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Mumps is an acute viral illness. Parotitis and orchitis were 

described by Hippocrates in the 5th century BCE. In 1934, 

Claud Johnson and Ernest Goodpasture showed that mumps 

could be transmitted from infected patients to rhesus monkeys 

and demonstrated that mumps was caused by a filterable 

agent present in saliva. This agent was shown to be a virus in 

1935. Mumps was one of the most common causes of aseptic 

meningitis and sensorineural hearing loss in childhood in the 

United States until the introduction of a vaccine in 1967. In 

1971, mumps vaccine was licensed in the United States as a 

combined measles, mumps, and rubella (MMR) vaccine. In 2005, 

a combination measles, mumps, rubella, and varicella (MMRV) 

vaccine was licensed.

During World War I, only influenza and gonorrhea were more 

common than mumps as causes of hospitalization among 

soldiers. A successful 2-dose vaccination program in the United 

States led to a greater than 99% reduction in the number of 

mumps cases reported annually. However, starting in 2006, 

there has been an increase in mumps cases and outbreaks, 

particularly in close-contact settings, with many occurring 

among fully vaccinated persons. 

Mumps Virus

Mumps virus is a paramyxovirus in the same group as 

parainfluenza and Newcastle disease viruses, which produce 

antibodies that cross-react with mumps virus. The virus has a 

single-stranded RNA genome.

The virus can be isolated or propagated in cultures of various 

human and monkey tissues and in embryonated eggs. It has 

been recovered from the saliva, cerebrospinal fluid, urine, blood, 

semen, breastmilk, and infected tissues of patients with mumps. 

Mumps virus is rapidly inactivated by formalin, ether, 

chloroform, heat, and ultraviolet light. 

Pathogenesis

The virus is acquired by respiratory droplet transmission. It 

replicates in the nasopharynx and regional lymph nodes. 

During viremia, the virus spreads to multiple tissues, including 

the meninges, salivary glands, pancreas, testes, and ovaries. 

Inflammation in infected tissues leads to characteristic 

symptoms of parotitis and other complications such as orchitis 

and aseptic meningitis. 

Mariel Marlow, PhD, MPH; Penina Haber, MPH; Carole Hickman, PhD; and Manisha Patel, MD, MS

Mumps

● Acute viral illness

● Parotitis and orchitis

described by Hippocrates

in 5th century BCE

● Viral etiology described

by Johnson and Goodpasture

in 1934

● Before vaccine, one of the

most common causes of

aseptic meningitis and hearing

loss among children and

hospitalization among military

● Vaccination led to

over 99% reduction in

mumps cases

Mumps Pathogenesis

● Respiratory transmission

of virus

● Replication in nasopharynx

and regional lymph nodes

● Multiple tissues infected

during viremia

Mumps Virus

● Paramyxovirus (RNA)

● Rapidly inactivated by

chemical agents, heat, and

ultraviolet light

https://www.cdc.gov/vaccines/pubs/pinkbook/mumps.html Aug 2021
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Clinical Features

The incubation period of mumps is usually 16 to 18 days but 

can range from 12 to 25 days. The prodromal symptoms are 

nonspecific and include myalgia, anorexia, malaise, headache, 

and low-grade fever. 

Mumps typically presents as parotitis (i.e., swelling of the 

parotid gland) or other salivary gland swelling lasting about 

5 days. Parotitis may be unilateral or bilateral, and swelling of 

any combination of single or multiple salivary glands may be 

present. Parotitis may first be noted as earache and tenderness 

on palpation of the angle of the jaw. Emergence of contralateral 

or same side parotitis within weeks to months after apparent 

recovery has been described. Mumps infection may present 

only with nonspecific or primarily respiratory symptoms or 

may be a subclinical infection. Before the introduction of the 

mumps vaccine, approximately 15% to 24% of infections were 

asymptomatic. The frequency of asymptomatic infection in 

vaccinated persons is unknown, but mumps is generally milder 

among vaccinated persons.

Mumps virus is the only infectious agent known to cause 

epidemic parotitis. Cases of mumps reinfection have 

been reported. 

Complications

Complications of mumps occur with or without parotitis or 

other salivary gland swelling and generally include orchitis, 

oophoritis, mastitis, pancreatitis, hearing loss, meningitis, 

and encephalitis. Nephritis, myocarditis and other sequelae, 

including paralysis, seizures, cranial nerve palsies, and 

hydrocephalus, in mumps patients have also been reported but 

are rare. Complications associated with mumps infection are 

usually more common among adults than children. Vaccinated 

persons are less likely to have mumps complications than 

unvaccinated persons.

