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MUMPSUMPS Mumps is an acute viral infection of theMumps is an acute viral infection of the

paramyxoviruses family. As its alternativeparamyxoviruses family. As its alternativename (infectious parotits) suggests, thename (infectious parotits) suggests, the

infection is characterized by swelling moreinfection is characterized by swelling morecommonly bilateral than unilateral of thecommonly bilateral than unilateral of theparotid salivary glands. The incubationparotid salivary glands. The incubationperiod is 14-21 days and is communicableperiod is 14-21 days and is communicablefrom 6 days before to 9 days after facialfrom 6 days before to 9 days after facialswelling is apparent. It can lead to brainswelling is apparent. It can lead to braininflammation, deafness or sterility.inflammation, deafness or sterility.

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Data on M ump sata on M ump s

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Mumps belongs toMumps belongs to ParmyxoviridaeParmyxoviridae

Viruses in the family Parmyxoviridae areViruses in the family Parmyxoviridae areclassified in two subfamilies,classified in two subfamilies,Paramyxovirinae and Pneumovirinae. TheParamyxovirinae and Pneumovirinae. The

latter subfamily contains two genera,latter subfamily contains two genera,Pneumovirus and Metapneumovirus. ThePneumovirus and Metapneumovirus. Thenumber of genera in the Paramyxovirinaenumber of genera in the Paramyxovirinaewas increased in 2002 from threewas increased in 2002 from three

(Respirovirus, Morbillivirus and(Respirovirus, Morbillivirus andRubulavirus) to five by the addition of twoRubulavirus) to five by the addition of twonew genera, Avulavirus and Henipavirus.new genera, Avulavirus and Henipavirus.

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Th e Ph ylo gen et ic t reeh e Ph ylo gen et ic t ree

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ORTHOMYXO / PA RAM YXORTHOMYXO / PA RAM YXOVirusesiruses

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Mum ps b elongs toum ps b elongs to Parmyxoviridaearmyxoviridae Looks similar to Orthomyxovirus,Looks similar to Orthomyxovirus, Larger in size, More Plemomorphic.Larger in size, More Plemomorphic. Spherical in shape 100 to 300 nmSpherical in shape 100 to 300 nm

Some times appear as filamentous,Gaint formsSome times appear as filamentous,Gaint formsare present.are present.

But contains only single stranded RNA.But contains only single stranded RNA. Do not contain segmented RNA likeDo not contain segmented RNA like

Orthomyxoviruses,Antigenic variation absent.Orthomyxoviruses,Antigenic variation absent. Reassortments like Influenzae viruses Reassortments like Influenzae viruses ABSENTBSENT ..

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Mumpsumps Mumpsumps oror epi dem ic pa ro ti tispidemic parotitis is a viralis a viral

disease of the human species, caused bydisease of the human species, caused by

the mumps virus. Prior to thethe mumps virus. Prior to the

development of vaccination and thedevelopment of vaccination and theintroduction of a vaccine, it was aintroduction of a vaccine, it was a

common childhood disease worldwide, andcommon childhood disease worldwide, and

is still a significant threat to health in theis still a significant threat to health in theDeveloping WorldDeveloping World

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In volvem ent o f S ali varyn volvem ent o f S ali varyGlandslands Painful swelling of thePainful swelling of the

salivary glandssalivary glands

(classically the(classically the

parotid glandparotid gland is theis themost typicalmost typical

presentation) Painfulpresentation) Painful

testicular swelling (testicular swelling (

orchitisorchitis) and) and rashrash maymayalso occuralso occur

http://en.wikipedia.org/wiki/Parotid_glandhttp://en.wikipedia.org/wiki/Parotid_glandhttp://en.wikipedia.org/wiki/Orchitishttp://en.wikipedia.org/wiki/Orchitishttp://en.wikipedia.org/wiki/Rashhttp://en.wikipedia.org/wiki/Rashhttp://en.wikipedia.org/wiki/Rashhttp://en.wikipedia.org/wiki/Orchitishttp://en.wikipedia.org/wiki/Parotid_gland

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In volvement o f Par otid Gl andn volvement o f Par otid Gl anda Maj or Man ifestati onMaj or Man ifestati on Swelling of theSwelling of the

salivary glands followssalivary glands follows

these symptoms.these symptoms.

