Talk to Patients About: Mumps.

More than 2,000 U.S. mumps cases occurred in 2018. That's down from 6,000-plus cases CDC reported in both 2016 and 2017, but a far cry from the hundreds reported in 2012. Texas is not immune. In 2018, mumps outbreaks occurred at Texas Christian University in Fort Worth, Texas State University in San Marcos, and a national cheerleading competition in Dallas. Mumps still spreads much faster and more dangerously among unvaccinated groups, and immunization remains the best protection.

[Dramatic achievements in infectious disease prevention and treatment in China during the past 70 years].

At the beginning of the founding of People's Republic of China, infectious diseases, such as smallpox, plague, cholera, dysentery, typhoid, measles, diphtheria, pertussis, meningitis, mumps, schistosomiasis, Kala Azar, hemorrhagic fever, leptospirosis, encephalitis B, typhus, malaria, Kala Azar, leprosy, scarlet fever and pinkeye, remained as epidemic in the country and endangered people's health. During the past 70 years, the Chinese government spent huge efforts in infectious disease prevention and treatment by promulgating and implementing series of relative policies, laws and strategies, and also encouraged all Chinese people to participate in. The achievements of these efforts in controlling infectious disease epidemic were extremely successful. Today, the outbreaks and epidemic of infectious diseases in China were rarely happened with the rapid decreases in incidence and mortality rates of all notifiable infectious diseases. Smallpox was eradicated, and polio, filariasis, leprosy and neonatal tetanus were nearly eradicated. In addition, the incidence rates of vaccine-preventable diseases, i.e. measles, diphtheria, pertussis, meningitis, encephalitis B, hepatitis A, mumps, rubella, tuberculosis, were dramatically decreased and remained at relatively low levels for years. The incidence and prevalence rates of hepatitis B infection in Children decreased significantly and reached the phase objectives. Moreover, incidence rates of natural iatrogenic infectious diseases, i.e. diarrhea, typhoid and other intestinal infectious diseases, leptospirosis and schistosomiasis, and vectorborne diseases, i.e. typhus, malaria, Kala Azar, reached the lowest and some even closed to be eliminated in China. In general, infectious diseases dropped to the tenth from the top one leading cause of all deaths, which means that the achievement of Chinese infectious disease prevention and treatment strategies contributed tremendously in improving Chinese people's health status and life expectancy.

Mumps: An Emergency Medicine-Focused Update.

BACKGROUND: Mumps is a Paramyxoviridae virus. This disease was rampant prior to introduction of the measles, mumps, and rubella vaccine, resulting in decreased incidence. This disease has demonstrated several outbreaks. OBJECTIVE: This review provides a focused evaluation of mumps, an update on outbreaks, management recommendations, and ways to decrease transmission. DISCUSSION: Clusters of mumps outbreaks continue to occur. The virus is a paramyxovirus, a single-stranded RNA virus. The vaccine can provide lifelong immunity if administered properly, though prior to 1967 and introduction of the vaccine, the virus was common. In the past decade, there have been several notable outbreaks. Humans are the only known hosts, with disease spread through exposure to droplets and saliva. Factors affecting transmission include age, compromised immunity, time of year, travel, and vaccination status. Upper respiratory symptoms, fever, and headache are common, with unilateral or bilateral parotitis, and the virus may spread to other systems. Diagnosis is clinical, though polymerase chain reaction and immunoglobulin testing are available. This review provides several recommendations for vaccine in pregnancy, patients living in close quarters, health care personnel, and those immunocompromised. Treatment is generally supportive, with emphasis on proper isolation to prevent widespread outbreaks. Although reporting regulations and procedures vary by state, mumps is reportable in most states. CONCLUSIONS: Mumps is an easily spread virus. Although vaccination is the most effective way to prevent transmission, early recognition of the disease is crucial. As an emergency physician, it is important to recognize the clinical presentation, recommended testing, treatment, and isolation procedures.

[It's never too late to be infected with mumps]. / Il n'est jamais trop tard pour les oreillons.

Mumps, although rare since the introduction of a systematic vaccination of children in 1981 in Switzerland, occurs principally in children and is uncommon in adults. Nevertheless, it should be considered in adult patients with a typical clinical presentation or with an atypical presentation suggesting the disease. The diagnosis is established based on the clinical presentation and the treatment is symptomatic.

Le diagnostic des oreillons, bien que rare depuis l'introduction en 1981 de la vaccination de routine chez les enfants en Suisse, est de nos jours essentiellement posé chez ces derniers et rarement chez les adultes. Il faut néanmoins y penser face à un tableau typique rencontré chez des patients adultes ou lors de présentation atypique partiellement évocatrice de cette maladie. Le diagnostic reste essentiellement clinique et le traitement symptomatique.

