Mumps Clinical Information
Information on mumps for health professionals, including epidemiology, symptoms, diagnosis, treatment, transmission, and vaccination.
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Symptoms of mumps
Transmission of mumps
Preventing transmission of mumps
Handling exposure to mumps
Mumps vaccination recommendations
Patients to consider for mumps (MMR) vaccination
- Mumps is characterized by a non-specific prodrome including myalgia, anorexia, malaise, headache and low-grade fever with an acute onset of unilateral or bilateral tender swelling of the parotid or salivary gland lasting 2 days without other apparent cause.
- Parotitis is the most common symptom and may be unilateral or bilateral. Any combination of single or multiple salivary glands may be affected. (Up to 30% of mumps infections are asymptomatic. An additional 40-50% may have only nonspecific or primarily respiratory symptoms.)
- Rare complications include meningitis, inflammation of the testicles or ovaries, inflammation of the pancreas, and permanent deafness.
Mumps should be considered in the differential diagnosis of patients presenting with parotitis or swelling of the salivary glands, regardless of vaccination history. Both serologic testing (including mumps IgM and acute and convalescent mumps IgG) and viral culture are strongly recommended to support the clinical diagnosis.
- MDH encourages health care providers to consider other infectious and non-infectious causes of parotitis, since negative lab results cannot be used to rule out mumps infection.
- MDH encourages health care providers to test patients with mumps symptoms as soon as possible after onset of symptoms in order to maximize the likelihood of reliable IgM and viral culture results.
- If the first IgM result is negative the IgM should be repeated on a second blood specimen collected 2-3 weeks after onset of symptoms.
Confirming a mumps diagnosis is complicated.
- Symptoms are non-specific. Parotitis not associated with mumps occurs, but epidemic parotitis is indicative of mumps.
- Mumps serologic testing is not definitive due to sensitivity and specificity issues, and the challenge of appropriate timing of testing.
- Mumps IgM results may be falsely positive due to cross-reactivity with other viruses.
- Mumps IgM antibodies usually are detectable by the 4th day of illness and peak about 1 week after onset of symptoms; however, mumps IgM antibodies may be transient or absent in persons with mumps who have received mumps vaccine.
- A positive mumps IgG early in the course of illness may indicate prior immunity or early infection, and therefore should not be relied upon to rule out mumps disease.
MDH epidemiologists are reporting mumps cases as confirmed only if they meet the following criteria:
- Symptoms clinically compatible with mumps, and
- Positive mumps IgM, rise in mumps IgG between acute and convalescent specimens, positive mumps culture, or positive mumps by PCR, or
- An epidemiologic link to a laboratory-confirmed case of mumps.
Refer to MDH Lab Testing for Mumps fact sheet for more information on lab testing for mumps.
Treatment is supportive.
- Persons with mumps are generally infectious from 2 days before onset of swelling (or illness if swelling isn’t present) to 4 days after onset of illness.
- The virus is spread by contact with infected respiratory tract secretions.
- The incubation period for mumps is usually 16 to 18 days, but can range from 12 to 25 days.
Public health recommendations for exposure follow-up and notification of case contacts are based on the following:
- Evaluation of clinical, laboratory, and epidemiologic information obtained while investigating the suspect case, and
- The public health urgency of the exposure situation.
School, childcare, and work settings:
- MDH recommends that suspect and confirmed mumps cases be excluded from school, childcare, work, or other settings conducive to droplet transmission through the 5th day following onset of swelling (or illness if swelling isn’t present). Health care providers are asked to support public health recommendations for exclusion.
- Exclusion for 9 days had been recommended previously based on reports of mumps virus isolation from saliva up to 9 days following onset of symptoms. A theoretical risk of transmission beyond 5 days is not supported by epidemiologic data.
Health care settings:
- Health care workers who develop mumps should be excluded from work until 9 days after onset of parotitis. (Note: Epidemiologic evidence suggests most transmission occurs within 5 days of symptom onset. MDH generally recommends that mumps cases remain at home for 5 days; however, exclusion throughout the entire possible infectious period is warranted in the health care setting.) Facilities may wish to consider allowing health care workers with mumps to return to work after 5 days, but wear a mask through day 9. Although this is not stated in standard guidelines, MDH considers this a reasonable approach.
- Health care workers should use droplet precautions in addition to standard precautions, when providing direct care to known or suspect mumps patients, including the collection of buccal or throat swab specimens. Surgical masks are recommended, and face shields may be considered for eye protection.
- Waiting room time should be minimized for patients who are being evaluated for mumps disease.
- Patients with potentially infectious mumps should be masked while in waiting areas.
- Usual procedures for cleaning, disinfecting, and re-using examination rooms and patient care equipment are sufficient following mumps patients.
There is no effective post-exposure recommendation to prevent secondary transmission. Post-exposure use of vaccine or Immune Globulin (IG) is not effective.
- Children should receive two doses of mumps vaccine (given as MMR) at 12 to 15 months of age and 4 to 6 years of age.
- Adults should receive at least one dose of mumps vaccine (two doses of MMR vaccine).
- Pregnant women should not receive mumps vaccine, although the risk in this situation is theoretic. There is no evidence that mumps vaccine virus causes fetal damage. Pregnancy should be avoided for 4 weeks after vaccination with MMR vaccine.
Patients presenting in clinic should be evaluated for mumps immune status (based on age, or disease or vaccination history). Serologic testing for immune status is not routinely recommended prior to vaccination. No more than two doses of MMR vaccine are recommended. Health care providers should consider offering MMR vaccine to the following groups:
- Persons born in 1957 or later who have no history of mumps disease or immunization, including conscientious objectors.
- Persons born outside the U.S. who may not be vaccinated against mumps.
- Patients who are health care workers with no documented evidence of mumps immunity and who have received fewer than two doses of mumps vaccine.
- College students who have received fewer than two doses of mumps vaccine. (Note: The Minnesota College Immunization Law, M.S.135A.14, implemented in 1989, requires one dose of mumps vaccine prior to college enrollment.) In response to the current mumps outbreaks in colleges in Iowa and other Midwestern states, the American College Health Association recently issued recommendations for two doses of mumps vaccine. While MDH supports this recommendation and encourages colleges to communicate this to their students, the Minnesota College Immunization Law has not been revised, and colleges are not legally responsible for implementing a two dose requirement at this time.
- Students in grades 2 through 6 who have not yet received a second
MMR vaccine (Note: The Minnesota School Immunization Law required a
second dose of MMR for entrance to kindergarten beginning in 2004;
therefore, students in kindergarten and grade 1, and grades 7 through
have likely received two doses.)
- Persons born before 1957 with no history of mumps disease.
- Other adults 32 years of age and older who may not have received two doses of current or optimally efficacious mumps vaccine.
Refer to MDH Mumps Vaccination and Disease History Status Assumptions by Age, Minnesota 2006 fact sheet for guidance in determining the age groups most likely to be under-immunized for mumps.
Mumps is a reportable disease. Report suspect cases of mumps immediately
to the Minnesota Department of Health. MDH can facilitate testing and
exposure follow-up. Call 651-201-5414 or toll-free 877-676-5414. Also
see Reporting Mumps.