Orchitis is the most common complication in post-pubertal 

males, occurring in approximately 30% of unvaccinated and 

6% of vaccinated post-pubertal males. With mumps-associated 

orchitis, there is usually abrupt onset of testicular swelling, 

tenderness, nausea, vomiting, and fever. Pain and swelling may 

subside in 1 week, but tenderness may last for multiple weeks. 

About half of patients with mumps orchitis develop testicular 

atrophy of the affected testis. While there is a theoretical risk 

for sterility based on the pathogenesis of the disease, no study 

has demonstrated a risk for sterility in men with mumps orchitis 

compared to those without mumps orchitis. 

In the prevaccine era, oophoritis and mastitis had been reported 

in 7% and 30%, respectively, of post-pubertal women with 

mumps. Among vaccinated post-pubertal women, oophoritis 

Mumps Complications

● Orchitis, oophoritis, mastitis,

pancreatitis, hearing loss, 

meningitis, and encephalitis

● More common among adults

than children

● Less likely in vaccinated persons

compared to unvaccinated

persons

● Meningitis, encephalitis,

pancreatitis, and hearing loss

1% or less among infected

persons in the postvaccine era

Mumps Clinical Features

● Incubation period usually 16 to

18 days (range, 12 to 25 days)

● Nonspecific prodrome of

myalgia, malaise, headache,

low-grade fever

● Typically presents

as parotitis

● May presents with respiratory

symptoms

or be subclinical
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and mastitis are reported in 1% or fewer of mumps patients. 

Oophoritis may mimic appendicitis. Among unvaccinated 

patients, clinical aseptic meningitis occurred in up to 10%, 

pancreatitis in up to 4%, and sensorineural hearing loss in up to 

4%. Meningitis is usually mild. Hearing loss is usually transient 

but may be permanent. 

In the postvaccine era, among all persons infected with 

mumps, reported rates of meningitis, encephalitis, pancreatitis, 

and hearing loss (either transient or permanent) have all 

been 1% or less. 

Permanent sequelae and death are very rare in both vaccinated 

and unvaccinated patients. 

Laboratory Testing

The diagnosis of mumps is usually suspected based on clinical 

presentation, in particular the presence of parotitis. However, if 

mumps is suspected, laboratory testing should be performed. 

Other infectious causes of parotitis that may also be tested 

as part of the differential diagnosis include Epstein-Barr virus, 

cytomegalovirus, parainfluenza virus types 1 and 3, influenza 

A virus (most commonly H3N2), enteroviruses, lymphocytic 

choriomeningitis virus, human immunodeficiency virus (HIV), 

and non-tuberculous mycobacterium. 

Mumps is confirmed by reverse transcriptase-polymerase 

chain reaction (RT-PCR) or viral culture from buccal/oral or 

urine specimens. A negative RT-PCR or viral culture in a person 

with clinically compatible mumps symptoms does not rule out 

mumps as a diagnosis. 

Acute mumps infection can be detected by the presence 

of serum mumps IgM. However, this test cannot be used to 

confirm a diagnosis of mumps. IgM response may be transient, 

delayed, or not detected. This may be because of previous 

contact with mumps virus either through vaccination or natural 

infection. A negative IgM in a person with clinically compatible 

mumps symptoms does not rule out mumps as a diagnosis. 

False negatives are common so results should be interpreted 

with caution. Collection of serum 3 to 10 days after parotitis 

onset improves the ability to detect IgM. 

Acute mumps infection can also be detected by a significant 

rise in IgG antibody titer between acute and convalescentphase serum specimens, also known as IgG seroconversion. 

However, this test cannot be used to confirm a diagnosis 

of mumps. False positive results can occur in both 

unvaccinated and vaccinated persons because assays may 

be affected by other diagnostic entities that cause parotitis. 

In addition, false negative results can occur in vaccinated 

and unvaccinated persons. By the onset of symptoms, in 
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someone who is vaccinated or had previous infection, the 

acute-phase IgG may already be elevated, and therefore 

a 4-fold rise cannot be detected when compared to the 

convalescent-phase serum sample. 

Laboratory testing can confirm the presence of mumps 

vaccine virus in a recently vaccinated and potentially 

exposed individual.

Epidemiology

Occurrence

Mumps occurs worldwide, with 500,000 cases reported on 

average annually. 