Postexposure Management of Vaccine-Preventable Diseases.

Because some parents are choosing to not vaccinate or only partially vaccinate their children, vaccine-preventable diseases that once were rarely seen in pediatric practice must now be considered part of the differential diagnosis when caring for these children. Measles, mumps, varicella, meningococcal disease, pertussis, and influenza are reviewed. Recommendations for prevention and treatment of these vaccine-preventable diseases are discussed.

Points & Pearls: Vaccine-preventable diseases in pediatric patients: a review of measles, mumps, rubella, and varicella

Vaccine-preventable diseases such as measles, mumps, rubella, and varicella continue to plague children and adults worldwide. Although public health programs have helped decrease the prevalence and sequelae of these diseases, outbreaks still occur. To limit the spread of these diseases, emergency clinicians must be able to readily identify the characteristic presentations of the rashes associated with measles, rubella, and varicella, as well as the common presenting features associated with mumps. Diagnostic laboratory studies are not usually necessary, as a complete history and physical examination usually lead to an accurate diagnosis. Treatment for these vaccine-preventable diseases usually consists of supportive care, but, in some cases, severe complications and death may occur. This issue provides a review of the clinical features, differential diagnoses, potential complications, and treatment options for measles, mumps, rubella, and varicella. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

Acupuncture for mumps in children.

BACKGROUND: Mumps is an acute, viral illness transmitted by respiratory droplets and saliva. A number of studies published in China have suggested that acupuncture is beneficial for children with mumps but the literature reporting the benefits or harms of acupuncture for mumps has not been systematically reviewed. OBJECTIVES: To determine the efficacy and safety of acupuncture for children with mumps. SEARCH METHODS: We searched CENTRAL (2014, Issue 11), MEDLINE (1950 to November week 3, 2014), EMBASE (1974 to December 2014), CINAHL (1981 to December 2014), AMED (1985 to December 2014), the Chinese BioMedical Literature Database (CBM) (1979 to November 2014), China National Knowledge Infrastructure (CNKI) (1979 to November 2014), Chinese Technology Periodical Database (CTPD) (1989 to November 2014) and Wanfang database (1982 to November 2014). We also handsearched a number of journals (from first issue to current issue). SELECTION CRITERIA: Randomised controlled trials comparing acupuncture with placebo acupuncture, no management, Chinese medication, Western medication or other treatments for mumps. Acupuncture included either traditional acupuncture or contemporary acupuncture, regardless of the source of stimulation (body, electro, scalp, fire, hand, fine needle, moxibustion). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data. We identified no trials for inclusion in this updated review. MAIN RESULTS: No study met our inclusion criteria. AUTHORS' CONCLUSIONS: We could not reach any conclusion about the efficacy and safety of acupuncture as we identified no trials for inclusion in this review. More high-quality research is needed.

Salivary gland disorders.

Salivary gland disorders include inflammatory, bacterial, viral, and neoplastic etiologies. The presentation can be acute, recurrent, or chronic. Acute suppurative sialadenitis presents as rapid-onset pain and swelling and is treated with antibiotics, salivary massage, hydration, and sialagogues such as lemon drops or vitamin C lozenges. Viral etiologies include mumps and human immunodeficiency virus, and treatment is directed at the underlying disease. Recurrent or chronic sialadenitis is more likely to be inflammatory than infectious; examples include recurrent parotitis of childhood and sialolithiasis. Inflammation is commonly caused by an obstruction such as a stone or duct stricture. Management is directed at relieving the obstruction. Benign and malignant tumors can occur in the salivary glands and usually present as a painless solitary neck mass. Diagnosis is made by imaging (e.g., ultrasonography, computed tomography, magnetic resonance imaging) and biopsy (initially with fine-needle aspiration). Overall, most salivary gland tumors are benign and can be treated with surgical excision.

Effectiveness of one dose of mumps vaccine against clinically diagnosed mumps in Guangzhou, China, 2006-2012.

Although mumps-containing vaccines were introduced in China in 1990s, mumps continues to be a public health concern due to the lack of decline in reported mumps cases. To assess the mumps vaccine effectiveness (VE) in Guangzhou, China, we performed a 1:1 matched case-control study. Among children in Guangzhou aged 8 mo to 12 y during 2006 to 2012, we matched one healthy child to each child with clinically diagnosed mumps. Cases with clinically diagnosed mumps were identified from surveillance sites system and healthy controls were randomly sampled from the Children's Expanded Programmed Immunization Administrative Computerized System in Guangzhou. Conditional logistic regression was used to calculate VE. We analyzed the vaccination information for 1983 mumps case subjects and 1983 matched controls and found that the overall VE for 1 dose of mumps vaccine, irrespective of the manufacture, was 53.6% (95% confidence interval [CI], 41.0-63.5%) to children aged 8 mo to 12 y. This post-marketing mumps VE study found that immunization with one dose of the mumps vaccine confers partial protection against mumps disease. Evaluation of the VE for the current mumps vaccines, introduction of a second dose of mumps vaccine, and assessment of modifications to childhood immunization schedules is essential.

