# Presentation: 282132

## Mumps and Mumps Vaccine

**Epidemiology and Prevention of Vaccine-Preventable Diseases**
**National Center for Immunization and Respiratory Diseases**
**Centers for Disease Control and Prevention**

**Revised March 2008**

## Note to presenters:

**Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at ****http://www.vaccineinformation.org/photos/index.asp**

## Mumps

**Acute viral illness**
**Parotitis and orchitis described by Hippocrates in 5th century BCE**
**Viral etiology described by Johnson and Goodpasture in 1934**
**Frequent cause of outbreaks among military personnel in prevaccine era**

**Notes:**
Only influenza and gonorrhea were more frequent among military personnel.

## Mumps Virus

**Paramyxovirus**
**RNA virus**
**One antigenic type**
**Rapidly inactivated by chemical agents, heat, and ultraviolet light **

## Mumps Pathogenesis

**Respiratory transmission of virus**
**Replication in nasopharynx and regional lymph nodes**
**Viremia 12-25 days after exposure with spread to tissues**
**Multiple tissues infected during viremia**

## Mumps Clinical Features

**Incubation period 14-18 days**
**Nonspecific prodrome of myalgia, malaise, headache, low-grade fever **
**Parotitis in 30%-40%**
**Up to 20% of infections asymptomatic**

## Mumps Complications

**Mumps Complications**

## Mumps Laboratory Diagnosis

**Isolation of mumps virus**
**Detection of mumps antigen by PCR**
**Serologic testing**
**positive IgM antibody**
**significant increase in IgG antibody between acute and convalescent specimens**

## Mumps Epidemiology

**Reservoir****	****	****Human**** ****	****	****	****	****Asymptomatic infections****	****	****	****	****may transmit**
**Transmission****	****	****Respiratory drop nuclei****	****	****	****	**
**Temporal pattern ****	****Peak in late winter and spring**** **
**Communicability****	****Three days before to four****	****	****	****	**** ****	****days after onset of active****	****	****	****	****disease**

## Mumps—United States, 1968-2007*

**Mumps—United States, 1968-2007***

**Year**

***2007 provisional total**

## Mumps—United States, 1980-2007*

**Mumps—United States, 1980-2007***

**Year**

***2007 provisional total**

**Notes:**
Resurgence in 1986-1987 involved primarily states that did not have school entry requirements for mumps.  

## Mumps—United States, 1980-2003
Age Distribution of Reported Cases

- Mumps—United States, 1980-2003
- Age Distribution of Reported Cases

**5-14 yrs**

**15-39 yrs**

**<5 yrs**

_**>**_**40 yrs**

**Year**

## Mumps, 2006

**>6,500 cases reported (314 cases reported in 2005)**
**Most cases associated with a large multi-state outbreak**
**Highest incidence was among young adults 18-24 years of age, many of whom were college students **
**Transmission of mumps virus occurred in many settings, including college dormitories and healthcare facilities **

***MMWR***** 2006;55(No. 42):1152-3**

## Factors Contributing To Mumps Outbreak, 2006

**College campus environment**
**Lack of a 2-dose MMR college entry requirement or lack of enforcement of a requirement**
**Delayed recognition and diagnosis of mumps**
**Mumps vaccine failure**
**Vaccine might be less effective in preventing asymptomatic infection or atypical mumps than in preventing parotitis**
**Waning immunity **

## Mumps Clinical Case Definition

**Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland lasting more than 2 days without other apparent cause**

## Mumps Vaccine

**Composition****	****	****Live virus (Jeryl Lynn strain)**** **
**Efficacy****	****	****	****80% (1 dose)**** **
**Duration of****Immunity****	****	****Lifelong**** **
**Schedule****	****	****At least 1 Dose**
**Should be administered with measles and rubella as MMR or with measles, rubella and varicella as MMRV **

## Mumps (MMR) Vaccine Indications

**One dose (as MMR) for preschool-age children 12 months of age and older and persons born during or after 1957 not at high risk of mumps exposure**
**Second dose (as MMR) for school-age children and adults at high risk of mumps exposure (i.e., healthcare personnel, international travelers and students at post-high school educational institutions**

## Mumps Immunity

**Documentation of adequate vaccination**
**Serologic evidence of mumps immunity**
**Birth before 1957**
**Documentation of physician- diagnosed mumps**

## Healthcare facilities should strongly consider recommending 2 doses of MMR vaccine to unvaccinated workers born before 1957 who do not have other evidence of mumps immunity

**Mumps Immunity**

## MMR Adverse Reactions

**Fever****	****	****	****  5%-15%**
**Rash****	****	****	****  5%**
**Joint symptoms****	****  25%**
**Thrombocytopenia****	****  <1/30,000 doses**
**Parotitis*****	****	****  rare**
**Deafness*****	****	****  rare**
**Encephalopathy****	****  <1/1,000,000 doses**

***reactions usually attributed to the mumps component**

## MMR VaccineContraindications and Precautions

**Severe allergic reaction to vaccine component or following a prior dose**
**Pregnancy**
**Immunosuppression**
**Moderate or severe acute illness**
**Recent blood product**

## Measles and Mumps Vaccines and Egg Allergy

**Measles and mumps viruses grown in chick embryo fibroblast culture**
**Studies have demonstrated safety of MMR in egg allergic children**
**Vaccinate without testing**

## Vaccine Storage and HandlingMMR Vaccine

**Store 35****o**** - 46****o****F (2****o**** - 8****o****C) (may be stored in the freezer)**
**Store diluent at room temperature or refrigerate**
**Protect vaccine from light**
**Discard if not used within 8 hours  reconstitution**

## Vaccine Storage and HandlingMMRV Vaccine

**Must be stored at an average temperature of 5****o****F (-15****o****C ) or colder at all times**
**May be stored at refrigerator temperature for up to 72 hours but must then be discarded if not used (do not refreeze)**
**Must be administered within 30 minutes of reconstitution or must be discarded**

## CDC Vaccines and ImmunizationContact Information  

**Telephone     800.CDC.INFO**** **
**Email****	****	****    nipinfo@cdc.gov**** **
**Website****	****    www.cdc.gov/vaccines**