Swelling of the glandsSwelling of the glandsnear the jaw linenear the jaw line

below the ears maybelow the ears may

give you "chipmunkgive you "chipmunk

cheekscheeks

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MumpsumpsAcute viral illnessAcute viral illness

Parotitis and orchitis described byParotitis and orchitis described by

Hi ppo cr ate s i n 5th ce ntur y B .Ci ppo cr ate s i n 5th ce ntur y B .C .Viral etiology described by Johnson and GoodViral etiology described by Johnson and Good

pasture in 1934pasture in 1934

Frequent cause of outbreaks among militaryFrequent cause of outbreaks among militarypersonnel in prevaccine erapersonnel in prevaccine era

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Mumb lin g s peech - M umpsumb lin g s peech - M umpsNamea me"mumps"mumps"

co mes f ro mo mes f ro man ol d wo rdn ol d wo rdfor " lu mp" o ror " lu mp" o ran ol d wo rdn ol d wo rdforor"m umb le. "m umb le. "

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Mu mps Viru su mps Viru s ParamyxovirusesParamyxoviruses

RNA virusRNA virus

One antigenic typeOne antigenic type

Rapidly inactivated byRapidly inactivated bychemical agents, heatchemical agents, heat

and ultraviolet lightand ultraviolet light

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Prop ert ies ofrop ert ies of MUMPSMUMPS viru s.iru s. Posses HN and FPosses HN and F

properties.properties.

Growth in Chick Embryos,Growth in Chick Embryos,

in the Amniotic cavity,in the Amniotic cavity,

Adopts in allantoic cavity,Adopts in allantoic cavity,

Cell cultures PrimaryCell cultures Primary

Monkey kidney,Monkey kidney,

Typical Paramyxoviruses,Typical Paramyxoviruses,

produce cytopathic effects.produce cytopathic effects.

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Pa thogen es is - Mu mpsa thogen es is - Mu mps RespiratoryRespiratory

transmission of virustransmission of virus

Replication inReplication in

nasopharynx andnasopharynx andregional lymph nodesregional lymph nodes

Viremia 12-25 daysViremia 12-25 days

after exposure withafter exposure with

spread to tissuesspread to tissues

Multiple tissuesMultiple tissues

infected duringinfected during

viremiaviremia

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Mum ps C linic al Fe atu resum ps C linic al Fe atu res Incubation period 14-18Incubation period 14-18

daysdays

Nonspecific prodromeNonspecific prodrome

of myalgia, malaise,of myalgia, malaise,headache, low-gradeheadache, low-grade

feverfever

Parotitis in 30%-40%Parotitis in 30%-40%

Up to 20% of infectionsUp to 20% of infectionsasymptomaticasymptomatic

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Mump s Clin ica l Ca seump s Clin ica l Ca seDefinitionefinitionAcute onset ofAcute onset of

unilateral or bilateralunilateral or bilateral

tender, self-limitedtender, self-limited

swelling of the parotidswelling of the parotidor other salivary glandor other salivary gland

lasting more than 2lasting more than 2

days without otherdays without other

apparent causeapparent cause

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Immu nit ymmu nit yAntibodies areAntibodies are

produced against theproduced against the

S and V surfaceS and V surface

antigens..antigens.. Mumps rare before 6Mumps rare before 6

months of age.months of age.

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Definiti on o f M umps Im mu nityefiniti on o f M umps Im mu nity Documentation of adequateDocumentation of adequate

vaccinationvaccination

Serologic evidence of mumpsSerologic evidence of mumps

immunityimmunity

Birth before 1957Birth before 1957

Documentation of physician-Documentation of physician-diagnosed mumps in the pastdiagnosed mumps in the past

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Comp lic ation wit h M UM PSomp lic ation wit h M UM PS .. Epididymo orchids.Epididymo orchids.

