Mumps Update
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  • 1. MUMPS UPDATE Dr.T.V.Rao MD 1
  • 2. MUMPS HIPPOCRATES 5th Century BC A Disease of Children, Non Suppurative Enlargement of Parotid Gland. 1934 – Good Pasture/ Johnson Dr.T.V.Rao MD
  • 3. Paramyxoviruses Dr.T.V.Rao MD
  • 4. Mumps belongs to ParmyxoviridaeViruses in the familyParmyxoviridae are classified intwo subfamilies, Paramyxovirinaeand Pneumovirinae. The lattersubfamily contains twogenera, Pneumovirus andMetapneumovirus. Dr.T.V.Rao MD
  • 5. Data on Mumps Dr.T.V.Rao MD
  • 6. Mumps belongs to ParmyxoviridaeLooks similar to Orthomyxovirus,Larger in size, More Pleomorphic.Spherical in shape 100 to 300 nmSome times appear as filamentous,Gaint formsare present.But contains only single stranded RNA.Do not contain segmented RNA likeOrthomyxoviruses,Antigenic variation absent.Reassortments like Influenza viruses – ABSENT. Dr.T.V.Rao MD
  • 7. MUMPS - VirusMumps is a single-stranded RNA virus anda member of the familyParmyxoviridae, genusParamyxoviruses. It has2 major surfaceglycoproteins: the hemagglutinin-neuraminidase and thefusion protein. Mumpsvirus is sensitive to heatand ultraviolet light Dr.T.V.Rao MD
  • 8. 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, Dr.T.V.Rao MDproduce Cytopathic
  • 9. MUMPSMumps is an acute viralinfection of theparamyxoviruses family.As its alternative name(infectious parotitis)suggests, the infection ischaracterized by swellingmore commonly bilateralthan unilateral of theparotid salivary glands. Dr.T.V.Rao MD
  • 10. MumpsThe incubation periodis 14-21 days and iscommunicable from 6days before to 9 daysafter facial swelling isapparent. It can leadto braininflammation, deafness or sterility Dr.T.V.Rao MD
  • 11. Mumbling speech - Mumps Name "mumps" comes from an old word for "lump" or an old word for "mumble." Dr.T.V.Rao MD
  • 12. MumpsMumps or epidemic parotitis is aviral disease of the human species,caused by the mumps virus. Prior tothe development of vaccination andthe introduction of a vaccine, it was acommon childhood diseaseworldwide, and is still a significantthreat to health in the DevelopingWorld Dr.T.V.Rao MD
  • 13. Mumps Clinical Case DefinitionAcute onset ofunilateral or bilateraltender, self-limitedswelling of theparotid or othersalivary gland lastingmore than 2 dayswithout otherapparent cause Dr.T.V.Rao MD
  • 14. Involvement of Salivary GlandsPainful swelling ofthe salivary glands(classically theparotid gland isthe most typicalpresentation)Painful testicularswelling (orchitis)and rash may alsooccur Dr.T.V.Rao MD
  • 15. 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 Dr.T.V.Rao MD
  • 16. Pathogenesis - MumpsRespiratorytransmission of virusReplication innasopharynx andregional lymph nodesViremia 12-25 daysafter exposure withspread to tissuesMultiple tissuesinfected during Viremia Dr.T.V.Rao MD
  • 17. Mumps Clinical Features Incubation period 14- 18 days Nonspecific prodrome of myalgia, malaise, head ache, low-grade fever Parotitis in 30%-40% Up to 20% of infections asymptomatic Dr.T.V.Rao MD
  • 18. Clinical Features MUMPS Inhalation / Conjunctiva. Replicates in URT Cervical Lymph nodes. Blood stream to other organs Incubation period 12- 25 days. Manifest with Parotid swelling Unilateral or Bilateral.Fever , Local pain at parotid region and Tenderness.Subsides In a Week. Dr.T.V.Rao MD
  • 19. Immunity Antibodies are produced against the S and V surface antigens.. Mumps rare before 6 months of age. Dr.T.V.Rao MD
  • 20. Complication with MUMPS.Epididymo orchids.May lead to atrophy, sterility, Low spermcounts.CNS involvement in 60% casesMay manifest with Aseptic meningitis,Deafness,Arthritis, Oopharitis,Nephritis andMyocarditis, Dr.T.V.Rao MD
