It’s a common anti-vaccine myth that we rename diseases to make them go away. It helps them explain the control, elimination, and eradication of diseases, since many of them don’t believe that vaccines actually work.
Now imagine that “they” actually found evidence that we did rename vaccine-preventable diseases!
That would be something, wouldn’t it…
Did CNN Rename Mumps?
Of course, they haven’t.
The original CNN story about the USS Fort McHenry stated that the sailors and Marines had parotitis, which was “due to an outbreak of a viral infection similar to mumps.”
Why didn’t they just say that they had mumps?
Because that’s not what they were told by the US Navy’s Fifth Fleet.
“… a military medical team specializing in preventative medical care is expected to deploy in the coming days to make an assessment if further steps may be needed, according to the official.”
US warship quarantined at sea due to virus outbreak
It may come as a surprise to some people, but many viruses and bacteria can cause parotitis. And until the outbreak was further investigated, they didn’t know if it really was mumps or another condition.
Since then, the Navy’s Bureau of Medicine and Surgery (BUMED) has stated that “based on clinical presentation and laboratory testing, these cases are currently classified as probable cases of mumps.”
Still, a very small percentage of the sailors and Marines on board have gotten mumps. That’s because vaccines work, even when they don’t work perfectly well.
“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.
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.
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.
It is not news that we have been seeing more cases of mumps in recent years.
It is also isn’t news that many of these folks are vaccinated.
“Long Beach has been hit with a mumps outbreak that is vaccine-resistant. According to health officials in the Long Island town, almost two dozen individuals are believed to have contracted the virus, with four confirmed cases and at least 14 suspected ones.”
“We are actually to the point that we are worried that this vaccine may indeed not be protecting against the strain of mumps that is circulating as well as it could.”
Dr. Dirk Haselow, Arkansas State Epidemiologist
Of course, to say that the vaccine may not be protecting folks “as well as it could” doesn’t mean it doesn’t work because the wild type mumps virus has evolved or mutated enough to surmount our current MMR vaccine.
Is Mutating Mumps More Than the MMR Can Manage?
Although anything is possible, we fortunately have plenty of research that says that the mumps virus hasn’t mutated and that the MMR still works.
In fact, although the MMR vaccine is made from the A strain or genotype of mumps, it provides good protection against all 12 known strains of wild mumps viruses, including genotype G that has been causing most of the recent outbreaks.
But how can it cover a different strain of virus that isn’t in the vaccine?
Because not all viruses and vaccines are like influenza.
“The genotyping of the mumps virus is based on the Small Hydrophobic (SH) protein, a nonstructural protein and genetically the most variable one. Based on the SH-protein 12 different mumps viruses were detected up to now. In recent epidemics in Western countries the genotype G was mainly detected, while the mumps viruses used in the live attenuated mumps vaccines belong to genotype A (Jeryl Lynn) and to a lesser extent to genotype B (Urabe). However, antibodies against the SH protein have not yet been observed in human serum. It is, therefore, unlikely that antibodies against the SH protein play an important role in antibody-mediated virus neutralization.”
Sabbe et al. on The resurgence of mumps and pertussis
It is well known that you need a very specific match of the flu vaccine to the wild flu virus that is going around to get good protection, but for many other viruses, the differences that determine the strain or genotype have nothing to do with how antibodies will recognize the virus.
“Since mumps virus is monotypic, vaccine from any strain should provide lifelong protection against subsequent infection.”
Palacios et al. on Molecular Identification of Mumps Virus Genotypes from Clinical Samples: Standardized Method of Analysis
“Studies have demonstrated that blood sera from vaccinated persons cross-neutralizes currently circulating mumps strains.”
CDC on Mumps for Healthcare Providers
And like measles, the mumps vaccine (MMR), protects against all strains of wild mumps viruses.
“Compared with attack rates of 31.8%–42.9% among unvaccinated individuals, attack rates among recipients of 1 dose and 2 doses of the Jeryl Lynn vaccine strain were 4%–13.6% and 2.2%–3.6%, respectively.”
Dayan et al. on Mumps Outbreaks in Vaccinated Populations: Are Available Mumps Vaccines Effective Enough to Prevent Outbreaks?
And like other vaccines, the mumps vaccine (MMR) works.
Even though they might never have had or seen a kid with mumps, most people know the tell-tale signs and symptoms.
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
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.