Reservoir

Mumps is a human disease. Although persons with 

asymptomatic or nonclassical infection can transmit the 

virus, no carrier state is known to exist. No animal or insect 

reservoir exists.

Transmission

Mumps is spread through infectious respiratory droplet 

secretions and saliva. 

Temporal Pattern

Mumps is reported throughout the year.

Communicability

Mumps contagiousness is similar to that of influenza and rubella 

but is less than that for measles or varicella. Although mumps 

virus has been isolated from 7 days before to 9 days after 

parotitis onset, the highest percentage of positive isolations 

and the highest virus loads occur closest to parotitis onset and 

decrease rapidly thereafter. Mumps is therefore most infectious, 

and most transmission likely occurs, in the several days before 

and after parotitis onset. Mumps is considered infectious from 2 

days before through 5 days after onset of parotitis. Transmission 

also likely occurs from persons with asymptomatic infections 

and from persons with prodromal symptoms.

Secular Trends in the United States

Mumps became nationally notifiable in 1968 with about 

152,000 cases reported. After the use of the mumps vaccine, 

cases began to decrease rapidly. By 1985, fewer than 3,000 cases 

were reported annually. 

Mumps Epidemiology

● Reservoir

■ Human 

● Transmission

■ Infectious respiratory droplet 

secretions

■ Saliva

● Temporal pattern

■ No temporal pattern

● Communicability

■ 2 days before through 5 days 

after onset of parotitis

Mumps Secular Trends 

in the United States

● About 152,000 cases reported 

in 1968

● Rapid decrease in cases after 

introduction of vaccine, but 

resurgence in mid-1980s 

among persons age 10 through 

19 years

● Measles occurrence among 

vaccinated school-aged 

children in the 1980s led to 

recommendations for a 

second dose

● After 2-dose recommendation 

was introduced, mumps cases 

steadily declined from 1989 

until 2004

● Increase in mumps cases since 

2006 with most cases in persons 

fully vaccinated
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In the mid-1980s there was a relative resurgence of mumps 

with approximately 13,000 cases reported in 1987. The highest 

incidence of mumps during the resurgence was among 

older school-age and college-age youth (age 10 through 19 

years), who were born before routine mumps vaccination 

was recommended. Several mumps outbreaks among highly 

vaccinated school populations were reported, indicating that 

high coverage with a single dose of mumps vaccine did not 

always prevent disease transmission. 

After two doses of measles, mumps, and rubella vaccine were 

recommended in 1989 for school-age children for improved 

measles control, the number of reported mumps cases steadily 

declined, from approximately 5,700 cases in 1989 to fewer than 

300 cases in 2004. 

Since 2006, there has been an increase in the number of 

reported mumps cases. Most cases reported in 2006 and 

2009-2010 were associated with a few large, localized outbreaks. 

However, since 2014, more than 1,000 mumps cases have been 

reported each year, and in 2019 nearly every state reported 

mumps cases. During January 2016 through June 2017, 150 

outbreaks were reported in 37 states, accounting for more than 

9,000 cases. Since 2006, most cases have been in persons who 

previously received 2 doses of MMR vaccine. Most outbreaks 

involved close-contact settings, such as households, schools, 

universities, athletics teams and facilities, church groups, 

workplaces, large parties, and other events.

Among children born during 2016–2017, 90.7% received 

measles, mumps, and rubella-containing vaccine by age 24 

months; this was not statistically significantly different from the 

coverage of 90.3% for children born during 2014–2015. 

Mumps Vaccines

The live, attenuated mumps vaccine (Jeryl Lynn strain) was 

licensed for use in the United States in 1967. Jeryl Lynn strain 

is the only mumps virus strain that has been used in mumps 

vaccines in the United States. In 1971, mumps vaccine was 

licensed as a combined measles, mumps, and rubella (MMR) 

vaccine. In 2005, a combination measles, mumps, rubella, and 

varicella (MMRV) vaccine was licensed. 

Mumps vaccine is available as measles, mumps, and rubella 

vaccine (MMR [MMR-II]) and measles, mumps, rubella, and 

varicella vaccine (MMRV [ProQuad]). Both MMR and MMRV 

vaccine contain live, attenuated viruses. Single-antigen mumps 

vaccine is not available in the United States. The Advisory 

Committee on Immunization Practices (ACIP) recommends that 

MMR or MMRV vaccine be used when any of the individual 

components is indicated. 

