MUMPS Dr.T.V.Rao MD
MUMPS • Mumps is an acute viral infection of the paramyxoviruses family. As its alternative name (infectious parotits) suggests, the infection is characterized by swelling more commonly bilateral than unilateral of the parotid salivary glands. The incubation period is 14-21 days and is communicable from 6 days before to 9 days after facial swelling is apparent. It can lead to brain inflammation, deafness or sterility.
Mumps belongs to Parmyxoviridae • Viruses in the family Parmyxoviridae are classified in two subfamilies, Paramyxovirinae and Pneumovirinae. The latter subfamily contains two genera, Pneumovirus and Metapneumovirus. The number of genera in the Paramyxovirinae was increased in 2002 from three (Respirovirus, Morbillivirus and Rubulavirus) to five by the addition of two new genera, Avulavirus and Henipavirus.
Mumps belongs toParmyxoviridae • Looks similar to Orthomyxovirus, • Larger in size, More Plemomorphic. • Spherical in shape 100 to 300 nm • Some times appear as filamentous,Gaint forms are present. • But contains only single stranded RNA. • Do not contain segmented RNA like Orthomyxoviruses,Antigenic variation absent. • Reassortments like Influenzae viruses – ABSENT.
Mumps • Mumps or epidemic parotitis is a viral disease of the human species, caused by the mumps virus. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide, and is still a significant threat to health in the Developing World
Involvement of Salivary Glands • Painful swelling of the salivary glands (classically the parotid gland is the most typical presentation) Painful testicular swelling (orchitis) and rash may also occur
Involvement of Parotid Gland a Major Manifestation • Swelling of the salivary glands follows these symptoms. Swelling of the glands near the jaw line below the ears may give you "chipmunk cheeks
Mumps • Acute viral illness • Parotitis and orchitis described by Hippocrates in 5th century B.C. • Viral etiology described by Johnson and Good pasture in 1934 • Frequent cause of outbreaks among military personnel in prevaccine era
Mumbling speech - Mumps • Name "mumps" comes from an old word for "lump" or an old word for "mumble."
Mumps Virus • Paramyxoviruses • RNA virus • One antigenic type • Rapidly inactivated by chemical agents, heat and ultraviolet light
Properties of MUMPS virus. • Posses HN and F properties. • Growth in Chick Embryos, in the Amniotic cavity, Adopts in allantoic cavity, • Cell cultures – Primary Monkey kidney, • Typical Paramyxoviruses, produce cytopathic effects.
Pathogenesis - Mumps • Respiratory transmission of virus • Replication in nasopharynx and regional lymph nodes • Viremia 12-25 days after exposure with spread to tissues • Multiple tissues infected during viremia
Mumps Clinical Features • Incubation period 14-18 days • Nonspecific prodrome of myalgia, malaise, headache, low-grade fever • Parotitis in 30%-40% • Up to 20% of infections asymptomatic
Mumps Clinical Case Definition • Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland lasting more than 2 days without other apparent cause
Immunity • Antibodies are produced against the S and V surface antigens.. • Mumps rare before 6 months of age.
Definition of Mumps Immunity • Documentation of adequate vaccination • Serologic evidence of mumps immunity • Birth before 1957 • Documentation of physician- diagnosed mumps in the past
Complication with MUMPS. • Epididymo orchids. • May lead to atrophy, sterility, Low sperm counts. • CNS involvement in 60% cases • May manifest with Aseptic meningitis, • Deafness, • Arthritis,Oopharitis,Nephritis and Myocarditis,
Complication with MUMPS. • Orchitis. This inflammatory condition causes swelling of one or both testicles. Orchitis is painful. • Pancreatitis.. • Encephalitis. A viral infection, such as mumps, can lead to inflammation of the brain (encephalitis). Although it's serious, encephalitis is a rare complication of mumps.
Complication with MUMPS. • Meningitis. Meningitis is infection and inflammation of the membranes and fluid surrounding your brain and spinal cord. • Inflammation of the ovaries. Pain in the lower abdomen in women may be a symptom of this problem. Fertility doesn't seem to be affected. • Hearing loss. • Miscarriages.
Laboratory Diagnosis • No Laboratory confirmation needed. • Atypical infection needs laboratory Diagnosis. • Virus isolated from Saliva Urine CSF. Culturing in Human amnion, He la cells. Immunoflorecence Methods. Isolation in Chick Embryos ELISA, Complement fixation tests, Doctortvrao's ‘e’ learning
CDC recommends • CDC recommends that a blood specimen and buccal /oral swab be collected from all patients with clinical features compatible with mumps. • Recommendations stands mainly for epidemiological surveys
Vaccination • Live attenuated vaccine Jernyl Lynn Strain Grown in chick embryo fibroblasts Vaccine as MMR vaccine A single dose protects for 10 years.
Mumps (MMR) Vaccine Indications • One dose (as MMR) for preschool-age children 12 months of age and older and persons born during or after 1957 not at high risk of mumps exposure Need for second dose • Second dose (as MMR) for school-age children and adults at high risk of mumps exposure (i.e., healthcare personnel, international travelers and students at post-high school educational institutions
Passive immunization against mumps • Immune globulin ineffective for post exposure prophylaxis • does not prevent disease or reduce complications • Transplacental maternal antibody appears to protect infants for first year of life
Epidemiology • Endemic – Prevalence all over the world • Immunization . Reduced the incidence. • Epidemics in children between 5-15. • No carriers. • Spread by Direct Contact • Saliva and urine are infective. • One Attack produces life time Immunity.
MMR VaccineContraindications and Precautions • Severe allergic reaction to vaccine component or following a prior dose • Pregnancy • Immunosuppression • Moderate or severe acute illness of other etiologies
MMR Vaccine and Autism • There is no scientific evidence that the risk of autism is higher among children who receive measles or MMR vaccine than among unvaccinated children • “The evidence favors a rejection of a causal relationship at the population level between MMR vaccine and autism spectrum disorders (ASD).” • - Institute of Medicine, April 2001
MMR combined vaccine is beneficial than separate component vaccines • Separate administration of measles, mumps, and rubella vaccines to children provides no benefit over administration of the combination MMR vaccine and could result in delays in immunization. Paediatricians need to work with families to ensure that children are protected early in the second year of life from these preventable diseases.
Mumps Vaccine and HIV Infection • MMR recommended for persons with asymptomatic and mildly symptomatic HIV infection • NOT recommended for those with evidence of severe immuno- suppression • HIV testing before vaccination is not recommended
Mumps control: • Mumps control: The control of mumps can be achieved through high routine coverage with an effective mumps-containing vaccine administered at 12–18 months of age. Children immunized with most mumps vaccines at the age of 12 months or older have excellent serological response rates. Programmes should aim at infant coverage of more than 90%. Low immunization coverage may reduce the number of cases in infants but fails to interrupt circulation of the mumps virus in the community.
Created for Awareness to Medical and Health Care Workers in the Developing World Dr.T.V.Rao MD Email firstname.lastname@example.org