Mumps, also called infectious or epidemic parotitis (or parotiditis), is a contagious viral disease. It usually causes painful enlargement of the salivary glands, particularly the parotids. The disease is generally self-limiting. Infection with the virus, including the approximately 30% of infections that are subclinical, results in lifelong immunity.

Mumps is most commonly a disease of childhood and adolescence. Although overall mortality is low, complications and fatalities occur more frequently in patients older than 20. Painful orchitis, sometimes resulting in testicular atrophy and, rarely, in sterility, is a particular concern when mumps occurs in postpubertal males.

The incidence of mumps has decreased approximately 99% in the U.S. since the introduction of the live virus vaccine in 1967. Prior to the vaccine, about half of all children contracted the disease. Now only about 1,500 cases are reported in the U.S. each year.

Mumps is caused by a paramyxovirus, spread through infected saliva and probably entering via the mouth. The incubation period is 14 to 24 days. Humans are the only reservoir of the mumps virus.

Most symptoms of mumps result from direct infection of the parotid glands, testes, pancreas, eyes, ovaries, or kidneys. The virus is also frequently neurotropic, resulting in central nervous system involvement.

• Lack of immunization
• Age: Peak incidence occurs between 5 and 9 years of age, followed by 1 to 4 and 10 to 14.

• Febrile illness: fever, chills, headache, anorexia, malaise
• Pain on chewing or swallowing
• Glandular swelling: in front of and below the ear, usually bilateral

• Acute suppurative parotitis (often due to Staphylococcus aureus)
• Mastoiditis
• Cervical lymphadenitis
• Salivary calculus
• Other viruses may cause parotid swelling including parainfluenza, Coxsackie, and influenza A
• Mikulicz's syndrome (chronic painless parotid and lachrymal gland edema of unknown etiology)
• Salivary gland tumors (benign or malignant)
• Drug-related parotid enlargement
• In the case of testicular involvement, must consider orchitis, epidydimitis, and testicular torsion

Parotid glands are extremely tender and feel jelly-like, with swelling anterior to the ear and above the angle of the jaw. Submaxillary and sublingual glands may also be involved. Skin over swollen glands may be tense and shiny, but not usually warm or erythematous. Stensen's duct may show signs of inflammation including edema and erythema.

• WBC: May show leukocytosis with predominance of lymphocytes, leukopenia, or normal count; most commonly shows slight reduction
• Serum amylase: May be elevated.

Not generally necessary, although studies, such as ultrasound, may be required to distinguish mumps orchitis from testicular torsion.

Complement fixation, hemagglutination inhibition, and enzyme-linked immunosorbent assay tests may be performed with paired samples from the acute and convalescent phases; antibodies tend to peak in the first week and drop off rapidly. The virus may be isolated from the throat, cerebrospinal fluid, blood, and possibly the urine.

The patient should be isolated until glandular swelling subsides. Treatment is symptomatic and should include a soft diet, avoidance of acidic food and beverages, and administration of analgesics. Orchitis requires bed rest. Pain may be relieved by means of ice packs. Relief may also be provided by supporting the scrotum with cotton or gauze (or an athletic supporter when ambulatory).

If patient develops pancreatitis (see section entitled Complications/Sequelae) with nausea and vomiting, administer IV fluids and treat appropriately. Please see monograph on Pancreatitis for detailed information.

Routine hearing tests should be performed on young children to detect any loss, as this is a common complication (see section entitled Complications/Sequelae).

In the case of mumps, medicines are intended for symptomatic relief and/or treatment of complications; generally, no medications other than analgesics are indicated for uncomplicated mumps.

As mentioned earlier, mumps is generally a self-limiting disease, the treatment of which typically entails providing symptomatic relief. Acupuncture has been reported to be effective in shortening the duration of mumps. Other CAM therapies may play a supportive role.

As stated earlier, acidic foods should be avoided; they can stimulate the secretion of enzymes from the parotid glands. Liberal fluid intake in frequent small sips should be recommended. Nutrients used to support the immune system in general include vitamin A, vitamin C, and zinc.

Herbal therapies utilized in clinical practice for the treatment of mumps include immune stimulating herbs, antipyretics, and antimicrobials, such as echinacea (Echinacea spp.), peppermint (Mentha piperita), onion (Allium cepa), yarrow (Achillea millefolium), elder (Sambucus nigra), and mullein (Verbascum thapsus). While the general immunomodulatory effects of echinacea and the antipyretic, antimicrobial, and antiviral actions of the other herbs listed have been reported (Blumenthal et al. 2000), their efficacy in the treatment of mumps specifically has yet to be explored in scientific studies.

Although they have not yet received scientific validation, acute homeopathic remedies may provide symptomatic relief and shorten the severity and duration of disease course. Morrison lists Abrotanum, Belladonna, Phytolacca, and Pulsatilla as possible remedies for mumps (Morrison 1993). Although not proven or accepted as an appropriate measure, some advocate homeopathic treatment for mumps and other childhood illnesses in lieu of vaccination (Maceoin and Cope 1988).

Acupuncture is thought to possibly reduce the severity and duration of the clinical course of mumps; however, the claims are difficult to assess given the self-limited nature of the disease. With that said, the following case reports from Chinese journals describe the clinical practice of using acupuncture for mumps.

