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San Antonio Metropolitan Health District
HEALTH ADVISORY UPDATE: MUMPS
April 7, 2017
As of April 7, 2017, Bexar County
has reported 9 cases of mumps in 2017, compared to 1 reported each year for the
previous 2 years. According to the Centers for Disease Control and Prevention,
37 states are reporting over 1,100 cases of mumps so far this year.
Due to the communicable nature of this disease, please consider mumps as a diagnosis for
any patient presenting with the following symptoms: Unilateral or bilateral
swelling of the parotid or salivary glands preceded by a lowgrade fever,
myalgia, malaise, or headache. Complications of mumps include: orchitis,
encephalitis, meningitis, oophoritis and/or mastitis, and deafness.
Diagnostic Testing:
All individuals suspected of having mumps should be
tested and reported to the local health department. Individuals previously
vaccinated may not develop detectable IgM antibodies; therefore collecting a
buccal swab for RT-PCR testing is
preferred. PCR specimen should be collected as soon as mumps is suspected
(maximum 7 days after parotitis onset). PCR testing for mumps is available
through commercial laboratories. Massage the parotid gland area for 30 seconds
before swabbing.
Testing Method among Individuals Vaccinated
Against Mumps
Testing Method
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Ideal Collection Time Frame
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Notes
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PCR
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1- 3 days after parotitis and
up to 7 days
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Not affected by
previous vaccination. Directly detects viral RNA and is not immune response
dependant.
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IgG
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NA
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IgG may peak a
very high response prior to IgM response in vaccinated individuals if
collected within 3 days of parotitis onset; must interpret carefully and look
at timing of collection from onset of symptoms.
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IgM
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3-5 days after
parotitis onset
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IgM collected prior to 3 days after onset may
be negative and
should not be used to rule out mumps.
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Interpretation of Serology Results for Mumps
Mumps exposure history
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IgM
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IgG
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Comments
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References
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Unvaccinated; no
history of mumps
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+
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+ or −
|
IgM may be
detected for weeks to months, 80 – 100% of serum samples IgM positive; low
levels of IgG may be present at symptom onset.
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Meurman et al.
1982; Sakata et al. 1985; Rota et al. 2013
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1–dose vaccine
history
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+ or
−
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Likely
+
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Approximately 50%
of serum samples collected 1–10 days after symptom onset were IgM- positive;
50%–80% of serum samples collected >10 days after symptom onset were IgM-
positive.
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Narita et al.
1998; Jin et al. 2004; Krause et al. 2007; Rota et al. 2013
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2–dose vaccine
history
|
+ or
−
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Likely
+
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13%–46% of serum
samples collected less than 3 days after symptom onset were IgM-
positive. 71% of serum samples
collected >3 days were IgM positive.
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Bitsko et al.
2008; Rota et al. 2009
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Reporting:
Healthcare providers and
laboratories should promptly report all suspected
cases of mumps to the respective local health department prior to receiving
laboratory results:
Bexar County Residents: Other
County Residents:
San Antonio
Metropolitan Health District Texas
Department of State Health Services Phone: (210) 207-8876 Health
Service Region 8
Fax: (210) 207-8807 Phone:
(210) 949-2000 or (210) 949-2121
Infection Control:
Mumps is transmitted from person
to person by respiratory droplets or saliva. The incubation period is 16-18
days (range of 12-25 days) from exposure to onset of parotitis. Persons are
contagious from 3 days before to 5 days after onset of parotitis.
People suspected of having mumps
should be told to stay home from work, school, daycare, and any public outings
(e.g., church, grocery store) until 5
days have passed since onset of parotitis. Mumps can be prevented with 2
doses of MMR vaccine. All healthcare facilities should ensure that they have
updated documentation of mumps immunity status for all staff, not just
healthcare providers. Documentation of immunity includes written record of
receipt of 2 MMRs, positive serological titers, or birth prior to 1957
(although healthcare facilities should consider vaccinating unvaccinated
personnel born before 1957 who do not have laboratory evidence of mumps immunity).
