Although things are much better than they were in the pre-vaccine era, we still have mumps outbreaks in the United States.
How does that work?
Waning immunity and folks who are unvaccinated.
How Contagious is Mumps?
Mumps is contagious, but not nearly as contagious as other vaccine-preventable diseases, such as measles.
“Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”
CDC on Transmission of Measles
Unlike measles, which is so contagious that you can get it if you are simply in the same room with someone that is sick, mumps typically requires prolonged, close contact.
“When you have mumps, you should avoid prolonged, close contact with other people until at least five days after your salivary glands begin to swell because you are contagious during this time. You should not go to work or school. You should stay home when you are sick with mumps and limit contact with the people you live with; for example, sleep in a separate room by yourself if you can.”
CDC on Mumps Outbreak-Related Questions and Answers for Patients
How do you get mumps?
Since the virus spreads through saliva and mucus, you can get sick if you are in close contact with someone with mumps and they:
- cough or sneeze
- use a cup or eating utensil that you then use
- touch an object or surface that you then touch (fomites)
And like many other vaccine-preventable diseases, people with mumps are usually contagious just before they begin to show symptoms.
“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”
CDC on Mumps for Healthcare Providers
The need for prolonged, close contact is likely why most outbreaks these days are on college campuses.
Is Your Child Protected Against the Mumps?
The MMR vaccine protects us against mumps – and measles and rubella.
One dose of MMR is 78% effective at preventing mumps, while a second dose increases that to 88%. Unfortunately, that protection can decrease over time.
Kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.
“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”
CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices
And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.
What to Do If Your Unvaccinated Child Is Exposed to Mumps
To be considered fully vaccinated and protected against mumps, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.
“Although mumps-containing vaccination has not been shown to be effective in preventing mumps in persons already infected, it will prevent infection in those persons who are not yet exposed or infected. If persons without evidence of immunity can be vaccinated early in the course of an outbreak, they can be protected prior to exposure.”
If your unvaccinated child is exposed to mumps, you should talk to your pediatrician or local health department, but unlike measles and chicken pox, there are no recommendations to start post-exposure prophylaxis.
Unfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed. They should still get an MMR though, as it will provide immunity against measles and rubella, and mumps if they don’t get a natural infection.
“Persons who continue to be exempted from or who refuse mumps vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”
Manual for the Surveillance of Vaccine-Preventable Diseases
Unvaccinated kids who are exposed to mumps will likely need to be quarantined, as you watch for signs and symptoms of measles developing over the next 12 to 25 days.
If your exposed child develops mumps, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to mumps. Your child with suspected mumps should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office.
It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with mumps could expose others, it just reduces the risk. You still want to avoid other people!
What to Do If Your Vaccinated Child Is Exposed to Mumps
If your fully vaccinated child is exposed to mumps, does that mean you are in the clear?
Again, it depends on what you mean by fully vaccinated.
It also depends on what you mean by exposed. Is it someone in the same school that your child has had no real contact with or a sibling that he is around all of the time?
And is your child fully vaccinated for his age or has he had two doses of MMR?
Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against mumps, even if they are not skipping or delaying any vaccines.
“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”
Ask the Experts about MMR
In most cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.
And one dose of MMR is about 78% effective at preventing mumps infections. A second dose does increase the vaccine’s effectiveness against mumps to over 88%.
An early second dose is a good idea though if your child might be exposed to mumps in an ongoing outbreak, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.
“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”
Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak
And in some cases, folks should now get a third of dose of MMR.
This third dose of MMR is not for post-exposure prophylaxis though, which again, doesn’t work for mumps. It is to prevent mumps from ongoing exposures.
You should still watch for signs and symptoms of mumps over the next 12 to 25 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.
Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to mumps will depend on your local or state health department.
What to Know About Getting Exposed to Mumps
Talk to your pediatrician if your child gets exposed to mumps, even if you think he is up-to-date on his vaccines, as some kids need a third dose of the MMR vaccine during on-going mumps outbreaks.
More on Getting Exposed to Mumps
- CDC – Mumps Outbreak-Related Questions and Answers for Patients
- CDC – Transmission of Mumps
- CDC – Mumps for Healthcare Providers
- CDC – Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP)
- CDC – Recommendations of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus-Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak (ACIP)
- Study – Impact of a third dose of measles-mumps-rubella vaccine on a mumps outbreak
- Ask the Experts about MMR
- CDC – Mumps Cases and Outbreaks
- You have been exposed to MUMPS….now what?
- Managing Mumps Exposures in Health Care Workers