Overview

Mumps is an acute disease (sudden onset and typically of short duration) of children and young adults caused by a paramyxovirus, a type of virus known for causing respiratory and other infections.

Mumps virus is spread via direct contact and by airborne droplets from the upper respiratory tract of infected individuals.

Normally, mumps is a mild disease that resolves on its own and disappears without long-term effects. However, complications may occur such as encephalitis (inflammation of the brain) or sensorineural deafness (hearing loss due to damage to the inner ear or auditory nerve).

The incubation period is typically 16–18 days after exposure to the virus (range 12–25 days). Patients are considered infectious from 2 days before to 5 days after the onset of parotitis (inflammation of the major salivary glands located on either side of the face).

Though mumps can occur in fully vaccinated individuals, those who are vaccinated are at much lower risk of developing mumps and its complications.

Crowded settings with frequent close contact such as shelters and close-knit communities are at increased risk of mumps outbreaks.

Transmission

Mumps virus spreads via direct contact and by airborne droplets from the upper respiratory tract of infected individuals.

Mumps is most frequently reported in children aged 5–9 years though adolescents and adults can also be affected.

Symptoms

After an incubation period of approximately 2 to 4 weeks, mumps begins with non-specific symptoms such as:

myalgia (muscle pain)

headache

malaise (general fatigue and tiredness)

low-grade fever.

Within a few days early symptoms lead to swelling of one or both of the main salivary glands on the sides of the face, known as the parotid glands. In 10% of cases other salivary glands will also swell.

Mumps is typically a mild disease that goes away on its own without causing lasting problems.

Complications that may occur include:

encephalitis (inflammation of the brain)

sensorineural deafness (hearing loss due to damage to the inner ear or auditory nerve)

orchitis (painful inflammation of the testes, which occurs in 20% of young adult males)

though extremely rare, other severe complications can occur even if there is no swelling of the salivary glands.

Vaccinated individuals are less likely to present with severe symptoms or complications.

Treatment and management

Diagnosis

Samples for RT-PCR (if available) testing should be taken within the first 10 days after the onset of gland swelling, ideally within the first 3 days. Detection of mumps IgM can aid in the diagnosis of mumps but a positive IgM result is only supportive laboratory evidence.

Isolation

Patients should stay isolated for 5 days after the swelling of their glands begins. Those who do not have gland swelling but have other symptoms should isolate themselves for 5 days from when the first symptom appears. In resource-limited settings, creating a supportive isolation area within the community, such as using a designated area with essential supplies, can help manage isolation.

Health care personnel requirements: only medical staff who are likely immune to mumps, either through vaccination or previous infection, should care for patients suspected of having mumps.

Prevention

Mumps protection measures

Adapted hygiene practices

Emphasize the importance of washing hands with soap (if available) and water whenever possible, especially before eating and after coughing or sneezing.

If sinks are not available in-patient areas Veronica buckets can be installed to provide water for hand hygiene close to the point of care. Alternatively, a handwashing basin, soap and a jug of clean water may be placed on a trolley used for ward rounds to encourage handwashing as often as needed between patient contacts.

When soap, clean water and alcohol-based handrubs are unavailable the following options can be considered:

Sodium hypochlorite may be added to water to achieve an end formulation of 0.05% sodium hypochlorite for temporary use in dispenser containers for hand hygiene.

Sodium hypochlorite solution will inactivate when exposed to open air and organic materials. If this method is used it is recommended that the solution be prepared in small batches daily and dispensed from closed containers.

Note also that sodium hypochlorite added to water with a high saline content (seawater) is also an option as long as an end formulation of 0.05% sodium hypochlorite is achieved. Other sources, such as rainwater, can also be considered.

Consider using other hand hygiene products that have antimicrobial properties such as waterless no-rinse hand soaps.

Use cloth face coverings

In the absence of standard masks, encourage the use of cloth face coverings made from available materials. These coverings can help reduce the spread of droplets when people cough or sneeze.

Modified physical distancing measures

In crowded settings where traditional physical distancing is not feasible, promote strategies like minimizing face-to-face interactions, exclusive use of personal items such as towels and utensils, and create makeshift barriers or designated areas to separate those showing symptoms from the rest of the community.

Vaccination

Prioritize vaccination. The mumps vaccine is available in different forms: as a single vaccine (monovalent), combined with measles (bivalent), and combined with both measles and rubella (MMR – measles-mumps-rubella vaccine).

Community engagement and health care coordination

Building strong community awareness and education on mumps symptoms, transmission and prevention helps in the early detection and control of outbreaks.

Engage community leaders and health care workers in outreach programmes to spread knowledge and enhance community readiness.

Share vital information about hygiene practices, symptom recognition and the importance of immediate health care consultation within your community.

Sources

CDC. Mumps: clinical diagnosis factsheet (https://www.cdc.gov/mumps/downloads/mumps-clinical-diagnosis-fact-sheet-508.pdf).

CDC. Manual for the Surveillance of Vaccine-Preventable Diseases. Chapter 9: Mumps (https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-9-mumps.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/pubs/surv-manual/chpt09-mumps.html).

WHO and UNICEF. Infection prevention and control and water, sanitation and hygiene measures in health-care settings and shelters/congregate settings in Gaza: technical note, 22 February 2024 (https://iris.who.int/handle/10665/376082).