The salivary glands are also called the parotid glands; therefore, mumps is sometimes referred to as an inflammation of the parotid glands (epidemic parotitis). The word mumps comes from an old English dialect word that means lumps or bumps within the cheeks.
Mumps is a very contagious infection that spreads easily in such highly populated areas as day care centers and schools. Although not as contagious as measles or chickenpox, mumps was once quite common. Prior to the release of a mumps vaccine in the United States in 1967, approximately 92% of all children had been exposed to mumps by the age of 15.
In these pre-vaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 1941 when approximately 250 cases were reported for every 100,000 people.
In 1968, the year after the live mumps vaccine was released, only 76 cases were reported for every 100,000 people. By 1985, less than 3,000 cases of mumps were reported throughout the entire United States, which works out to about 1 case per 100,000 people.
The reason for the decline in mumps was the increased usage of the mumps vaccine. However, 1987 noted a five-fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws.
Since then, state-enforced school entry requirements have achieved student immunization rates of nearly 100% in kindergarten and first grade. In 1996, the Centers for Disease Control and Prevention (CDC) reported only 751 cases of mumps nationwide, or, in other words, about one case for every five million people.
Causes and symptoms
However, an infected person may not experience these initial symptoms. Swelling of the salivary glands in the face (parotitis) generally occurs within 12–24 hours of the above symptoms. Accompanying the swollen glands is pain on chewing or swallowing, especially with acidic beverages, such as lemonade.
A fever as high as 104°F (40°C) is also common. Swelling of the glands reaches a maximum on about the second day and usually disappears by the seventh day. Once a person has contracted mumps, he or she becomes immune to the disease, despite how mild or severe symptoms may have been.
While the majority of cases of mumps are uncomplicated and pass without incident, some complications can occur. Complications are, however, more noticeable in adults who get the infection. In 15% of cases, the covering of the brain and spinal cord becomes inflamed (meningitis).
Symptoms of meningitis usually develop within four or five days after the first signs of mumps. These symptoms include a stiff neck, headache, vomiting, pain with bending or flexing the head, and a lack of energy. Mumps meningitis is usually resolved within seven days, and damage to the brain is exceedingly rare.
Mumps infection can spread into the brain causing inflammation of the brain (encephalitis). Symptoms of mumps encephalitis include the inability to feel pain, seizures, and high fever.
Encephalitis can occur during the parotitis stage or one to two weeks later. Recovery from mumps encephalitis is usually complete, although complications, such as seizure disorders, have been noted. Only about 1 in 100 patients with mumps encephalitis dies from the complication.
About one-quarter of all post-pubertal males who contract mumps can develop a swelling of the scrotum (orchitis) about seven days after the parotitis stage. Symptoms include marked swelling of one or both testicles, severe pain, fever, nausea, and headache. Pain and swelling usually subside after 5–7 days, although the testicles can remain tender for weeks.
Girls occasionally suffer an inflammation of the ovaries, or oophoritis, as a complication of mumps, but this condition is far less painful than orchitis in boys.
As of late 2002, some researchers in Europe are studying the possibility that mumps increases a person’s risk of developing inflammatory bowel disease (IBD) in later life. This hypothesis will require further research, as present findings are inconclusive.
Diagnosis
When mumps reaches epidemic proportions, diagnosis is relatively easy on the basis of the physical symptoms. The doctor will take the child’s temperature, gently palpate (touch) the skin over the parotid glands, and look inside the child’s mouth. If the child has mumps, the openings to the ducts inside the mouth will be slightly inflamed and have a “pouty” appearance.
With so many people vaccinated today, a case of mumps must be properly diagnosed in the event the salivary glands are swollen for reasons other than viral infection. For example, in persons with poor oral hygiene, the salivary glands can be infected with bacteria. In these cases, antibiotics are necessary.
Also in rare cases, the salivary glands can become blocked, develop tumors, or swell due to the use of certain drugs, such as iodine. A test can be performed to determine whether the person with swelling of the salivary glands actually has the mumps virus.
As of late 2002, researchers in London have reported the development of a bioassay for measuring mumps-specific IgG. This test would allow a doctor to check whether an individual patient is immune to mumps, and allow researchers to measure the susceptibility of a local population to mumps in areas with low rates of vaccination.
Treatment
Nutritional therapy
Nutritional therapy may alleviate pain and aid healing. A nutritionist or naturopath may recommend the following:
- drinking lots of fluids to replace fluid loss
- eating only such easy-to-digest foods as soups, broth or bland foods
- taking multivitamin/mineral supplement to help boost the immune function
Homeopathy
A number of homeopathic remedies can be used in the treatment of mumps. For example, belladonna may be useful for flushing, redness, and swelling. Bryonia (wild hops) may be useful for irritability, lack of energy, or thirst. Phytolacca (poke root) may be prescribed for extremely swollen glands.
