What is mumps
Transmission of the mumps virus occurs through the saliva or respiratory droplets of an infected person. The incubation period is usually 16 to 18 days but can range from 12 to 25 days. A person is infectious up to 2 days before symptoms begin and until 9 days after. Symptoms include myalgia, malaise, fever, and headache followed by tender swelling of parotid or other salivary glands (sublingual, submaxillary). Up to 50% of those infected can present atypically and 20% can be asymptomatic, which compicates disease control efforts.
Compications of mumps caninclude orchitis (in 20% of postpubertal males), oophoritis, mastitis (30% of postpubertal females), pancreatitis (4%), deafness (5/100,000), encephalitis (2/10,000), and spontaneous abortion 25% of first-trimester pregnancies.5,6
How can you help bring this outbreak under control?
Appropriate steps can be grouped into office infection control practices, diagnosis and reporting, and community infection control measures (TABLE).
Office infection control. Office infection control (subject of a Practice Alert8) is critical so that health care settings do not become a major source of disease transmission. Make sure you and your staff have immunity to mumps. Health care workers should receive 2 doses of MMR vaccine at least a month apart. If mumps occurs in your area, consider requiring proof of immunity, even for those born before 1957.
Make sure that tissues and hand sanitizers are available for patients in the waiting areas, and that signs are posted advising respiratory hygiene. Instruct your front-office staff to ask patients to cover their mouths and noses when they cough and sneeze. Make masks available to any patient who is unable or unwilling to comply; surgical masks are sufficient. Health care staff should be familiar with and use recommended hand sanitation practices.
Don’t let patients with parotid gland swelling sit in the waiting area—place them in an examination room and ask them to wear a mask.
Diagnosis and reporting. When you suspect mumps, collect any specimens requested by the local health department. This probably includes an immediate serum sample for IgM or IgG and possibly a convalescent serum for IgG; it may include a throat swab or urine sample for viral isolation. You should know the phone number of the local health department or have access to their Web site so that current recommendations for specimen collection and analysis can be obtained quickly.
Community infection control. If you suspect a patient has mumps, report it to the local health department and instruct the patient to remain in isolation for 9 days after the start of symptoms. Family members and close contacts should be assisted in assuring they are immune to mumps.
Review with each patient their immunization status; encourage those without documented immunity to mumps to receive the vaccine, if they have no contraindications.
TABLE
Family physicians’ role in controlling mumps
| OFFICE INFECTION CONTROL |
| Post respiratory hygiene notices |
| Make readily available for patients and staff tissues, tissue disposal containers, and hand sanitizers |
| Instruct office staff to request patients use respiratory hygiene |
| Have masks available for those who cannot or refuse to comply with respiratory hygiene |
| Train staff to place patients suspected to have mumps in an examine room immediately and to provide them a mask |
| Instruct staff to use recommended hand sanitation methods |
| Insure that staff are immunized |
| DIAGNOSING AND REPORTING |
| Maintain a high index of suspicion for mumps |
| Collect recommended laboratory specimens |
| COMMUNITY INFECTION CONTROL |
| Report suspected mumps cases to the local public health department |
| Advise those infected to remain in isolation until 9 days after the start of symptoms |
| Help insure families and close contacts of those infected are immunized against mumps |
| Check mumps immunization status of all patients |