Introduction

Mumps, caused by a paramyxovirus, is spread via direct contact or by airborne droplets from the upper respiratory tract of infected individuals. Humans are the only known natural host for mumps virus. The incubation period of mumps is usually 16 to 18 days but can range from 12 to 25 days. Mumps is a leading cause of acquired sensorineural deafness among children. After about 1 week, fever and glandular swelling disappear, and unless complications occur, the illness resolves completely.

Before the 1960s, when mumps vaccines became commercially available, mumps was a common infectious disease in all parts of the world, with annual incidences ranging from 100–1000 cases/100 000 population. In hot climates the disease may occur at any time of year, whereas in temperate climates the incidence peaks in winter and spring. Many countries experience epidemics at intervals of 2–5 years. Although mumps is most frequently reported in children aged 5–9 years, both adolescents and adults may be affected.

Case definition

i. Suspected

• Parotitis, acute salivary gland swelling, orchitis, or oophoritis unexplained by another more likely diagnosis, OR
• A positive lab result with no mumps clinical symptoms (with or without epidemiological-linkage to a confirmed or probable case).

ii. Probable

Acute parotitis or other salivary gland swelling lasting at least 2 days, or orchitis or oophoritis unexplained by another more likely diagnosis, in:

• A person with a positive test for serum anti-mumps immunoglobulin M (IgM) antibody, OR
• A person with epidemiologic linkage to another probable or confirmed case or linkage to a group/community defined by public health during an outbreak of mumps.

iii. Confirmed

A positive mumps laboratory confirmation for mumps virus with reverse transcription polymerase chain reaction (RT-PCR) or culture in a patient with an acute illness characterized by any of the following:

• Acute parotitis or other salivary gland swelling, lasting at least 2 days
• Aseptic meningitis
• Encephalitis
• Hearing loss
• Orchitis
• Oophoritis
• Mastitis
• Pancreatitis

Signs and symptoms

• unilateral or bilateral swelling of the parotid glands.
• myalgia, headache, malaise and low-grade fever.

Complications

• permanent paralysis
• seizures hydrocephalus
• deafness
• inflammation of one or both testicles (orchitis)
• spontaneous abortions during pregnancy in adult females

Epidemiology and Situation Analysis

Botswana is currently experiencing an increase of mumps cases which started in two districts namely GoodHope and Greater Gaborone districts and has since spread across to other districts. 323 cases of mumps have been reported since week 28 - 42. The majority of the cases are school going children aged 5 – 14 years. To date, no mumps related deaths have been reported. Interventions are ongoing and the situation is under control. Botswana has not included Mumps containing vaccine in the National Routine Immunization schedule due to low to zero reported cases over decades hence 100% of the cases have not been vaccinated against mumps disease.

Clinical Case Management

There’s no specific treatment for mumps. The disease i=s self-limiting and usually goes away on its own within a couple of weeks. Mumps treatment focuses on alleviating symptoms. The following steps can help manage symptoms:

• Drink plenty of fluids.
• Gargle warm salt water.
• Eat soft, easy-to-chew foods.
• Avoid acidic foods that make your mouth water.
• Suck on an ice pop to soothe a sore throat.
• Place ice or heat packs on swollen glands.
• Take painkillers such as Paracentamol and Ibuprofen to reduce fever and help with pain.
• Children should stay out of school until symptoms have lessoned

Don’t give your child aspirin. Children with viruses such as mumps who take aspirin can develop Reye’s syndrome, a dangerous disease that causes liver failure, swelling of their brain and even death. Because mumps is viral, antibiotics cannot be used to treat it and at present there are no antiviral medications that can treat mumps. While mumps is typically a mild disease, it can cause serious complications.

Transmission

It is transmitted through direct contact with saliva or respiratory droplets from an infected person with mumps. It spreads when an infected person:

• Coughs sneezes, or talks
• Shares items that may have saliva on them, such as water bottles or cups
• Participates in close-contact activities with others, such as playing sports, or
• Touches objects and surfaces that are then touched by others

Signs and symptoms

Mumps typically starts with fever, headache, muscle aches, tiredness, and loss of appetite; then most people have swelling of their salivary glands, called parotitis, causing puffy cheeks and a swollen jaw.

Prevention

People who have mumps can help prevent the virus from spreading to others by:

• Reducing contact with others
• Staying home from work or school for 5 days after your salivary glands begin to swell. Do not attend parties or social events!
• Avoiding close contact with people who live in your house
• Covering mouth and nose with a tissue when coughing or sneezing and throwing the tissue in the trash
• Washing hands often with soap and water
• Avoiding sharing objects that might have saliva on them, like water bottles or cups
• Disinfecting frequently touched objects and surfaces

The best protection against mumps is MMR (measles-mumps-rubella) vaccine.

Complications

Mumps can cause complications that include:

• Swelling of the testicles (Orchitis) in males who have reached puberty
• Swelling of ovaries (Oophoritis) and/or swelling of breasts (mastitis) in females who have reached puberty
• Swelling of the tissue (Meningitis) covering the brain and spinal cord
• Swelling of the brain (Encephalitis)
• Loss of hearing
• Some people who get mumps have very mild symptoms (like a cold), or no symptoms at all and may not know they have the disease.
• In rare cases, mumps can cause more severe complications.
• Most people with mumps recover completely within two weeks.
• Background: Acute viral illness . Caused by a paramyxovirus
• Typically parotitis or other salivary gland swelling
• Usually unilateral or bilateral and lasts 3 to 7 days
• May be preceded by non-specific prodromal symptoms
• Incubation period is 12 to 25 days
• Parotitis typically presents 16 to 18 days after exposure to mumps virus
• Can occur in fully vaccinated people
• Unvaccinated more likely to get mumps and its complications
• Can also occur in persons who previously had mumps
• 20% of unvaccinated people are asymptomatic