Tag: mumps testing

Mumps on the USS Fort McHenry

Like measles, we are seeing more mumps these days.

“Beginning in 1991, the military services implemented universal recruit immunization with a single dose of MMR vaccine, regardless of prior vaccination history. Shortly thereafter, and informed by the results of population serosurveys, the Air Force transitioned to a policy of targeted MMR vaccination, limiting the administration of MMR vaccine to recruits lacking serologic evidence of immunity to measles or rubella. With recent outbreaks of mumps, concerns have arisen that the practice of not specifically screening for mumps immunity in determining the need for MMR vaccine could lead to a relative increase in mumps risk among military recruits subject to screening. “

Eick et al on Incidence of mumps and immunity to measles, mumps and rubella among US military recruits, 2000–2004

Unlike measles, the MMR vaccine provides good, but not great protection against mumps.

And although military recruits are screened to see if they have low titers for measles and rubella, they still aren’t screened for mumps. The theory is that if their measles and rubella titers are low, then their mumps titer will be low too and they will get an MMR vaccine. Of course, this misses some who just have a low mumps titer, possibly an effect of waning immunity.

Mumps on the USS Fort McHenry

And that’s why we have been seeing mumps outbreaks on college campuses and most recently, on a Navy ship, although that isn’t a reason for everyone to go out and check their titers.

A tiny handful of measles outbreaks? There have been over 700 cases in the US during the past two years! There were only 37 cases in 2004.

Robert F. Kennedy, Jr has a lot to say about mumps…

He says that mumps outbreaks have devastated fully vaccinated populations at Harvard, Temple, Syracuse, Louisiana State, IU, and the U of Missouri…

And that mumps “epidemics” haven’t been covered by the media, because they don’t want to embarrass Merck…

Why won’t the media cover the mumps outbreaks! Oh, wait…

He also seems to think that these mumps cases have caused a national security threat

Is any of this true?

The simple fact that you can find a ton of stories in the media about the mumps outbreaks (they are not epidemics) gives you a good clue that they aren’t.

What about the quarantined sailors on the USS Fort McHenry?

That is true, but consider that only 27 of 700 of them have gotten parotitis, presumed to have been caused by mumps.

While you would expect that no one would get mumps or any other vaccine-preventable disease these days, that is just under 4% of those on board the ship.

What would have happened in the pre-vaccine era?

Although deaths were rare, mumps caused a lot of considerable loss of service and sick time in the military in the pre-vaccine era.
Although deaths were rare, mumps caused a lot of considerable loss of service and sick time in the military in the pre-vaccine era.

A whole lot more people would have gotten sick!

In the pre-vaccine era, although mumps was supposed to be a common childhood illness, about 1/3 to 1/2 of military recruits had never had mumps.

That meant big outbreaks of mumps that were hard to control, unlike what we see today.

“This article reports a recent public health response to 3 imported mumps cases occurring at Fort Campbell, Kentucky, that resulted in a contact investigation for 109 close contacts across varied settings. No secondary mumps cases were identified.”

Public Health Response to Imported Mumps Cases – Fort Campbell, Kentucky, 2018

Instead, not only do fewer people get sick during mumps outbreaks these days, but fortunately, they have fewer complications.

What kind of complications?

Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.
Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.

In addition to a swollen jaw, mumps is known to cause orchitis, aseptic meningitis, oophoritis, pancreatitis, and encephalitis.

“Risk was reduced for hospitalization, mumps orchitis and mumps meningitis when patient had received 1 dose of measles, mumps, and rubella vaccine. The protective effect of vaccination on disease severity is critical in assessing the total effects of current and future mumps control strategies.”

Young et al on Mumps Complications and Effects of Mumps Vaccination, England and Wales, 2002–2006

Fortunately, those complications are reduced when you get vaccinated. And so are your risks of actually getting mumps in the first place!

“This study demonstrates a significant preventive effect of two-dose vaccination against mumps complications (orchitis, meningitis, or encephalitis) and hospitalization for mumps.”

Orlíkováet al on Protective effect of vaccination against mumps complications, Czech Republic, 2007-2012.

Kennedy doesn’t mention a protective effect of the MMR vaccine, does he?

Remember, vaccines aren’t perfect, but even those that don’t work as well as the others still protect you from many of the worst complications and are much better than getting the disease naturally.