May lead to atrophy, sterility, Low spermMay lead to atrophy, sterility, Low sperm

counts.counts.

CNS involvement in 60% casesCNS involvement in 60% cases

May manifest with Aseptic meningitis,May manifest with Aseptic meningitis,

Deafness,Deafness,Arthritis,Oopharitis,Nephritis andArthritis,Oopharitis,Nephritis and

Myocarditis,Myocarditis,

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Comp lic ation wit h M UM PSomp lic ation wit h M UM PS .. Orc hi ti src hi ti s . This inflammatory conditionThis inflammatory condition

causes swelling of one or both testicles.causes swelling of one or both testicles.Orchitis is painful.Orchitis is painful.

Panc reat it is.anc reat it is. .. Enc epha lit is.nc epha lit is. A viral infection, such asA viral infection, such as

mumps, can lead to inflammation of themumps, can lead to inflammation of the

brain (encephalitis). Although it's serious,brain (encephalitis). Although it's serious,encephalitis is a rare complication ofencephalitis is a rare complication ofmumps.mumps.

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Comp lic ation wit h M UM PSomp lic ation wit h M UM PS .. Meningi ti s.eningi ti s. Meningitis is infection andMeningitis is infection and

inflammation of the membranes and fluidinflammation of the membranes and fluidsurrounding your brain and spinal cord.surrounding your brain and spinal cord.

Infl am mati on of the ova riesnfl am mati on of the ova ries . Pain inPain inthe lower abdomen in women may be athe lower abdomen in women may be asymptom of this problem. Fertility doesn'tsymptom of this problem. Fertility doesn'tseem to be affected.seem to be affected.

Heari ng l oss .eari ng l oss . Mis carri ages.is carri ages.

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Laborat or y Dia gnos isaborat or y Dia gnos is No Lab ora tory co nfi rmat io n nee dedo Lab ora tory co nfi rmat io n nee ded .. Atypical infection needs laboratory Diagnosis.Atypical infection needs laboratory Diagnosis. Virus isolated fromVirus isolated from

SalivaalivaUrinerineCSF.SF.

Culturing inCulturing in Hu ma n amn io n, He la cel lsu ma n amn io n, He la cel ls ..Immunoflorecence Methods. Isolation in Chick EmbryosImmunoflorecence Methods. Isolation in Chick Embryos

EL ISA, Compl eme nt fixa tio n tes ts ,L ISA, Compl eme nt fixa tio n tes ts ,Doc tort v rao' s e l ea rni ngoc tort v rao' s e l ea rni ng

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CD C recomm en dsD C recomm en ds CDCDC recommendsrecommends

that a blood specimenthat a blood specimenand buccal /oral swaband buccal /oral swabbe collected from allbe collected from allpatients with clinicalpatients with clinicalfeatures compatiblefeatures compatiblewith mumps.with mumps.

RecommendationsRecommendationsstands mainly forstands mainly forepidemiologicalepidemiologicalsurveyssurveys

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Vaccin at ionaccin at ion Live attenuatedLive attenuated

vaccinevaccine

Jernyl Lynn St ra inernyl Lynn St ra inGrown in chick embryoGrown in chick embryo

fibroblastsfibroblasts

Vaccine as MMR vaccineVaccine as MMR vaccine

A single dose protectsA single dose protectsfor 10 years.for 10 years.

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Mump s ( MMR) Va ccin eump s ( MMR) Va ccin eIn dica tion sn dica tion sOne dose (as MMR) for preschool-ageOne dose (as MMR) for preschool-age

children 12 months of age and olderchildren 12 months of age and olderand persons born during or afterand persons born during or after

1957 not at high risk of mumps1957 not at high risk of mumpsexposureexposure Nee d fo r s econd doseee d fo r s econd dose Second dose (as MMR) for school-ageSecond dose (as MMR) for school-age

children and adults at high risk of mumpschildren and adults at high risk of mumpsexposure (i.e., healthcare personnel,exposure (i.e., healthcare personnel,international travelers and students atinternational travelers and students atpost-high school educational institutionspost-high school educational institutions

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Pas si v e im m uni za tio nag a in s t mu m ps

Immune globulin ineffective for postexposure prophylaxis

does not prevent disease or reducecomplications

Transplacental maternal antibody appears

to protect infants for first year of life

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Epidemiolog ypidemiolog y Endemic Prevalence all over the worldEndemic Prevalence all over the world

Immunization . Reduced the incidence.Immunization . Reduced the incidence.