Acupuncture for mumps in children.

BACKGROUND: Mumps is an acute, viral illness transmitted by respiratory droplets and saliva. A number of studies published in China have suggested that acupuncture is beneficial for children with mumps but the literature reporting the benefits or harms of acupuncture for mumps has not been systematically reviewed. OBJECTIVES: To determine the efficacy and safety of acupuncture for children with mumps. SEARCH METHODS: We searched CENTRAL (2012, Issue 4), MEDLINE (1950 to April week 4, 2012), EMBASE (1974 to May 2012), CINAHL (1981 to May 2012), AMED (1985 to May 2012), the Chinese BioMedicine Database (CBM) (1979 to May 2012), China National Knowledge Infrastructure (CNKI) (1979 to May 2012), Chinese Technology Periodical Database (CTPD) (1989 to May 2012) and WANFANG database (1982 to May 2012). We also handsearched a number of journals (from first issue to current issue). SELECTION CRITERIA: We included randomised controlled trials comparing acupuncture with placebo acupuncture, no management, Chinese medication, Western medication or other treatments for mumps. Acupuncture included either traditional acupuncture or contemporary acupuncture, regardless of the source of stimulation (body, electro, scalp, fire, hand, fine needle, moxibustion). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the quality of included studies. We calculated risk ratios (RR) with their 95% confidence intervals (CI) for the effective percentage and standardised mean differences (SMD) with 95% CIs for the time to cure. MAIN RESULTS: Only one study with 239 participants met our inclusion criteria. There were a total of 120 participants in the acupuncture group, of which 106 recovered, with their temperature returning back to normal and no swelling or pain of the parotid gland; the condition of 14 participants improved, with a drop in temperature and alleviation of swelling or pain of the parotid gland. There were 119 participants in the Western medicine group, of which 56 recovered and the condition of 63 improved. The acupuncture group had a higher recovery rate than the control group. The relative RR of recovery was 1.88 (95% CI 1.53 to 2.30). However, the acupuncture group had a longer time to cure than the control group. The mean was 4.20 days and the standard deviation (SD) was 0.46 in the acupuncture group, while in the control group the mean was 3.78 days and the SD was 0.46.There was a potential risk of bias in the study because of low methodological quality. AUTHORS' CONCLUSIONS: We could not reach any confident conclusions about the efficacy and safety of acupuncture based on one study. More high-quality research is needed.

Estudio de un brote epidémico de ámbito poblacional por el virus de la parotiditis G1 en JEREZ de la Frontera / Study of a population-wide epidemic outbreak of mumps virus G1 in Jerez de la Frontera (Spain)

ObjetivosCaracterizar el brote epidémico, evaluar la efectividad vacunal y analizar las medidas de prevención y control.DiseñoEstudio observacional transversal de casos según persona, lugar, tiempo.Emplazamiento: Ciudad Jerez de la Frontera y 8 centros de atención primaria.ParticipantesSe incluyen 116 casos de parotiditis notificados a lo largo de 7 meses, el último caso en junio de 2008.Mediciones principalesVariables principales: edad, sexo, centro de estudio o trabajo, fecha de inicio de los síntomas, descripción clínica, complicaciones, aislamiento y genotipo del virus, antecedentes y composición de las vacunas administradas. Cálculo de la efectividad vacunal total. Se ha realizado una búsqueda activa de casos y estudio de contactos en el medio familiar, laboral y ocio.ResultadosEdad media casos 16,24 años (DE: 10,6). El 68,96% de los casos han sido alumnos y el 31,03% procedían del medio familiar y laboral. Las tasas de coberturas de vacunación antiparotiditis fueron superiores al 90%. La efectividad vacunal completa (2 dosis), en menores de 20 años, ha sido: 99,84% (IC 95%=99,77-99,89), siendo menor en el centro docente con mayor tasa de ataque, inmunizados con la actual vacuna, procedente de cepa Jeryl Lynn: 71,01% (IC 95%=55,85-80,97). El 13,79% de los casos tienen 2 dosis de esta cepa. Iniciado el brote se procedió a vacunar a la población susceptible: 11.381 dosis en el medio docente y 93 en el medio extraescolar.ConclusionesBrote de parotiditis, por virus G1, en población con altas tasas de cobertura de vacuna antiparotiditis, con territorios con baja efectividad con la actual vacuna. La vacunación masiva poblacional ha contribuido a la resolución del brote(AU)

