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Mumps

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An acute infectious disease caused by a paramyxovirus, primarily affecting children younger than 15 years manifested by parotiditis.

At least 10 different genotypes A-J of mumps virus have been identified.

Different genotypes have different geographical distribution and some C, D, H, and J have neurovirulence.

Incidence of mumps encephalitis averages 260 per 100,000 cases.

Transmitted by respiratory droplets and saliva.

Incubation period of 16-18 days.

Typically presents during the late winter early spring.

Classic presentation is parotitis, usually preceded by nonspecific prodromal symptoms.

Illness start with general malaise, a discomfort coming to most childhood viral illnesses, headaches, fever, bodyaches, anorexia, and fatigue.

20-30% of infected patients are asymptomatic.

Asymptomatic presentation common in young children.

incidence has fallen by more than 99% from the pre vaccine era.

Only 350 cases reported in 2011.

Mumps vaccine, part of mumps, measles and rubella (MMR) recommended for children 12 months or older, with a second dose recommended for children 4-6 years of age.

Transmission can occur from patients with subclinical or clinically significant disease.

Outbreaks can occur in vaccinated populations with intense exposures (Barskey AE et al).

Incidence of mumps encephalitis averages 260 per 100,000 cases.

Infection with fever associated with acute self limited salivary gland swelling which may be unilateral or bilateral with predominantly parotiditis lasting longer than 2 days with no other apparent etiology.

Complications include meningoencephalitis, impaired hearing, thyroiditis, pancreatitis, orchitis, epididymitis, ovarian inflammation, and thrombocytopenia.

Orchitisis seen frequently and can on rare occasion lead to low fertility.

The most common cause of parotitis.

Postinfectious consequences include cerebeller ataxia, dysautonomia, encephalomyelitis, and transverse myelitis.

Rate of clinical meningitis rages from 0.1% to 15%.

Meningitis can present before, following or concurrent with parotid swelling.

Diagnosis is made clinically and with the swab inside the cheek and a blood sample.

No agent eradicates the virus.

Treatment is mostly by alleviating symptoms can include anti inflammatory drugs and cold packs to swollen parotitis or testicles.

Mumps vaccine is part of the combined mumps, measles-rubella vaccine.

Two doses of the vaccine recommended in early childhood.

The mumps vaccine efficacy is relatively low: a single dose is about 80% effective, two doses increase the efficacy to almost 90%.

Immunizations induced by mumps vaccine weakened with age.

Vaccinated individuals can get mumps, although the symptoms are generally milder, and complications or more rare.

Mumps outbreak can occur among vaccinated populations and between 2015 and 2017 there were about 150 outbreaks and 9000 cases in the United States.

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