Mumps Vaccines

● MMR (MMR-II)

● MMRV (ProQuad)
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Characteristics

MMR vaccine is a lyophilized preparation of measles virus 

vaccine live, an attenuated line of measles virus, derived from 

Enders’ attenuated Edmonston strain and propagated in chick 

embryo cell culture; mumps virus vaccine live, the Jeryl Lynn 

strain of mumps virus propagated in chick embryo cell culture; 

and rubella virus vaccine live, the Wistar RA 27/3 strain of live 

attenuated rubella virus propagated in WI-38 human diploid 

lung fibroblasts. MMRV vaccine contains measles, mumps, and 

rubella virus of equal titer and identical to those in the MMR 

vaccine. The titer of Oka varicella zoster virus is higher in MMRV 

vaccine than in single-antigen varicella vaccine, a minimum of 

9,772 plaque-forming units (PFU) versus 1,350 PFU, respectively. 

MMR and MMRV vaccines are supplied as a lyophilized 

(freeze-dried) powder and are reconstituted with sterile, 

preservative-free water. Both vaccines contain gelatin. MMR and 

MMRV vaccines are administered by the subcutaneous route. 

Each dose of MMR and MMRV vaccine contains neomycin as an 

antibiotic. It contains no adjuvant or preservative. 

Vaccination Schedule and Use

MMR vaccine or MMRV vaccine can be used to implement 

the vaccination recommendations for prevention of measles, 

mumps, and rubella. MMR vaccine is licensed for use in persons 

age 12 months or older. MMRV vaccine is licensed for use in 

persons age 12 months through 12 years; MMRV vaccine should 

not be administered to persons age 13 years or older. 

Two doses of MMR vaccine, separated by at least 4 weeks, are 

routinely recommended for children age 12 months or older. 

Dose 1 of MMR vaccine should be given at age 12 through 

15 months. A second dose of MMR vaccine is recommended 

based on previous observations of the failure of some to 

generate an immune response to measles following dose 1. 

Dose 2 is routinely given at age 4 through 6 years, before a 

child enters kindergarten or first grade. All students entering 

school should receive 2 doses of MMR vaccine (with the 

first dose administered at age 12 months or older) before 

enrollment. Dose 2 of MMR vaccine may be administered as 

soon as 4 weeks after dose 1. 

The minimum interval between doses of MMRV vaccine is 

3 months, although when dose 2 is administered 4 weeks 

following dose 1, it can be considered valid. For the first dose 

of measles, mumps, rubella, and varicella vaccines at age 12 

through 47 months, either separate MMR and varicella (VAR) 

vaccines, or MMRV vaccine, may be used. However, the risk of 

febrile seizures is about twice as high for children receiving 

MMRV vaccine versus separate MMR and VAR vaccines. Providers 

who are considering administering MMRV should discuss the 

benefits and risks of both vaccination options with the parents. 

Mumps Vaccine Characteristics

● Live, attenuated vaccine

● Available as lyophilized powder 

and reconstituted with sterile, 

preservative-free water

● Administered by subcutaneous 

injection

● Contains gelatin

● Contains neomycin

Mumps Vaccination Schedule

● 2 dose series at age 12 through 

15 months and at age 4 

through 6 years

● Minimum age for dose 1 is 12 

months

● Minimum interval from dose 1 

to 2 is 4 weeks for MMR and 3 

months for MMRV (although a 

4-week interval is valid)

● Discuss risks and benefits of 

MMRV versus separate MMR 

and VAR 

■ Separate MMR and VAR 

vaccines preferred for dose 1 

in ages 12 through 47 months

■ MMRV preferred for dose 2 

and dose 1 at age 48 months 

or older
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15

Unless the parent or caregiver expresses a preference for MMRV, 

separate MMR vaccine and VAR vaccine should be administered 

for the first dose in this age group. For the second dose of 

measles, mumps, rubella, and varicella vaccines at any age and 

for the first dose at age 48 months or older, the use of MMRV 

generally is preferred over separate injections of its equivalent 

component vaccines (i.e., MMR vaccine and VAR vaccine). 

Vaccination of Adults

Adults born in 1957 or later should receive at least 1 dose of 

MMR vaccine unless they have documentation of vaccination 

with at least 1 dose of measles, mumps, and rubella-containing 

vaccine or other acceptable presumptive evidence of immunity 

to these three diseases. Except for health care personnel, who 

should have documented immunity, birth before 1957 generally 

can be considered acceptable evidence of immunity to measles, 

mumps, and rubella. 

