Public Health Alert: Recent Increase in Mumps

Over recent months there has been an increase in the number of cases of mumps notified to the Public Health Unit among residents of Sydney’s eastern and southern suburbs. 62 cases were reported for January to September 2007 compared with 29 for the same period in 2006. The main groups of the population who are being affected are young males: 61% of the cases notified in 2007 were aged 20-29 years, of whom 63% were male. Local government areas in south-eastern Sydney with increased notifications include Botany, Woollahra, Randwick, Waverley, Sutherland and Rockdale. Similar increases in mumps in young adults have been reported to be occurring overseas (Eastern Europe, Canada, USA) as well as in South Australia. In the past, mumps infection was a common childhood illness; however, since the introduction of mumps immunisation in the early 1980s it has become much less common in Australia.

What is Mumps?

Mumps is an acute infection caused by the mumps virus, characterised by fever, headaches and swelling of the salivary glands, especially the parotids, and sometimes of the pancreas, ovaries or testes.

Symptoms may include:

• fever
• loss of appetite
• tiredness
• headaches
• swelling and tenderness of the parotid salivary glands, located within the cheeks, near the jaw line, below the ears. This swelling may be one sided.

About one third of infected people do not show any symptoms at all. Mumps is usually a more severe illness in people infected after puberty.

Complications from the mumps are rare but can include:

• inflammation of the brain (encephalitis)
• inflammation of the lining of the brain and spinal cord (meningitis)
• inflammation of the testicles (orchitis), the ovaries (oophoritis), or breasts (mastitis)
• spontaneous abortion
• hearing loss
• Other complications may include arthritis, kidney involvement, inflammation of the thyroid gland and deafness.
• Sterility (inability to have children) in males is extremely rare

Case1

"Andrew” is a 28yr old engineer who works in the family business. In September he attended a GP surgery for review of headaches, fever and mild nausea. He was advised he probably had Influenza and suggested symptomatic relief only. He attended the local hospital emergency department and was not admitted. 2 days later his cheek had become swollen and high temperatures and headaches continued. He again saw his GP who diagnosed him with Mumps. Andrew remained at home for 4 days and took pain relief only. His testicles became very swollen and he could not sit down and his headaches became unmanageable. He was admitted to hospital where the diagnosis of “Mumps Orchitis” was made. He remained in hospital for 9 days where he received intravenous fluids, antibiotics and pain relief. He was assessed by Infectious Diseases and Urological teams who were concerned about the potential for him to become sterile. Andrew is now completely well, but follow-up is required from sterility specialists as his sperm count is well below what it should be. He did not know his mumps vaccination status.
He knew of no close friends that were unwell, although he had frequented hotels and bars that were quite crowded, and so may have been exposed to someone infectious in this way.

Case 2:

“Ellen” is a 28-year-old bar worker. One night during September she woke and noticed a lump on her jaw. By the morning, the right side of her jaw line was swollen and the swelling went up to under her ear. Ellen saw her doctor that day who requested a blood test for mumps. By that afternoon her symptoms had increased and she also had a fever, headaches and her muscles felt ‘like jelly’. She felt a downward pressure when she turned her head and had particularly painful shooting pains when eating. Ellen required regular doses of pain relief tablets to enable her to eat. These symptoms continued for two weeks and she was unable to work for almost 3 weeks. Ellen had not received the MMR vaccine as a child, and although she is now immune for mumps, she is considering receiving the MMR vaccine to protect her from measles.

How is it Spread?

It is spread from person-to-person by respiratory droplets or direct contact with items contaminated with infected saliva.

People with mumps can be infectious up to seven days before and nine days after swelling of the salivary glands begins. The period of greatest infectiousness occurs between two days before to four days after the onset of symptoms.

The time from being exposed to the virus and becoming sick can range from 12 to 25 days but is most commonly 16 to 18 days.

Who is at Risk?

Anyone who comes into contact with infectious cases can get mumps, unless they are immune due to past infection or have been protected through immunisation. Receipt of two doses of a mumps-containing vaccine generally is felt to provide protection against disease.

Diagnosis and Treatment

The doctor may diagnose mumps based on the symptoms and signs alone. A blood test (know as serology or Mumps IgM) is the most common means of confirming the diagnosis. In some instances, samples may be collected from the throat, urine or spinal cord fluid to confirm the diagnosis.

There is no specific treatment for mumps. Simple analgesics may reduce pain and fever. Warm or cold packs to the swollen glands may provide relief.

Prevention and Vaccination

To help stop spreading the virus to others, people with mumps should stay at home in isolation until the swelling in the salivary glands disappears, or up to nine days after the onset of swelling (whichever is sooner). Both the infectious person and their carers should wash hands carefully after contact. Children with mumps are excluded from childcare and school until the infectious period is over.

A vaccine that only protects against mumps is not available in Australia; however, mumps-measles-rubella (MMR) vaccine is part of the Australian standard vaccination schedule. MMR vaccine should be given to children at age 12 months and again at four years of age. People born after 1965 should ensure they have received TWO doses of MMR vaccine (at least one month apart). After the illness, lifelong immunity to mumps occurs.

Further information

http://www.health.nsw.gov.au/pubs/2007/pdf/Factsheetmumps.pdf