The Mumps!

How to protect your family from the current outbreak.

United States health officials have declared the current mumps outbreak throughout New York and New Jersey the largest in years. With more than 375 cases diagnosed between June and December of 2009, it has become especially important to take precautions and prevent contraction of the viral disease. What follows are the top things that every parent should know about the mumps.

First and foremost, the mumps is a highly contagious viral infection. The mumps virus attacks selected tissues in the body. Its “favorite” is the salivary gland, especially the parotid glands located in front of and below the ear canals, but also all of the salivary glands located under the lower jaw. The swelling of these glands produces pain and the characteristic facial changes. The virus also occasionally attacks testicles (namely in post-adolescent males) and the pancreas, and can cause inflammation of the brain (meningoencephalitis) and of the auditory nerve, leading to loss of hearing.

When an outbreak of a virus reoccurs, parents frequently want to know why. However, mumps is a bit of a mystery right now. In the past, comebacks of vaccine-preventable diseases were due to the fading of antibody levels with age. This explains why smallpox, diphtheria and tetanus are known to require boosters every ten years to maintain protection. Recurring outbreaks can also be due to high concentrations or crowding of unvaccinated individuals (hemophilus, whooping cough), immunosuppression (TB, polio) and antigen drift, or mutations of pathogens (flu, pneumococcus). Any of these could be happening here.

Another explanation for the current outbreak is a mimic disease. In the 1970s, a doctor noticed far more cases than expected of what appeared to be juvenile rheumatoid arthritis in a small town. Investigation of this cluster led to the discovery of Lyme disease, which had similar symptoms. What brings up this possibility is this: The one patient I saw had an absolutely perfect clinical picture of mumps, including contact with other mumps cases. But the blood test did not confirm it. Is this really mumps, or an emerging infection that mimics it? At this point I would hesitate to guess.

Due to the reappearance of mumps, many parents have expressed their concerns over the efficacy of the measles mumps rubella (MMR) vaccine, wondering if it is simply failing to work. But parents should not worry about this possibility. The vaccine is working. Let’s not forget that mumps is more contagious than swine flu. And if the vaccines were worthless, we would have more mumps than flu around— not 180 cases, but more than 180,000. As to why it did not work as well as expected, that is a subject of an ongoing investigation. The Health Department is trying to find the common denominator in the affected individuals, down to cross-checking the lot numbers of vaccines administered many years ago to these patients, in order to see if there may have been a defective batch around that time.

What we seem to have is vaccine failure in less than 1 percent of recipients, even in fairly small communities. Consider this: If people with mumps shopped, worked and took public transportation while highly contagious, like the week before the appearance of symptoms, and the epidemic did not extend beyond this small group, then the vaccine proves effective in helping to prevent further spread of the illness.

For people concerned that their child’s initial vaccination is ineffective, I say that it won’t hurt to get another MMR vaccine. Even if vaccine failure is to blame for this epidemic, isolation is probably impractical, as viral shedding can continue for nearly one month, starting days before any symptoms are present.

Regarding treatment for the mumps, be sure your child takes in lots of fluids to let saliva flow freely, and help your child avoid sour foods that cause an over-stimulation of the salivary glands. “Real” treatment such as administering IV fluids is only needed in the fairly small fraction of patients who develop pancreatitis (severe abdominal pain with nausea), meningoencephalitis (severe headache with mental status changes) or other rare complications. Infertility is a possible consequence of testicular inflammation in post-adolescent males, but at this time no specific treatment is available to prevent this.