Colleges and other post-high-school educational institutions 

are potential high-risk areas for measles, mumps, and rubella 

transmission because of large concentrations of persons. 

Prematriculation vaccination requirements for measles 

immunity have been shown to significantly decrease the 

risk of measles outbreaks on college campuses where such 

requirements are implemented and enforced. All students 

entering colleges, universities, technical and vocational 

schools, and other institutions for post-high-school 

education should receive 2 doses of MMR vaccine or have 

other acceptable evidence of measles, mumps, and rubella 

immunity before entry.

For unvaccinated health care personnel born before 1957 

who lack laboratory evidence of measles, mumps, or rubella 

immunity or laboratory confirmation of disease, health care 

facilities should have policies that offer 2 doses of MMR vaccine 

at the appropriate interval for measles and mumps and 1 dose 

of MMR vaccine for rubella, respectively. Health care facilities 

should also have policies for such personnel that recommend 2 

doses of MMR vaccine during an outbreak of measles or mumps 

and 1 dose during an outbreak of rubella. This recommendation 

is based on serologic studies indicating that among hospital 

personnel born before 1957, 5% to 10% had no detectable 

measles, mumps, or rubella antibody. Adequate vaccination for 

health care personnel born during or after 1957 consists of 2 

appropriately spaced MMR doses for measles and mumps, and 

at least 1 dose of MMR for rubella.

Revaccination

Measles-, mumps-, or rubella- virus-containing vaccine 

administered prior to age 12 months (e.g., for international 

travel) should not be counted as part of the 2-dose series. 

Children vaccinated before age 12 months should be 

MMR Vaccination of Adults

● Certain persons without 

acceptable presumptive 

immunity:

■ At least 1 dose MMR for 

unvaccinated adults

■ 2 doses MMR for students 

entering colleges, universities, 

technical and vocational 

schools, and other 

post-high-school 

educational institutions

■ 2 doses MMR for measles 

and mumps and at least 1 

dose MMR for rubella for 

healthcare personnel

● Healthcare personnel during 

an outbreak

■ 2 doses MMR for measles or 

mumps outbreak and 1 dose 

MMR for rubella outbreak
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revaccinated with 2 doses of appropriately spaced MMR or 

MMRV vaccine, the first dose administered when the child is 

age 12 through 15 months (12 months if the child remains in 

an area where disease risk is high) and the second dose at least 

4 weeks later.

Persons who experienced perinatal HIV infection who may have 

received MMR vaccine prior to the establishment of effective 

combined antiretroviral therapy (cART), should be revaccinated 

with 2 appropriately spaced doses of MMR (i.e., the dose does 

not count) unless they have other acceptable current evidence 

of immunity. MMR series should be administered once effective 

cART has been established for at least 6 months and there is no 

evidence of severe immunosuppression. 

Vaccination during Mumps Outbreaks

During an outbreak, a third dose of MMR vaccine is 

recommended for groups determined by public health 

authorities to be at increased risk for acquiring mumps to 

improve protection against mumps disease and related 

complications. Public health authorities will communicate 

to providers which groups are at increased risk and should 

receive an MMR dose. Everyone who is determined to 

be part of the group at increased risk and does not have 

contraindications should receive a dose of MMR vaccine. 

This includes people who do not have vaccine records that 

prove they received two doses of MMR vaccine in the past, 

and people who have evidence of presumptive immunity. 

No additional dose is recommended for people who already 

received three or more doses before the outbreak.

Mumps Immunity

Generally, persons can be considered immune to mumps 

if they were born before 1957, have serologic evidence of 

mumps immunity (equivocal test results should be considered 

negative), or laboratory confirmation of disease, or have 

documentation of adequate vaccination for mumps. 

Demonstration of mumps IgG antibody by any commonly used 

serologic assay is acceptable evidence of mumps immunity but 

does not necessarily predict protection against mumps disease. 

During an outbreak, close contacts of mumps patient(s) should 

not be tested for laboratory evidence of immunity since a 

positive IgG titer may indicate acute infection.

Immunogenicity and Vaccine Efficacy

Mumps vaccine produces an inapparent, or mild, 

noncommunicable infection. Approximately 94% of recipients 

of a single dose develop measurable mumps antibody. 

