It is Thursday 5 January 2017, and in Australia it’s Summer. It’s been lovely and warm in Canberra and better yet, it’s been moist. So is tonight’s show M for Moist? No, sadly it isn’t. Nor is it M for one of my all-time favourite diseases, viz., Melioidosis. That will have to wait for another time. No tonight, M is for Mumps.
I’ve been noticing over at ProMED-mail that there have been quite a lot of notifications of mumps outbreaks in the USA. I read in an online article from Forbes, that the blame is being sheeted home to the anti-vaccination movement. The case numbers in 2016 easily more than double those in recent years except for an exceptional spike in 2006.
So what is Mumps? Mumps is a viral infection caused by the Mumps virus. It’s spread person to person through contact with respiratory secretions like snot and saliva from infected people. Like many other microorganisms, fomite transmission is also possible. It’s not wise to share toothbrushes and spoons with people who have mumps. A person infected with mumps can be infectious for about week before the onset of symptoms and a week after symptoms start.
The incubation period is typically between 16 and 18 days.
The diagnosis is often made clinically, however, in an era when diseases like Mumps are less common and because of the public health implications, a pathology test like polymerase chain reaction of a mouth swab may be required. An incidental finding will be an elevated serum amylase.
As a childhood illness, the most common presentation includes a prodromal period of low-grade fever, headache and malaise. This is soon followed by swelling of one or both parotid glands which can last up to a week. Your parotid glands are found in your cheeks. Incidentally, did you know that parotid Melioidosis is relatively common in Thailand and virtually unknown in Australia? The swelling can cause jaw pain and speaking can be difficult. I remember as a kid waking up one day after feeling a bit off-colour, and having this pain in my cheeks and pain when I tried to speak. I remember walking into my parent’s bedroom to complain about this unusual finding. Dad, (who was a GP at the time) kept me home from school for the rest of the week.
While these symptoms may not worry people too much, and certainly the anti-vaccination people seem to think these signs and symptoms are trivial, the problem is the complications associated with mumps viral infection. The complications include:
- Painful testicular swelling in one or both testes. Contrary to popular belief infertility isn’t that common after mumps.
- Aseptic meningitis can occur in up to 10 per cent of patients depending on the study population. Many of these cases of meningitis occur without parotid swelling.
- Ovarian swelling occurs in a small number of patients and includes some lower abdominal discomfort.
- Acute pancreatic inflammation can cause abdominal pain and vomiting in a small number of patients.
- Encephalitis (that’s brain infection) occurs in a very small number of patients and fatalities have been reported. I hope anti-vaccination advocates do not find this acceptable.
- Profound high-frequency sensorineural deafness can also occur in one or both ears.
This is not a list that can be laughed off.
Mumps is easily prevented with the Measles Mumps Rubella (MMR) vaccination. Two doses are recommended in childhood, first at 12 months and then at 4 years.
As you can imagine, in a non-immune population, adolescents and young adults are at significant risk. As teens and young adults explore their early sexuality, not only are they at risk of diseases like glandular fever but mumps outbreaks can occur in schools and universities. This is mainly a function of kissing. Of course, other sexual activity will raise concerns about old-time favourites like gonorrhoea, syphilis and chlamydia.
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