One thousand cases of mumps in children aged 5 to 10 years treated with ear needling of the pingjian point (MA-T2) were reviewed. All patients suffered from common symptoms of mumps. When there was pain and swelling on a single parotid gland, the needle was inserted on the affected side; otherwise, if involvement was on both sides, needles were placed bilaterally with depth of insertion limited appropriately. All cases achieved improvement and/or resolution of symptoms, some after only one treatment and all within five treatments. The sooner the child was seen following onset of symptoms, the fewer the number of acupuncture treatments were needed (Song 1989). Again, for a variety of reasons (including lack of certainty about whether the diagnosis of mumps was definitively established), it is difficult to draw conclusions from these results. However, they raise the possibility that acupuncture may be used as an adjunct for supportive care in the case of mumps.

A clinical report of 108 cases of acute mumps in patients aged 3 months to 24 years treated with acupuncture yielded similar results. Duration of disease at time of presentation ranged from one to four days. There was unilateral involvement in 37 cases and bilateral involvement in 71. Eighty-nine patients had fever; 19 patients had tonsillar swelling and pain. Bilateral taichong (LR 3) and hegu (LI 4) points were selected. The reinforcing method was used for the taichong points and the reducing method used for hegu points. In cases of high fever, dazhui (DU 14) and waiguan (SJ 5) were added. With cough and tonsillar swelling, shaoshang (LU 11) and shangyang (LI 1) were also used. Of the 108 cases, 32 experienced resolution of symptoms after only one treatment, 33 after 2 treatments, 29 after 3, 4 after 4, and 5 after 5 treatments. Five cases were improved and none failed to improve, for a reported success rate of 95.4% and an overall effective rate of 100% (Dong et al. 1995). As with the previous report of case histories, it is difficult to draw definitive conclusions about the efficacy of acupuncture in this condition. 

[Note: Reinforcing (or tonifying) in acupuncture refers to the building up of deficient yin, yang, or qi in an organ by a needling technique that stimulates energy flow in the corresponding meridian. Reducing (or dispersing) refers to the opposite, i.e., the draining away of excessive or stagnant energy that has accumulated because of blocked circulation in the affected area (Kaplan 2000).]

N/A

Live mumps virus vaccine is approximately 95% effective in preventing the disease. It is available alone or combined with vaccines for measles and rubella. The vaccine produces a subclinical, noncommunicable infection; immunity seems to last at least 20 years. Very few side effects have been reported. Administration of the vaccine is routinely recommended at any time on or after the first birthday, generally at 15 months, but may be administered to adolescents and adults as well. Contraindications include: (1) pregnancy, (2) severe febrile illness, (3) anaphylactic allergy to eggs or neomycin (history of contact dermatitis from neomycin is not a contraindication to the vaccine), (4) recent immunoglobulin injection, or (5) immunodeficiency (however, asymptomatic HIV-positive children should be vaccinated).

• Meningoencephalitis: Meningeal signs manifest in up to 15% of cases; usually not severe. Encephalitis reports range up to 5 in 1,000 mumps cases, with fatalities from mumps encephalitis of about 1.4%. About 30% of mumps infections with central nervous system involvement occur without associated parotitis.
• Deafness: Sensorineural, about 0.5 to 5.0 per 100,000 reported mumps cases; one of the most frequent common causes of unilateral hearing loss. Onset occurs four to five days after infection; often transient.
• Orchitis: Occurs in 20% to 35% of postpubertal male patients, generally 7 to 10 days after onset of parotitis. Manifests with edema and acute pain. Usually unilateral.
• Testicular atrophy: In about 35% of patients following mumps orchitis; rarely, in bilateral cases, sterility.
• Pancreatitis: Rare, generally resolves in about one week with full recovery.
• Other possible CNS manifestations include cerebellar ataxia, transverse myelitis, hydrocephalus, facial palsy, and Guillain-Barré syndrome.
• Myocarditis, mastitis, thyroiditis, nephritis, arthritis, and thrombocytopenic purpura are all rare possible complications.

For uncomplicated mumps, the prognosis is excellent. Complications are more likely in postpubertal patients.

Spontaneous abortion occurs in as many as 27% of cases of mumps in first trimester of pregnancy. Vaccinated women should avoid pregnancy for three months after vaccination. Avoid giving live virus vaccine to pregnant women.

Advisory Committee on Immunization Practices (ACIP). Mumps Prevention. MMWR Morb Mortal Wkly Rep. 1989;38(22):388-392, 397-400.

Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck & Co.; 1999:2325-2327.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000:458-459.

Dong GR, Zhang Y, Yan YX. Bilateral Taichong and Hegu in treatment of mumps: an observation of 108 cases. Int J Clin Acupunct. 1995;6(1):65-66.

Felter R. Mumps. In: Adler J, Brenner B, Dronen S, et al., eds. Emergency Medicine: An On-line Medical Reference. Accessed at www.emedicine.com on September 18,2000.

Kaplan MS. The abbreviated history and development of acupuncture and moxibustion. North American Society of Acupuncture and Alternative Medicine. Accessed at www.nasa-altmed.com/alterna3.htm on September 18, 2000.

Maceoin D, Cope E. A hearing for an alternative approach to vaccine. Guardian. October 19,1988.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:3-7, 58-62, 297-299, 310-315.

Song GY. 1000 cases of mumps treated with ear needling on Pingjian point (MA-T2). J Tradit Chin Med. 1989;9(1):14.