Seroconversion rates are similar for single antigen mumps 

Mumps Immunity

● Born before 1957

● Serologic evidence of mumps 

immunity (equivocal tests are 

considered negative)

■ Mumps IgG antibody does not 

necessarily predict protection; 

during an outbreak, close 

contacts of mumps patient(s) 

should not be tested for 

serologic evidence of 

immunity

● Laboratory confirmation 

of disease

● Documentation of adequate 

vaccination for mumps

Mumps Vaccine Efficacy 

● Antibodies develop in 

approximately 94% of recipients 

of a single dose

● One dose produced 78% 

effectiveness and two doses 

88% effectiveness
Mumps

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15

vaccine, MMR vaccine, and MMRV vaccine. Postlicensure 

studies determined that vaccine effectiveness of one dose of 

mumps or MMR vaccine was 78% and two dose mumps vaccine 

effectiveness is 88%. 

Contraindications and Precautions 

to Vaccination 

As with other vaccines, a history of a severe allergic reaction 

(anaphylaxis) to a vaccine component or following a prior 

dose is a contraindication to further doses. Moderate or severe 

acute illness (with or without fever) in a patient is considered a 

precaution to vaccination, although persons with minor illness 

may be vaccinated. 

MMR and MMRV vaccines both contain minute amounts of 

neomycin and gelatin. Persons with alpha-gal allergy may 

wish to consult their physician before receiving a vaccine that 

contains gelatin.

Severe immunocompromise (e.g., from hematologic and solid 

tumors, receipt of chemotherapy, congenital immunodeficiency, 

long-term immunosuppressive therapy or patients with 

HIV infection who are severely immunocompromised) is a 

contraindication for MMR and MMRV vaccination. If the person’s 

level of immunocompetence is uncertain, the decision to 

vaccinate should be made by the health care provider that 

prescribed the immunosuppressive medication for those 

patients whom immunocompromise is due to medication. 

Patients who have not received chemotherapy for at least 3 

months, whose disease remains in remission, and who have 

restored immunocompetence, may receive MMR or MMRV 

vaccine. Healthy, susceptible close contacts of severely 

immunocompromised persons should be vaccinated. 

Persons receiving systemic high-dose corticosteroid therapy 

(2 milligrams per kilogram of body weight or more per day or 

20 milligrams or more per day of prednisone) for 14 days or 

more should not receive MMR or MMRV vaccine because of 

concern about vaccine safety. MMR or MMRV should not be 

administered for at least 1 month after cessation of systemic 

high-dose corticosteroid therapy. Although persons receiving 

high doses of systemic corticosteroids daily or on alternate 

days for less than 14 days generally can receive MMR or MMRV 

immediately after cessation of treatment, some experts prefer 

waiting until 2 weeks after completion of therapy.

Available data indicate that vaccination with MMR has not 

been associated with severe or unusual adverse reactions in 

HIV-infected persons who are not severely immunosuppressed, 

although antibody responses have been variable. MMR 

vaccine is recommended for susceptible HIV-infected 

persons age 12 months or older with no evidence of current 

Mumps Vaccine Contraindications 

and Precautions

● Contraindication

■ Severe allergic reaction 

to vaccine component or 

following a prior dose

■ Severe immunocompromise

■ Systemic high-dose 

corticosteroid therapy for 14 

days or more

■ HIV infection, regardless of 

immunocompetence status*

■ Family history of congenital or 

heredity immunodeficiency in 

first-degree relatives

■ Pregnancy

● Precaution

■ Moderate or severe 

acute illness

■ Alpha-gal allergy (consult 

with physician)

■ Receipt of antibodycontaining blood products 

(wait 3 to 11 months 

to vaccinate)

■ History of thrombocytopenic 

purpura or thrombocytopenia

■ Need for tuberculin skin 

testing or interferon-gamma 

release assay testing

■ Simultaneous use of aspirin or 

aspirin-containing products*

■ Personal or family history of 

seizures of any etiology*

■ Receipt of specific antiviral 

drugs 24 hours before 

vaccination*

*MMRV only
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Mumps

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severe immunosuppression (“no evidence of current severe 

immunosuppression” is defined as CD4 percentages greater 

than or equal to 15% for 6 months or longer for persons age 5 

years or younger; and CD4 percentages greater than or equal 

to 15% and CD4 count greater than or equal to 200 cells/mm

3

for 6 months or longer for persons older than age 5 years). MMR 

vaccine is not recommended for HIV-infected persons with 

evidence of severe immunosuppression. 

MMRV is not approved for and should not be administered to a 

person known to be infected with HIV.