Epidemics in children between 5-15.Epidemics in children between 5-15. No carriers.No carriers.

Spread by Direct ContactSpread by Direct Contact

Saliva and urine are infective.Saliva and urine are infective. One Attack produces life time Immunity.One Attack produces life time Immunity.

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Pro motin g M ump s V acci nati onro motin g M ump s V acci nati on

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MMR V ac ci neMR V ac ci neContrai ndic ati ons a nd Pr ecau ti on sontrai ndic ati ons a nd Pr ecau ti on s Severe allergic reaction to vaccineSevere allergic reaction to vaccine

component or following a prior dosecomponent or following a prior dose

PregnancyPregnancy

ImmunosuppressionImmunosuppression

Moderate or severe acute illness of otherModerate or severe acute illness of other

etiologiesetiologies

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M M R Va ccin e an dM R Va ccin e an d Au t i smu t i s m There is noThere is no scienti fi c evid enc ecienti fi c evid enc e that thethat the

risk of autism is higher among childrenrisk of autism is higher among childrenwho receive measles or MMR vaccine thanwho receive measles or MMR vaccine than

among unvaccinated childrenamong unvaccinated children The evidence favors a rejection of aThe evidence favors a rejection of acaus al re lat ions hip at theaus al re lat ions hip at thepo pula tion leve l be twee n MM Ro pula tion leve l be twee n MM Rva ccine and autism spe ctruma ccine and autism spe ctrumdi so rde rs (ASD) .i so rde rs (ASD) . -- Institute of Medicine, April 2001Institute of Medicine, April 2001

isis

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M M R c om bi n ed v a cc in eM R c om bi n ed v a cc in e isisbeneficial than separate componentbeneficial than separate component

vaccinesvaccines Separate administration of measles,mumps, and rubella vaccines to childrenprovides no benefit over administration of

the combination MMR vaccine and couldresult in delays in immunization.

Paediatricians need to work with familiesto ensure that children are protected earlyin the second year of life from thesepreventable diseases.

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Mumps Va cc in e a nd H IVumps Va cc in e a nd H IVInfectionnfection MMRMR recommendedrecommended

for persons withfor persons withasymptomatic andasymptomatic andmildly symptomaticmildly symptomaticHIV infectionHIV infection

NOT recommendedNOT recommendedfor those withfor those withevidence of severeevidence of severeimmuno- suppressionimmuno- suppression

HIV test ing befor eIV test ing befor evaccination is notaccination is notrecomme nde decomme nde d

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Mump s con troump s con tro ll:: Mumps controumps co ntr o l: The control of mumps can bel: The control of mumps can be

achieved through high routine coverage with anachieved through high routine coverage with aneffective mumps-containing vaccineeffective mumps-containing vaccineadministered atadministered at 1218 mont hs of a ge218 mont hs of a ge ..Children immunized with most mumps vaccinesChildren immunized with most mumps vaccinesat the age of 12 months or older have excellentat the age of 12 months or older have excellentserological response rates. Programmes shouldserological response rates. Programmes shouldaim at infant coverage of more than 90%. Lowaim at infant coverage of more than 90%. Low

immunization coverage may reduce the numberimmunization coverage may reduce the numberof cases in infants but fails to interruptof cases in infants but fails to interruptcirculation of the mumps virus in the community.circulation of the mumps virus in the community.

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Created for Awareness toCreated for Awareness to

Medical and Health CareMedical and Health CareWorkers in the DevelopingWorkers in the Developing

WorldWorldDr.T.V.Rao MDDr.T.V.Rao MD

Emailmaildoctortvrao@gmail.comdoctortvrao@gmail.com