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Mumps

 

Revised March 9, 1995
IMMUNIZATION INFORMATION - MUMPS
OVERVIEW

The Disease

Mumps is a common childhood disease. The most obvious sign of mumps is swelling of the cheeks and jaw, caused by inflammation in the salivary glands. There is usually fever and headache too. But mumps can also cause more serious illness. It can cause deafness. About 1 child in every 10 who gets mumps also gets meningitis (an inflammation of the coverings of the brain and spinal cord). Occasionally the disease also causes encephalitis, which is inflammation of the brain itself. Usually, the child recovers without permanent damage. About 1 out of every 4 teenage or adult men who get mumps develops a painful swelling of the testicles. People get mumps through contact with others who are already infected. It can be spread by coughing, sneezing, or simply talking.

Before a vaccine was available, nearly every child got mumps. Now the number of cases is much lower. However, children who are not immunized are still very likely to get the disease.

Mumps Immunization

Mumps vaccine is usually given together with measles and rubella vaccines in a shot called MMR.

State Immunization Requirements

Laws requiring school children to be immunized against mumps now exist in 43 of the 50 States. Laws requiring children entering day care to be immunized against mumps exist in 42 states. States with weak or no school requirements have more cases of mumps.

MMR Vaccine

Your child will usually get measles, mumps and rubella vaccines all together in one shot called MMR. This shot is usually given between 12 and 15 months of age. All three of these vaccines work very well, and will protect most children for the rest of their life. However, for about 5% of children the first dose of MMR does not work. For that reason, a second dose is recommended to give these children another chance to become immune. Some doctors give this second dose when the child enters kindergarten or first grade. Others prefer to wait until the child enters middle or junior high school. Your doctor will tell you when to bring your child in for the second dose of MMR.

Measles, mumps, and rubella vaccines can each be given separately. There is also an MR vaccine, which protects against measles and rubella, but not mumps. These vaccines are not as common as MMR, and your doctor will tell you if your child should get any of them. Sometimes ¾ usually during a measles outbreak ¾ children are given measles or MMR vaccine before their first birthday. These children should be given another dose of MMR at 12-15 months and then a third dose when it would normally be given.

Possible Side Effects and Adverse Reactions to Measles, Mumps, and Rubella Immunization

MEASLES. About 1 child in 5 will get a rash or fever beginning a week or two after vaccination. These reactions last for a few days and usually do not harm the child.

MUMPS. Side effects from mumps vaccine are very rare. Occasionally a child will get a mild fever one or two weeks after vaccination, or swollen glands in the cheeks or under the jaw. Serious reactions are extremely rare.

RUBELLA. About 1 child out of 7 will get a rash or swelling in the lymph glands after getting rubella vaccine. This usually happens within a week or two after the shot and lasts 1 or 2 days. Also, about 1 child out of 100 will have some pain or stiffness in the joints, which can last from a few days to a few weeks. There is also a slight chance (less than 1 in 100) that a child will have painful swelling of the joints (arthritis) after getting rubella vaccine. This usually lasts only a few days, but it can last longer, and can come and go. Joint problems occur more often in adults, especially women.

Brief convulsions have occasionally been reported among children who have gotten MMR vaccine. These usually happen 1 or 2 weeks after the shot and come from the fever caused by the vaccine rather than the vaccine itself. Once in a great while a child will get encephalitis (inflammation of the brain) after getting an MMR shot. This happens less than once out of every million shots, and experts are not sure that the MMR vaccine is the cause of this problem. Remember, though, if that same million children got measles, about 1,000 of them would get encephalitis, 6,000 to 7,000 would have convulsions, and several hundred would die. Doctors agree that the benefits of MMR vaccine are very much worth any slight risk.

There are several reasons why some people might need to put off getting MMR vaccine, or not get the shot at all. If your child has any of the following conditions, tell the doctor or nurse.

  • If the child is sick with something more serious than a common cold.
  • If the child has ever had a serious (life-threatening) allergy problem after eating eggs.
  • If the child has had a serious allergy problem to an antibiotic called neomycin.
  • If the child has any disease that makes it hard to fight infection, such as cancer, leukemia, or lymphoma.
  • If the child is taking special cancer treatments such as x-rays or drugs, or other drugs such as prednisone or steroids that make it hard for the body to fight infection.
  • If the child has received gamma globulin during the past 3 months.
  • If the child has a serious or unusual problem after getting this vaccine, call a doctor or get the child to a doctor right away.

MEASLES OR RUBELLA VACCINATION FOR ADULTS

Measles- Some adults should be vaccinated against measles. Anyone who got their measles shot before their first birthday should get another measles shot. So should anyone who was vaccinated between 1963 and 1967 with certain vaccines that didn't work as well as those used today. Anyone entering college, working in a medical facility, or planning to travel overseas should also be vaccinated. If you are in one of these groups, or aren't sure, check with your doctor.