  • 21. Complication with MUMPS.Orchitis. This inflammatorycondition causes swelling of one orboth testicles. Orchitis is painful.Pancreatitis..Encephalitis. A viral infection, suchas mumps, can lead to inflammationof the brain (encephalitis). Althoughits serious, encephalitis is a rarecomplication of mumps. Dr.T.V.Rao MD
  • 22. Meningoencephalitis, In clinically diagnosed Meningoencephalitis, a CSF mononuclear pleocytosis occurs, as does normal glucose, although hypoglycorrhachia has been reported. The mumps virus may be isolated from CSF early in the illness. Mumps Meningoencephalitis carries a good prognosis and is usually associated with an uneventful recovery. Dr.T.V.Rao MD
  • 23. Laboratory Diagnosis No Laboratory confirmation needed. Atypical infection needs laboratory Diagnosis. Virus isolated from Saliva Urine CSF.Culturing in Human amnion, He la cells.Immunofluorescence Methods. Isolation in Chick EmbryosELISA, Complement fixation tests, Dr.T.V.Rao MD
  • 24. Mumps Laboratory DiagnosisIsolation of mumps virusDetection of mumps antigen by PCRSerologic testing positive IgM antibody significant increase in IgG antibody between acute and convalescent specimens Dr.T.V.Rao MD
  • 25. CDC recommendsCDC recommendsthat a bloodspecimen and buccal/oral swab becollected from allpatients with clinicalfeatures compatiblewith mumps.Recommendationsstands mainly forepidemiologicalsurveys Dr.T.V.Rao MD
  • 26. Vaccination Live attenuated vaccine Jernyl Lynn Strain Grown in chick embryo fibroblasts Vaccine as MMR vaccine A single dose protects for 10 years. Dr.T.V.Rao MD
  • 27. Mumps (MMR) Vaccine IndicationsOne dose (as MMR) for preschool-age children 12 months of age andolder and persons born during orafter 1957 not at high risk ofmumps exposureNeed for second doseSecond dose (as MMR) for school-age children andadults at high risk of mumps exposure(i.e., healthcare personnel, international travelers andstudents at post-high school educational institutions Dr.T.V.Rao MD
  • 28. 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 Dr.T.V.Rao MD
  • 29. MMR Vaccine and AutismThere is no scientific evidence that the riskof autism is higher among children whoreceive measles or MMR vaccine thanamong unvaccinated children“The evidence favors a rejection of a causalrelationship at the population levelbetween MMR vaccine and autismspectrum disorders (ASD).”- Institute of Medicine, April 2001 Dr.T.V.Rao MD
  • 30. MMR combined vaccine is beneficialthan 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. Dr.T.V.Rao MD
  • 31. Mumps Vaccine and HIV InfectionMMR recommendedfor persons withasymptomatic andmildly symptomaticHIV infectionNOT recommendedfor those withevidence of severeimmuno-suppressionHIV testing beforevaccination is notrecommended Dr.T.V.Rao MD
  • 32. EpidemiologyEndemic – Prevalence all over the worldImmunization . Reduced the incidence.Epidemics in children between 5-15.No carriers.Spread by Direct ContactSaliva and urine are infective.One Attack produces life time Immunity. Dr.T.V.Rao MD
  • 33. Control of Mumps:Mumps control: The control of mumps canbe achieved through high routine coveragewith an effective mumps-containing vaccineadministered at 12–18 months of age.Children immunized with most mumpsvaccines at the age of 12 months or olderhave excellent serological response rates.Programmes should aim at infant coverageof more than 90%. Low immunizationcoverage may reduce the number of cases ininfants but fails to interrupt circulation of themumps virus in the community. Dr.T.V.Rao MD
  • 34. Passive immunization against mumps– Immune globulin ineffective for post exposure prophylaxis • does not prevent disease or reduce complications– Trans placental maternal antibody appears to protect infants for first year of life Dr.T.V.Rao MD
  • 35. For Article of Current Interest Visit me on Dr.T.V.Rao MD
  • 36. Programme Created byDr.T.V.Rao MD for Medical and Paramedical Students in Developing World Email doctortvrao@gmail.com Dr.T.V.Rao MD