ObjectivesTo characterize the mumps outbreak, assess the effectiveness of vaccines and discuss prevention and control measures.DesignObservational cross-sectional study of cases by person, place, and time.LocationCity Jerez de la Frontera and 8 Primary Care centres.ParticipantsA total of 116 cases of mumps were reported throughout seven months, with the last case in June 2008.MeasurementsMain outcomes: age, sex, place of study or work, symptoms start date, clinical description, complications, and genotype of virus isolation, history and vaccination compositions. Calculation of total vaccine effectiveness. Active case finding and contact studies were performed on the families, work places and leisure areas.ResultsThe mean age of the cases was 16.24 years(SD 10.6). The majority (68.96%) of the cases were children at school and 31.03% arose from family and work areas. Mumps vaccine coverage rates were above 90%. The complete vaccine effectiveness (2 doses); for those under 20 years-old it was: 99.84% (95% CI=99.77 - 99.89), being lower in schools with the highest attack rate, immunised with current vaccine from Jeryl Lynn strain: 71.01% (95% CI=55.85 80.97). Two doses of this strain were used in 13.79% of the cases. Susceptible populations were vaccinated at the start of the outbreak: 11,381 doses used in schools and 93 outside schools.ConclusionsAn outbreak of mumps virus G 1 population with high rates of mumps vaccine coverage, with areas with low vaccine effectiveness with current vaccine. Mass vaccination of population has contributed to the resolution of the outbreak(AU)

The increasing incidence of mumps orchitis: a comprehensive review.

There has been a recent increase in mumps orchitis among pubertal and postpubertal males. These outbreaks can be attributed to a reduction in the uptake of measles-mumps-rubella (MMR) vaccine during the early to mid-1990 s in children who have now matured. The mumps virus is commonly associated with extra-salivary complications. Unvaccinated postpubertal males diagnosed with mumps virus frequently develop complications such as mumps orchitis. Therefore, it is important that urologists are familiar with the diagnosis, treatment and complications of this condition. Here we review the epidemiology, clinical presentation, diagnostic methods, treatment options and complications of mumps orchitis, as a complication of mumps virus, with particular emphasis on testicular atrophy, subfertility and infertility.

Mumps: a resurgent disease with protean manifestations.

Mumps has re-emerged as an infection in the developed world. Its epidemiology has changed, with the majority of cases now primarily affecting adolescents and adults. While mumps is easily suspected if parotitis is present, parotitis is absent in 10%-30% of symptomatic cases. Mumps is a systemic infection with a variety of extra-parotid complications. In Australia, mumps diagnosis is confirmed by antibody testing and reverse transcriptase-polymerase chain reaction techniques. Suitable specimens for testing are serum, saliva, urine and cerebrospinal fluid. Treatment is generally supportive, although intravenous immunoglobulin therapy may have a future role in mumps management. Interferon alpha-2b treatment may be considered specifically for mumps epididymo-orchitis. Mumps vaccine is included in the measles-mumps-rubella (MMR) vaccine. In Australia, this vaccine is routinely administered at the ages of 1 and 4 years. Serious reactions to the mumps components of the MMR vaccine are rare.

Mumps vaccine failure investigation in Novosibirsk, Russia, 2002-2004.

The aims of this study were to estimate the importance of vaccine failure (VF) in cases of mumps during 2002-2004 in the city of Novosibirsk, Western Siberia, Russia, and to genotype the responsible virus strain. Mumps virus-specific RT-PCR testing of saliva was performed for 18 cases of mumps. Sera were tested for IgM and IgG, IgG avidity, and the ability to neutralise a panel of mumps viruses, including the Leningrad-3 mumps vaccine virus. Of the 12 patients for whom vaccination status was positively determined, 11 showed serological evidence of primary VF. Sequence analysis of virus RNA amplified from saliva revealed a genotype C2 virus in 2002, a genotype H2 virus in 2003, and both genotypes in 2004. Although several vaccinated patients were positive for mumps virus IgG at the time of first sampling, only nominal levels of neutralising antibody were detected, and these were effective in neutralising the vaccine strain, but not genotype C and H mumps virus strains. These results suggest that the majority of cases of mumps in vaccinees are caused by primary VF, defined as either a lack of seroconversion or a lack of IgG maturity, as based on avidity testing. The results also support the hypothesis that sera of low neutralising antibody titre have a limited ability to neutralise heterologous mumps virus strains, suggesting that antigenic differences between circulating and mumps vaccine virus strains may play a role in cases of breakthrough infection. Consistent with previous reports, mumps virus genotypes C and H continue to circulate in Novosibirsk.