January, 2007. Seminal work and, where appropriate, recently published articles were preferentially selected.
SeminarMumps
Introduction
Mumps is best known as a common childhood viral disease, and is characterised by swelling of the parotid gland (figure 1). The disease is preventable by vaccine, and mumps vaccination is almost universally used in developed countries nowadays. Compared with other common vaccine-preventable diseases, such as measles and pertussis, mumps is more benign. Consequently, topics relating to mumps have been somewhat neglected; however, large outbreaks in the UK and USA have sparked a new interest in mumps.
Section snippets
Mumps virus
Mumps virus, the causative agent of mumps infection, is an enveloped RNA virus that belongs to the genus Rubulavirus in the family Paramyxoviridae.1, 2 In electron microscopy, the virion presents as a particle with a shape that varies between spherical and pleiomorphic with a diameter of about 200 nm (figure 2). The viral genome is contained in a linear molecule of single-stranded, negative-strand RNA, 15 384 nucleotides in length, which encodes six structural proteins and at least two
Clinical presentations
About a third of mumps infections arise without recognised symptoms.35 Clinically manifest infections might start with a short prodromal phase of low-grade fever, anorexia, malaise, and headache (table).
Clinical diagnosis
The standard clinical case definition of mumps is acute onset of unilateral or bilateral swelling of the parotid or other salivary glands lasting 2 or more days without any other apparent cause.98 Although parotitis is indeed the hallmark of mumps, in many cases, salivary-gland swelling is not apparent, especially in individuals with mumps meningitis, many of whom present without detectable salivary-gland enlargement.53, 55 Salivary-gland swelling is also caused by other infectious agents,
Treatment
There is no specific antiviral therapy for mumps. Since the illness is generally benign and self-resolving, treatment is mostly symptomatic and supportive—eg, use of analgesic medications to relieve pain associated with parotitis or orchitis; or lumbar puncture to relieve headache associated with meningitis. Use of steroids should be avoided in the treatment of mumps orchitis because steroids can decrease testosterone concentrations, and can increase concentrations of follicle-stimulating and
Vaccination
All available mumps vaccines consist of live attenuated mumps virus.133 At least 11 strains are presently in use throughout the world: the Jeryl Lynn and Urabe Am9 strains have been the most commonly used followed by the Leningrad-Zagreb, Leningrad-3, and Rubini strains; the newer RIT 4385 strain has been derived from the Jeryl Lynn strain. The use of other available mumps strains has been limited, in most cases to one country only. Mumps vaccines (panel) are available as monovalent vaccines or
Prevaccine era
Historically, mumps gained recognition as a disease arising in military and other similar crowded settings.176 With increased urbanisation, mumps became known as a common childhood disease. Seroprevalence and notification data from European countries have been used to derive characteristics of mumps epidemiology in the prevaccination era.177 During this period, mumps was characterised by interepidemic periods of 4–5 years, a peak in the force of infection among children aged 5–7 years, and a
Future research
Unresolved issues—related to mumps vaccines and vaccination—should be given high priority. First, the causes of the moderate effectiveness of mumps vaccines, and their relative contributions must be established. Second, immunological markers of immunity against mumps should be identified. Third, ideal schedules for mumps vaccination in different settings should be established to optimise the control of mumps with vaccines. Nowadays, most countries that use routine mumps vaccination have a
Search strategy and selection criteria
References (188)
The molecular epidemiology of mumps virus
Infect Genet Evol
(2004)- et al.
Mumps virus neutralizing antibodies do not protect against reinfection with a heterologous mumps virus genotype
Vaccine
(2001) - et al.
Isolation of virus during the incubation period of mumps infection
J Pediatr
(1968) Techniques of laboratory diagnosis, tests for susceptibility, and experiments on specific prophylaxis
J Pediatr
(1946)- et al.
Serum sperm antibodies are not elevated after mumps orchitis
Fertil Steril
(2002) - et al.
