COMMUNICABLE DISEASES Mumps Professor Qayser Sahib Al Habeeb Specialist in Internal and Community Medicine Department of Family and Community Medicine College of Medicine University of Duhok
Mumps Infectious Parotitis Epidemic Parotitis It is an acute viral disease caused by mumps virus, a member of the family Paramyxoviridae
■ MOT : --- droplets --- contact ( direct and indirect) --- airborne ■ I.P : 16 – 18 days ( 12 – 25 days) ■ C. P : 1 week before to at least 5 days after glandular swelling. ■ Reservoir : humans .
Clinically: ■ it starts with non specific prodrome of --- myalgia, headache, fever. --- trismus & pain near the angle of the jaw to be followed soon by: ■ tender swelling of one or both parotid glands (in 30-40% of infected persons) It may also involve the submandibular or the sublingual salivary glands.
Parotid Swelling :
--- is first visible in front of the lower part of the ear. --- usually peaks in 1 to 3 days --- pushes the angle of the ear up and out. --- As swelling worsens, the angle of the jawbone below the ear is no longer visible. --- Often, the jawbone cannot be felt because of swelling of the parotid.■ Resolution usually occurs over 1-2 weeks ■ Up to 20% of infections are asymptomatic; (may transmit infection)■ 40-50% of infections may have only non specific or primarily respiratory symptoms
In children, mumps is usually a mild disease.
Adults may have more serious disease and more complications.Complications: 1- CNS: Meningitis 15 % of clinical cases Encephalitis rare 2- Glandular: Orchitis 10 % post pubertal boys Oophoritis 5 % post pubertal girls Panreatitis 2 - 5 % 3- Others: myocarditis, pericarditis, deafness
Mumps orchitis in a 6-year-old boy. This complication is unusual in prepubertal boys. The highest risk for orchitis is in males between 15 and 29 years of age.
Diagnosis: ◙ --- Clinical suspicion --- raised serum amylase --- relative lymphocytosis --- normal or ↓ blood count ◙ Proof is provided by demonstration of : --- specific antibodies (IgM or IgG) or --- isolation of the virus (CSF, saliva, urine) or --- detection by PCR
Prevention and control: ◙ Vaccination with the live attenuated mumps vaccine ( available combined with rubella & measles vaccine: MMR). ◙ Respiratory isolation and private room for at least 5 days from the onset. ◙ Concurrent disinfection. ◙ Exclusion of cases from school, child care or workplace until 5 days after onset.
◙ Investigation of contacts and source of infection ◙ --- Susceptible contacts should be offered MMR immunization. --- Immunoglobulin is not effective in preventing mumps.◙ Exclusion of non immune contacts from school until at least 26 days after the onset of parotitis in the last person with mumps.
MMR Vaccine: --- results in seroconversion to all three viruses in over 95% of recipients. --- it is recommended for all children at 12 months of age.
--- a second dose is recommended at 4 years of age, prior to school entry. --- since the MMR vaccine viruses are not transmissible, there is no risk of infection originating from vaccines.