A family history of congenital or hereditary immunodeficiency 

in first-degree relatives (e.g., parents and siblings) is a 

contraindication for MMR or MMRV vaccine unless the immune 

competence of the potential vaccine recipient has been 

substantiated clinically or verified by a laboratory.

A history of thrombocytopenic purpura or thrombocytopenia 

is a precaution for MMR and MMRV vaccine. Such persons 

may be at increased risk for developing clinically significant 

thrombocytopenia after MMR or MMRV vaccination. 

Simultaneous use of aspirin or aspirin-containing products is a 

precaution for MMRV vaccine due to the varicella component. 

The manufacturer recommends that vaccine recipients avoid 

the use of salicylates for 6 weeks after receiving MMRV vaccine 

because of the association between aspirin use and Reye 

syndrome following chickenpox. 

A personal or family (i.e., sibling or parent) history of seizures 

of any etiology is a precaution for MMRV vaccine but not MMR. 

Children with a personal or family history of seizures of any 

etiology should ideally be vaccinated with separate MMR and 

VAR vaccines because the risks for using MMRV vaccine in this 

group of children generally outweigh the benefits.

MMR vaccine may be administered to egg-allergic persons 

without prior routine skin testing or the use of special protocols.

Spacing Considerations 

The effect of the administration of antibody-containing blood 

products (e.g., immune globulin, whole blood or packed 

red blood cells, or intravenous immune globulin) on the 

response to MMR or MMRV vaccine is unknown. Because of the 

potential inhibition of the response to vaccination by passively 

transferred antibodies, neither MMR vaccine nor MMRV 

vaccine (nor VAR vaccine) should be administered for 3 to 11 

months after receipt of antibody-containing blood products. 

The interval between the antibody-containing blood product 

and receipt of MMR or MMRV vaccine is determined by the 

type of product administered. Antibody-containing products 

should not be given for 2 weeks following vaccination unless 
Mumps

235

15

the benefits exceed those of the vaccine. In such cases, vaccine 

recipients should either be revaccinated later at the appropriate 

intervals (ranging 3 to 11 months) or tested for immunity and 

revaccinated if seronegative.

Need for tuberculin skin testing or interferon-gamma release 

assay (IGRA) testing is a precaution for MMR and MMRV 

vaccine. Measles vaccine (and possibly mumps, rubella, and 

varicella vaccines) may transiently suppress the response 

to tuberculin skin test (TST) in a person infected with 

Mycobacterium tuberculosis. TST and measles-containing 

vaccine may be administered at the same visit if necessary. 

Simultaneously administering TST and measles-containing 

vaccine does not interfere with reading the TST result at 

48 to 72 hours and ensures that the person has received 

measles vaccine. If the measles-containing vaccine has been 

administered recently, TST screening should be delayed for at 

least 4 weeks after vaccination.

Receipt of specific antiviral drugs (e.g., acyclovir, famciclovir, 

or valacyclovir) 24 hours before vaccination is a precaution for 

MMRV vaccine due to the varicella component. These drugs 

should be avoided for 14 days after vaccination.

Vaccination in Pregnancy

Pregnancy is a contraindication for MMR or MMRV vaccine. 

Pregnancy should be avoided for 4 weeks following MMR or 

MMRV vaccine. Close contact with a pregnant woman is not a 

contraindication to MMR or MMRV vaccination of the contact.

If a pregnant woman inadvertently receives MMR or MMRV 

vaccine, termination of pregnancy is not recommended because 

the risk to the fetus appears to be extremely low. Instead, 

individual counseling for these women is recommended. 

Vaccine Safety

Studies have shown MMR and MMRV vaccines are safe and welltolerated. The National Academy of Medicine, formerly called 

the Institute of Medicine, reviewed the evidence between MMR 

vaccination and certain adverse events. The experts determined 

that evidence supports a causal relation between MMR 

vaccination and anaphylaxis, febrile seizures, thrombocytopenic 

purpura, transient arthralgia, and measles inclusion body 

encephalitis in persons with demonstrated immunodeficiencies.