Acute and chronic inflammatory diseases of the salivary glands: diagnosis and management
Otolaryngol Clin North Am
(1977) - et al.
A case of mumps epididymitis
Lancet
(2006) Systemic treatment with interferon-alpha 2B: an effective method to prevent sterility after bilateral mumps orchitis
J Urol
(1991)- et al.
Mumps oophoritis: a cause of premature menopause
Fertil Steril
(1975) Mumps meningoencephalitis in children
J Pediatr
(1958)
Sudden total bilateral deafness due to asymptomatic mumps infection
Int J Pediatr Otorhinolaryngol
Perinatal mumps infection
J Pediatr
Mumps followed by diabetes
Lancet
Hospital admission for selected single virus infections prior to diabetes mellitus
Diabetes Res Clin Pract
ICTVdB management. 01.048.1.03.00. Mumps virus
Mumps virus
Hemagglutinin-neuraminidase glycoprotein as a determinant of pathogenicity in mumps virus hamster encephalitis: analysis of mutants selected with monoclonal antibodies
J Virol
Antigenic and genetic characterization of the fusion (F) protein of mumps virus strains
Arch Virol
Proposed criteria for classification of new genotypes of mumps virus
Scand J Infect Dis
Molecular epidemiology of mumps virus in Japan and proposal of two new genotypes
J Med Virol
Antigenic relationships between six genotypes of the small hydrophobic protein gene of mumps virus
J Gen Virol
Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools
Pediatr Infect Dis J
Isolation of mumps virus from children with acute lower respiratory tract disease
Am J Epidemiol
The etiology of mumps
Am J Hyg
Mumps meningoencephalitis with and without parotitis
Am J Dis Child
Isolation of mumps from the blood of a patient
Proc Soc Exp Biol Med
Viremia in human mumps infection
Arch Intern Med
Mumps virus replication in human lymphoid cell lines and in peripheral blood lymphocytes: preference for T cells
Infect Immun
Clinical and laboratory studies of mumps. II. Detection and duration of excretion of virus in urine
Proc Soc Exp Biol Med
Virus excretion and antibody response in saliva in natural mumps
Tohoku J Exp Med
Isolation of mumps virus at autopsy
Am J Pathol
Acute hemorrhagic pancreatitis and pseudocyst due to mumps
Ann Surg
The histopathology of acute mumps orchitis
Am J Pathol
Mumps orchitis
Mumps virus recovered from testicles by fine-needle aspiration biopsy in cases of mumps orchitis
Scand J Infect Dis
Mumps epididymo-orchitis with prolonged detection of virus in semen and the development of anti-sperm antibodies
J Med Virol
Persistence of neuroadapted mumps virus in brains of newborn hamsters after intraperitoneal inoculation
J Infect Dis
The pathology of mumps encephalitis with report of a fatal case
J Pediatr
Meningoencephalomyelitis with epidemic parotitis. Clinicopathologic report
Arch Neurol
Fatal mumps meningoencephalitis. Isolation of virus from human brain (case report)
Rev Inst Med Trop Sao Paulo
Primary mumps meningo-encephalitis
Arch Intern Med
Intrauterine infection with mumps virus
Obstet Gynecol
Mumps virus isolated from a fetus
BMJ (Clin Res Ed)
Observations on a mumps epidemic in a virgin population
Am J Hyg
Mumps with presternatal edema
Bull Johns Hopkins Hosp
Mumps virus infection in adults: three cases of supraglottic edema
Laryngoscope
Sperm count, morphology and motility after unilateral mumps orchitis
J Reprod Fertil
The incidence and outcome of mumps orchitis in Rochester, Minnesota, 1935 to 1974
Mayo Clin Proc
Epididymitis in mumps, including orchitis: further clinical studies and comments
Ann Intern Med
The frequency of mumps and of mumps orchitis and the consequences for sexuality and fertility
Acta Genet Stat Med
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