Rubella- Experts recommend that all adolescents and adults should be immune to rubella. This is especially important for women who might become pregnant. Even if you think you have had rubella you might not be immune, because rubella is easy to confuse with other diseases. If you are not sure whether you are immune to rubella, it is a good idea to check with your doctor. Women should not get rubella vaccine if they are pregnant or might become pregnant within 3 months. However, if you are vaccinated and then find out you were pregnant at the time, it shouldn't be a cause for concern. Rubella vaccine has never been known to harm an unborn child. It is safe to have a child immunized even if there is a pregnant woman in the household. The rubella vaccine virus will not spread from the vaccinated child to the pregnant woman.

MUMPS GENERAL INFORMATION

Mumps infection is caused by a virus similar in nature to the influenza virus.

Mumps usually causes fever, headache, and swollen, painful glands under the jaw. The initial symptoms of mumps include neck or ear pain, loss of appetite, tiredness, headache, and low-grade fever. Up to one-third of infected persons have minimal or no manifestations of disease. Swelling of salivary glands in the lower jaw is the most common symptom with the involved gland soon becoming visibly enlarged. Salivary glands on either side of the face may be affected and any combination of single or multiple salivary gland involvement may occur. Severe pain can accompany the swelling, which tends to occur within the first 2 days, and may first be noted as an earache with tenderness to touch. These symptoms tend to decrease after 1 week and are usually gone within 2 weeks. Additional symptoms include a headache, and mild meningitis, which is an inflammation in the covering of the brain or spinal cord, and about 1 out of every 4 teenage or adult males with mumps will have a painful swelling of the testicles for several days. This usually does not make a person sterile and unable to father children.

Mumps can also cause several more severe complications such as swelling or inflammation of the brain (encephalitis), or hearing loss. Before there was a mumps vaccine, many children had hearing loss caused by mumps. Mumps has been one of the leading causes of acquired deafness in childhood; onset may be sudden or gradual and deafness may be complete or permanent. Other complications involve organs such as the heart, pancreas, and ovaries. Transient arthritis has been reported in some males. Complete recovery is the rule. While deaths due to mumps have been reported, fatalities from mumps are rare.

No conclusive evidence exists to link birth defects with mumps infection during pregnancy.

Prior to the licensing of the mumps vaccine in the 1960's, more than 200,000 cases of mumps occurred each year. In recent years, 4,500 to 13,000 cases of mumps have been reported each year in the United States and outbreaks still occur. Vaccination has resulted in a decline in mumps by more than 90%. The number of mumps cases peaks during the winter-spring, but cases occur year- round. Outbreaks have been common wherever there are large groups of children or young adults in close contact with each other, such as in schools, prisons, orphanages, etc.

In recent years older children and teenagers have developed mumps. Mumps is uncommon in infants less than 1 year of age. Mumps is equally common in males and females. Teenagers and adults, especially males, who catch mumps are often much sicker for a longer period of time than younger children with a mumps infection.

Mumps is not as contagious as measles or chickenpox. A person is considered to be contagious from 3 days before to the 4th day of active disease, and even those who have few or no symptoms can transmit the disease. During mumps infection, the virus can been found in many parts of the body including fluids such as, saliva, urine, blood, breast milk, as well as in infected body tissues. Transmission of the virus is through direct contact with infected fluids, or contaminated objects such as toys, dishes, etc. Symptoms can appear 14 to 25 days after exposure to an infected person, with an average waiting time of between 16 and 18 days.

IMMUNITY

In general a person can be considered immune to mumps only if they meet one of the following four criteria:

1. They have documentation of receipt of 1 dose of live mumps vaccine on or after 12 months of age; or
2. They have documentation of physician-diagnosed mumps disease; or
3. They have documentation of laboratory testing which indicates immunity; or
4. They were born before 1957.

If you are in doubt as to your immune status, consult with your doctor. In many cases, the appropriate action is to receive a dose of vaccine; there is no increased risk for getting local or other reactions from mumps vaccination if you are already immune to mumps.

MUMPS PREGNANCY

Natural mumps infection during pregnancy has not been associated with an increased risk of premature delivery or birth defects. However, mumps infections during the first trimester may increase the rate of miscarriages. Birth defects have rarely been reported among children of women who had mumps while they were pregnant, but mumps has not been proven to be the cause of the defects. This is in contrast to rubella (sometimes called German Measles) which does cause birth defects, particularly if rubella is contracted during the first three months of pregnancy.

Despite the fact that neither natural mumps nor mumps vaccine are known to cause birth defects, mumps-containing vaccine should not be given to a woman known to be pregnant or who is considering becoming pregnant within three months.

A pregnant woman who inadvertently receives a dose of mumps vaccine, should consult with a doctor. The precaution against vaccinating a pregnant women is based on the theoretical risk of infection in the unborn child; however, there is no actual evidence that mumps or mumps vaccine can harm the developing unborn child. Mumps vaccination during pregnancy is not a reason in itself to consider interruption of the pregnancy, however, the decision to continue a pregnancy is always a personal and medical decision which can only be made by the pregnant woman and her physician.