A homeopathic physician should always be consulted for appropriate doses for children, and remedies that do not work within one day should be stopped. A homeopathic preparation of the mumps virus can also be used prophylactically or as a treatment for the disease.
Herbal therapy
Several herbal remedies may be useful in helping the body recover from the infection or may help alleviate the discomfort associated with the disease. Echinacea (Echinacea spp.) can be used to boost the immune system and help the body fight the infection.
Other herbs taken internally, such as cleavers (Galium aparine), calendula (Calendula officinalis), and phytolacca (poke root), target the lymphatic system and may help to enhance the activity of the body’s internal filtration system. Since phytolacca can be toxic, it should only be used by patients under the care of a skilled practitioner.
Topical applications are also useful in relieving the discomfort of mumps. A cloth dipped in a heated mixture of vinegar and cayenne (Capsicum frutescens) can be wrapped around the neck several times a day. Cleavers or calendula can also be combined with vinegar, heated, and applied in a similar manner.
Acupressure
Acupressure can be used effectively to relieve pain caused by swollen glands. The patient can, by using the middle fingers, gently press the area between the jawbone and the ear for two minutes while breathing deeply.
Allopathic treatment
When mumps occurs, the illness is usually allowed to run its course. The symptoms, however, are treatable. Because of difficulty swallowing, the most important challenge is to keep the patient fed and hydrated.
The individual should be provided a soft diet, consisting of cooked cereals, mashed potatoes, broth-based soups, prepared baby foods, or foods put through a home food processor.
Aspirin, acetaminophen, or ibuprofen can relieve some of the pain due to swelling, headache, and fever. Avoiding fruit juices and other acidic foods or beverages that can irritate the salivary glands is recommended, as is avoiding dairy products that can be hard to digest.
In the event of complications, a physician should be contacted at once. For example, if orchitis occurs, a physician should be called. Also, supporting the scrotum in a cotton bed on an adhesive-tape bridge between the thighs can minimize tension. Ice packs are also helpful.
Expected results
When mumps is uncomplicated, the prognosis for full recovery is excellent. In rare cases, however, a relapse occurs after about two weeks. Complications can also delay complete recovery.
Prevention
A vaccine exists to protect against mumps. The vaccine preparation (MMR) is usually given as part of a combination injection that helps protect against measles, mumps, and rubella.
MMR is a live vaccine administered in one dose between the ages of 12-15 months, 4-6 years, or 11-12 years. Persons who are unsure of their mumps history and/or mumps vaccination history should be vaccinated.
Susceptible health care workers, especially those who work in hospitals, should be vaccinated. Because mumps is still prevalent throughout the world, susceptible persons over age one who are traveling abroad would benefit from receiving the mumps vaccine.
The mumps vaccine is extremely effective, and virtually everyone should be vaccinated against this disease. There are, however, a few reasons why people should not be vaccinated against mumps:
- Pregnant women who contract mumps during pregnancy have an increased rate of miscarriage, but not birth defects. As a result, pregnant women should not receive the mumps vaccine because of the possibility of damage to the fetus. Women who have had the vaccine should postpone becoming pregnant for three months following vaccination.
- Unvaccinated persons who have been exposed to mumps should not get the vaccine, as it may not provide protection. The person should, however, be vaccinated if no symptoms result from exposure to mumps.
- Persons with minor fever-producing illnesses, such as an upper respiratory infection, should not get the vaccine until the illness has subsided.
- Because mumps vaccine is produced using eggs, individuals who develop hives, swelling of the mouth or throat, dizziness, or breathing difficulties after eating eggs should not receive the mumps vaccine.
- Persons with immune deficiency diseases and/or those whose immunity has been suppressed with anti-cancer drugs, corticosteroids, or radiation should not receive the vaccine. Family members of immunocompromised people, however, should get vaccinated to reduce the risk of mumps.
- The CDC recommends that all children infected with human immunodeficiency disease (HIV) who are asymptomatic should receive an MMR vaccine at 15 months of age.
The mumps vaccine has been controversial in recent years because of concern that its use was linked to a rise in the rate of childhood autism. The negative publicity given to the vaccine in the mass media led some parents to refuse to immunize their children with the MMR vaccine. One result has been an increase in the number of mumps outbreaks in several European countries, including Italy and the United Kingdom.
In the fall of 2002, the New England Journal of Medicine published a major Danish study disproving the hypothesis of a connection between the MMR vaccine and autism.
A second study in Finland showed that the vaccine is not associated with aseptic meningitis or encephalitis as well as autism. Since these studies were published, American primary care physicians have once again reminded parents of the importance of immunizing their children against mumps and other childhood diseases.
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