Mumps is best known for the puffy cheeks and tender, swollen jaw that it causes. This is a result of swollen salivary glands under the ears on one or both sides, often referred to as parotitis. Other symptoms that might begin a few days before parotitis include: Fever. Headache.

1. EPIDEMIOLOGY AND CONTROL FOR MUMPS
Professor Dr. AB Rajar, MBBS, Dip-Diab, MPH, Ph.D. CPHE
Director of Research and Innovative Center
[IBN-E-SINA UNIVERSITY]

2. Learning Objectives
• After one hour lecture the students will be
able to understand the:
– Define mumps
– Discuss the importance of the agent,
host, and environmental factors of
mumps.
– Describe the preventive and control
measures for mumps.

3. Introduction
• The “mumps” (British word): grimace or
grin(as a result of parotid gland swelling).
• Acute infectious disease due to “myxovirus
parotiditis”, RNA paramyxovirus (Genus
Rubulavirus) mainly glands and nervous
system.
• Mortality is negligible.

4. Definition
• Mumps is an acute viral infection of
childhood that typically involves
swelling of one or both parotid glands,
although many different organs can be
infected.

5. EPIDEMIOLOGY

6. EPIDEMIOLOGY
• Mumps is endemic in most unvaccinated
populations
• The virus is spread from the human
reservoir by ;
• Direct contact
• Airborne droplets
• Fomites contaminated by saliva
• Possibly by urine
• It is distributed worldwide
• Affects both sexes equally

7. EPIDEMIOLOGY
• Before the Introduction of the vaccine in
1967:
• The peak incidence of the disease
occurred in children 5-9 years of age
• 85% of infections occurred in children
younger than 15 years of age.
• Now most cases occur in young adults,
producing outbreaks in colleges or in the
workplace.

8. EPIDEMIOLOGY
• Epidemics occur in all seasons but
are slightly more frequent in late
winter and spring.

9. EPIDEMIOLOGY
• A.DISTRIBUTION:
– BY TIME:
• Winter and spring are the seasons of
greatest prevalence
– BY PLACE:
• Overcrowding
• Poor nutrition
– BY Person:
• Age: Children under 15 are at risk but can occur at
any age if not vaccinated
• Immunity: Children under 6 months are immune
because of maternal antibodies.
• Life-long immunity after one attack

10. EPIDEMIOLOGY
• B.DETERMINANTS:
– 1.PRIMARY DETERMINANTS:
• The etiological agent is Myxovirus parotitis is an RNA virus
of the myxovirus family
– 2.SECONDARY DETERMINANTS:
• Overcrowding
• Poor nutrition
• Winter and Spring seasons.

11. EPIDEMIOLOGY
• C. Frequency:
• The disease is endemic in Pakistan (old
concept).
• Cases occur throughout the year
• 85% of infections occur in children
• Outbreaks are serious and frequent
• Mortality rate is negligible

12. EPIDEMIOLOGY
• SOURCE OF INFECTION:
• Clinical and sub-clinical cases
• PERIOD OF COMMUNICABILITY:
• 5 days before and a week after the onset of
symptoms.
• Reservoir:
• Human Beings
• Incubation period:
• 12-26 days usually 18 days. [2-3 wks.]

13. EPIDEMIOLOGY
• MODES OF TRANSMISSION:
• DIRECT:
• By direct contact with an infected person or by
droplet infection.
• INDIRECT:
• Through freshly soiled articles with the saliva of
infected people.
• Infective material:
• Saliva
• Swab taken from the body surface
• Blood urine and human milk

14. EPIDEMIOLOGY
• Approximately 30-40% of infections are
asymptomatic /subclinical.
• In children, prodromal manifestations are
rare but may be manifest by:
• Fever
• Muscular pain (especially in the neck)
• Headache
• Malaise typically precedes the parotid
swelling by 12 to 24 hours

15. CLINICAL FEATURES

16. CLINICAL FEATURES
• COMMON COMPLAINTS ARE:
– Earache on the side of parotid involvement
– Discomfort with eating or drinking acidic food
– Parotid pain is most pronounced during the
first few days of swelling
– The opening of the Stenson duct on the
buccal mucosa is edematous and
erythematous.
– Trismus (spasm of the masticatory muscles)
can occur.