Most adverse events reported following MMR vaccination 

(such as fever and rash) are attributable to the measles 

component. After MMR vaccination, 5% to 15% of susceptible 

persons develop a temperature of 103°F (39.4°C) or higher, 

usually occurring 7 to 12 days after vaccination and generally 

lasting 1 or 2 days. Most persons with fever do not have other 

symptoms. MMR vaccine is associated with a very small risk 

Mumps Vaccine Safety

MMR

● Fever of 103°F (39.4°C) or 

higher

■ 5%–15%

● Rash

■ 5%

● Febrile seizures

■ 1 in every 3,000 to 

4,000 doses

● Anaphylactic reactions

■ 1.8 to 14.4 cases per 

million doses

● Arthralgias and other joint 

symptoms

■ 25% (adult women)

MMRV

● Fever of 102°F or higher

■ 21.5%

● Febrile seizures

■ 1 additional per 2,300 to 

2,600 children age 12 through 

23 months
236

Mumps

 15

of febrile seizures; approximately one case for every 3,000 

to 4,000 doses of MMR vaccine administered. The febrile 

seizures typically occur 6 to 14 days after vaccination and do 

not appear to be associated with any long-term sequelae. 

Children with a personal or family history of febrile seizures or 

family history of epilepsy might be at increased risk for febrile 

seizures after MMR vaccination.

MMR vaccine may cause a transient rash in approximately 

5% of vaccine recipients, usually appearing 7 to 10 days after 

vaccination. Laboratory testing can confirm the presence of 

measles or mumps vaccine virus in a recently vaccinated and 

potentially exposed individual.

Allergic reactions following the administration of MMR 

vaccine are rare. Most of these are minor and consist of a 

wheal and flare or urticaria at the injection site. Immediate, 

anaphylactic reactions to MMR vaccine occur in 1.8 to 14.4 

cases per million doses. 

Arthralgias and other joint symptoms are reported in up 

to 25% of adult women following MMR vaccination and 

are associated with the rubella component. Transient 

lymphadenopathy sometimes occurs following receipt of MMR 

or other rubella-containing vaccine, and parotitis has been 

reported rarely (less than 1%) following receipt of MMR or 

other mumps-containing vaccine. 

Rarely, MMR vaccine may cause thrombocytopenia within 

two months after vaccination. The clinical course of these 

cases is usually transient and benign, although hemorrhage 

occurs rarely. Based on case reports, the risk for MMR vaccineassociated thrombocytopenia may be higher for persons who 

have previously had immune thrombocytopenic purpura, 

particularly for those who had thrombocytopenic purpura after 

an earlier dose of MMR vaccine.

Measles inclusion body encephalitis has been documented after 

measles vaccination in persons with immune deficiencies. The 

illness is also known to occur within 1 year after initial infection 

with wild-type measles virus and has a high death rate. In the 

cases after MMR vaccination, the time from vaccination to 

development of measles inclusion body encephalitis was 4–9 

months, consistent with development of measles inclusion body 

encephalitis after infection with wild-type measles virus. 

In MMRV vaccine prelicensure studies conducted among 

children age 12 to 23 months, fever (reported as abnormal or 

elevated greater than or equal to 102°F oral equivalent) was 

observed 5 to 12 days after vaccination in 21.5% of MMRV 

vaccine recipients compared with 14.9% of MMR vaccine and 

VAR vaccine recipients. Two postlicensure studies indicated that 

one additional febrile seizure per 2,300 to 2,600 children age 12 

through 23 months occurred 5 to 12 days after the first dose of 
Mumps

237

15

MMRV vaccine, compared with children who had received the first 

dose of MMR vaccine and VAR vaccine administered as separate 

injections at the same visit. Data from postlicensure studies do 

not suggest that this increased risk exists for children age 4 to 6 

years receiving the second dose of MMRV vaccine.

Multiple studies, as well as a National Academy of Medicine 

Vaccine Safety Review, refute a causal relationship between 

autism and MMR vaccine or between inflammatory bowel disease 

and MMR vaccine.

Vaccine Storage and Handling

For MMR-II and Proquad storage and handling specifics, refer 

to the manufacturer. For complete information on storage and 

handling best practices and recommendations, please refer 

to CDC’s Vaccine Storage and Handling Toolkit, www.cdc.gov/

vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf.

Surveillance and Reporting for Mumps

Mumps became nationally notifiable in the United States in 

1968. For information on guidance for state and local health 

department staff who are involved in surveillance activities for 

vaccine-preventable diseases, please consult the Manual for 

the Surveillance of Vaccine-Preventable Diseases, www.cdc.gov/

vaccines/pubs/surv-manual/chapters.html.

Acknowledgements

The editors would like to acknowledge Amy Parker Fiebelkorn and 

Mona Marin for their contributions to this chapter. 

NOTES
238

Mumps

 15

NOTES

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