13 Mumps

13.2 Clinical features

Mumps is transmitted by airborne droplets or direct contact with infected respiratory tract secretions or urine. Humans are the only known host of the virus.

Classic mumps, an acute viral illness, is characterised by fever, headache, and swelling and tenderness of one or more parotid (salivary) glands. At least 30 percent of mumps infections in children are asymptomatic. Patients may have no involvement of salivary glands but still experience involvement of other organs (eg, orchitis or meningitis).

The complications of symptomatic mumps include aseptic meningitis in 15 percent (almost always without sequelae), orchitis (usually unilateral) in up to 20 percent of post-pubertal males, and oophoritis in 5 percent of post-pubertal females. Sterility occurs rarely. Profound unilateral nerve deafness occurs in 1 in 15,000 cases. Encephalitis has been reported to occur at a frequency of between 1 in 400 and 1 in 6000, the latter being a more realistic estimate.

The case fatality rate for mumps encephalitis is 1.4 percent, while the overall mumps case fatality rate is reported as 1.8 per 10,000 cases. Pancreatitis, neuritis, arthritis, mastitis, nephritis, thyroiditis and pericarditis may also occur. Mumps in the first trimester of pregnancy may increase the rate of spontaneous abortion, but there is no evidence that it causes fetal abnormalities.

The period of communicability ranges from seven days before the onset of parotitis until nine days after the onset of illness. Exposed non-immune individuals should be considered infectious from 12 to 25 days after exposure.