Mumps was often described as one of the top diseases that incapacitated soldiers in the prevaccine era.
Mumps was often described as one of the top diseases that incapacitated soldiers in the prevaccine era.

Vaccines are safe, with few risks, and are obviously necessary.

Is the mumps vaccine a national security threat? The only threat are the folks who continue to push anti-vaccine misinformation.

More on Mumps on the USS Fort McHenry

Does Your Child with Parotitis Have Mumps?

Even though they might never have had or seen a kid with mumps, most people know the tell-tale signs and symptoms.

Classically, mumps is associated with parotitis, with swelling of the salivary glands.
Classically, mumps is associated with parotitis, with swelling of the salivary glands.

But mumps isn’t the only thing that causes parotitis, especially in the post-vaccine era.

Does Your Child with Parotitis Have Mumps?

So having parotitis doesn’t automatically mean that you have mumps.

“Mumps is diagnosed by a combination of symptoms and physical signs and laboratory confirmation of the virus, as not all cases develop characteristic parotitis and not all cases of parotitis are caused by mumps.”

Mumps Questions and Answers

What else can cause parotitis?

  • bacterial infections, including Staphylococcus aureus, especially when the swelling is just on one side of the child’s face
  • blockage of the salivary gland because of a stone in the duct that drains the glands (sialadenitis), again, would be more common on just one side of the child’s face
  • viral infections, including adenovirus, Epstein-Barr virus (EBV), CMV, coxsackie A virus, HHV-6, influenza A, parainfluenza virus types 1, 2 and 3, and echovirus
  • less common causes in children might include medications, benign and malignant tumors, and immunologic diseases

So how do you know if your child with parotitis has the mumps or some other infection or condition?

“Mumps infection is most often confused with swelling of the lymph nodes of the neck. Lymph node swelling can be differentiated by the well-defined borders of the lymph nodes, their location behind the angle of the jawbone, and lack of the ear protrusion or obscuring of the angle of the jaw, which are characteristics of mumps.”

Mumps for Healthcare Providers

There are an increasing number of mumps outbreaks being reported these days and many cases are in vaccinated teens, so it might be easy to just say it is the mumps and recommend that you wait it out, as there is no treatment for the mumps or most other viral infections.

The only problem with that strategy is that if your child has a bacterial infection that is causing their parotitis, then they will likely need antibiotics. Some even go on to develop abscesses that need to be drained. Getting diagnosed with mumps might delay their treatment. And kids with mumps get quarantined far longer than kids with other viral infections.

Fortunately, testing is available, either a real-time RT-PCR (rRT-PCR) or mumps virus culture from a parotid duct swab. You can also do titer testing, although testing for the mumps virus is considered to be more accurate.

So does your child with parotitis have mumps?

They likely do if they have acute parotitis lasting at least 2 days, and either:

  • a positive test for serum anti-mumps immunoglobulin M (IgM) antibody,
  • a positive test for mumps virus with  the reverse transcription polymerase chain reaction (RT-PCR) test or culture
  • a link or exposure to someone else with mumps

Of course, there are other signs and symptoms of mumps besides parotitis. In fact, instead of the parotid gland, your child with mumps could have swelling of other salivary glands, like their sublingual or submandibular gland.

Confusing things, some kids with mumps do have parotitis on just one side of their face, or one side swells before the other. So you can’t say it isn’t mumps just because it is one side. And some kids with mumps never even develop parotitis, but may still have other symptoms and go on to develop complications of mumps.

“CDC recommends that a buccal or oral swab specimen and a blood specimen be collected from all patients with clinical features compatible with mumps.”

CDC on Collecting and Shipping Specimens for Suspected Mumps Cases

Still, many recent studies have confirmed few actual cases of mumps among kids with parotitis, especially among sporadic, non-outbreak cases. That makes it important to actually confirm that a child has mumps if you are going to diagnosis them with mumps.

And get your kids vaccinated and protected. The mumps vaccine isn’t perfect, but you are still much more likely to get mumps if you are unvaccinated.

What to Know About Mumps and Parotitis

While most kids with mumps have parotitis, not everyone with parotitis will have mumps, as there are many other things that cause pain and swelling of the parotid glands.

More on Mumps and Parotitis