Children of a pregnant women can receive the vaccine. This will pose no risk to the pregnant mother.

MUMPS VACCINE INFORMATION

Live mumps virus vaccine was licensed in December 1967. The current vaccine results in protective immunity in over 90% of vaccinated persons. The slight infection induced by the vaccine can not be transmitted to other persons.

Most adverse events following mumps vaccination consist of fever or swollen glands. Rare cases of neurologic problems have been reported. No long-term effects have been reported.

Recently a higher rate of serious adverse side effects have been reported for a mumps vaccine used in Japan and other countries. However, this is not the vaccine used in the United States. The mumps vaccine used in the United States is one of the safest live viral vaccines.

WHO SHOULD BE VACCINATED & DOSING SCHEDULE

All infants 12 months of age or older should receive the mumps vaccine, preferably in combination with measles and rubella vaccines (MMR vaccine). If MMR vaccine is used, normal vaccination usually occurs around 15 months of age. All older children not previously immunized should receive the vaccine. Only a single dose of vaccine is currently recommended.

Since most persons born before 1957 are likely to have been infected naturally by mumps virus, persons born before 1957 can generally be considered immune.

All adolescents and adults, who are not considered immune to mumps and are therefore susceptible to mumps infection, should receive the vaccine. Testing for immunity is not necessary (or recommended) since re-vaccination of those who are immune (either by prior infection or vaccination) is safe.

Vaccination after exposure, while not effective in preventing mumps if significant exposure to mumps has already occurred, is not harmful and may possibly avert later disease. Neither mumps immune globulin nor immune globulin is effective in preventing mumps after a person has been exposed.

WHO SHOULD NOT BE VACCINATED WITH MUMPS VACCINE

Women who are pregnant, or who are considering pregnancy within the next 3 months, should not receive the mumps vaccine given either by itself or in combination with measles and rubella vaccines (MMR). This precaution is based on the theoretical risk of adverse effects on the unborn child after vaccination during pregnancy, although there is no evidence that this occurs.

Persons with defective immune systems should not be given mumps vaccine. This would include persons with leukemia, lymphoma, certain cancers, or therapy with certain cancer treatment drugs, radiation, or large doses of steroids. A physician should be consulted before a patient with a defective immune system is given mumps vaccine. However, a person who has contact with or lives in a household with an immunosuppressed person may be given mumps vaccine.

Patients with leukemia in remission who have not received chemotherapy for at least three months may receive live-virus vaccines, including mumps vaccine. Short term, (less than 2 weeks,) low to moderate-dose steroid therapy, topical steroid therapy, long-term alternate-day treatment with moderate doses of short-acting steroids, and joint or tendon injections of steroids are not reasons to withhold the vaccine.

Persons with HIV infection, whether symptoms of AIDS are present or not, may be given the combined Measles-mumps-rubella vaccine (MMR). Available information on vaccination of HIV-infected children indicate that MMR has not been associated with severe or unusual adverse events, although the response to the vaccine may be less than in a normal child.

Persons with severe allergy to eggs should not receive the vaccine. Severe allergy means an intense life-threatening reaction requiring medical attention. Persons who have egg allergies that are not life threatening in nature can be vaccinated. If a person can eat eggs, then the allergy is not considered to be severe.

All mumps vaccines contain trace amounts of the antibiotic neomycin. Persons who have experienced a severe allergic reaction to neomycin requiring medical attention should not be given the vaccine. Persons who have only a history of skin inflammation after contact with neomycin can be vaccinated. Live mumps vaccine does not contain penicillin, so persons allergic to penicillin can safely take the vaccine.

Persons with a moderate or severe illness can be vaccinated as soon as they have recovered. Children with minor illness, such as a mild upper-respiratory infection with or without low-grade fever, can be vaccinated.

Mumps vaccine should not be given for at least 6 weeks, and preferably for 3 months, after a person has been given Immune Globulin, sometimes known as IG or Gamma Globulin, whole blood, or other antibody containing blood products. IG should not be given within 14 days of administration of mumps vaccine. In either situation, IG may interfere with response to the vaccine.

A family history of diabetes is not a reason to withhold vaccination.

MUMPS STATISTICS

Prior to vaccine licensure and during the early years of vaccine use, most reported cases of mumps occurred in children aged 5-9 years; 90% of cases occurred in children under 15 years of age. In the late 1980's, however, there was a shift in age of infection incidence towards older children, although the risk of infection in all age groups, due to the use of mumps vaccine, has declined overall by more than 90%. Males and females are equally likely to become infected.

The highest annual number of reported mumps cases (212,932) occurred in 1964. In recent years, 4,500 to 13,000 cases of mumps have been reported each year in the United States and outbreaks of mumps still occur.

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