17. CLINICAL FEATURES

18. CLINICAL FEATURES
• Other salivary glands such as the
submandibular and sublingual glands
may also be involved.
• In 10-15% of patients only the
submandibular gland(s) may be
swollen.
• Parasternal edema can be notable.

19. DIFFERENTIAL DIAGNOSIS
• Bacterial parotitis:
• Glands are swollen, warm, and tender
with pus expressing from the duct.
• Calculus in the salivary duct:
• May be detected by palpation.
• Drug reaction:
• Iodine mumps is the commonest type.
• Parotid Tumors
• Actinomycosis.

20. COMPLICATIONS

21. COMPLICATIONS
• EPIDIDYMO-ORCHITIS:
• In 20-30% of post-pubertal males, mumps
is complicated by orchitis.
• Testicular enlargement occurs and
subsides after some days.
• Orchitis is followed by progressive
atrophy of the tests in ½ to 1/3 of the
cases.
• If bilateral atrophy occurs, subnormal
sperm counts are common resulting in
infertility.

22. COMPLICATIONS
• CNS INVOLVEMENT:
• The onset of symptoms of CNS
involvement may occur 3-10 days after
the onset of parotitis.
• CSF protein is elevated.
• Glucose may be normal or low in CSF.
• Encephalitis results in behavior
disorder, headache, seizures, deafness,
and visual disturbances.

23. COMPLICATIONS
• PANCREATITIS:
• Pancreatitis involvement is a potentially
serious manifestation of mumps.
• It should be suspected in patients with
abdominal pain and tenderness.
• OOPHORITIS:
• Pelvic pain and tenderness are noted in about
7% of post-pubertal female patients.
• There is no evidence of impairment of
fertility.

24. DIAGNOSIS

25. DIAGNOSIS
• The diagnosis of mumps parotitis is
usually apparent from the clinical
symptoms and physical examination.
• Routine laboratory tests are
nonspecific; usually leukopenia is
present with relative lymphocytosis.
• An elevation in serum amylase levels is
common; the rise tends to parallel the
parotid swelling and then return to
normal within 2 weeks.

26. DIAGNOSIS
• IgG and IgM antibodies are most
commonly used for diagnosis.
• IgM antibodies are detectable in the
first few days of illness and are
considered diagnostic.
• Mumps virus can be cultured from the
saliva, cerebrospinal fluid, blood, urine,
brain, and other infected tissues.

27. TREATMENT

28. TREATMENT
• Non-specific treatment:
• Analgesic for pain.
• Bland diet (soft foods)
• Rest
• In case of Epididymo-Orchitis
• Surgical decompression of the testicles.
• Infiltration of the spermatic cord with
local anesthesia.
• Broad spectrum anesthesia.

29. PREVENTION

30. PREVENTION
• Vaccination:
• Live attenuated vaccine ( single or MMR)
• Single dose of 0.5 ml I/M at 15 months or
anytime later on.
• Immunoglobulins:
• Not effective

31. Assessment
Q-1 Mumps is a highly contagious viral
infection transmitted from person to
person.
• Which of the following is not the common
symptom of the mumps virus?
a) Fever
b) Muscle aches
c) Swollen salivary glands
d) Skin rashes

32. Assessment
Q-2 Each of the following pathogens can
cause respiratory infections in
humans, EXCEPT?
A-Respiratory syncytial virus
B-Parainfluenza virus
C-Measles virus
D-Rabies virus

33. Assessment
Q-3 Mumps virus can primarily infect which
of the following organs?
• Choose the correct answer:
a) Salivary glands
b) Limbs
c) Eyes
d) Ears

34. Thank You