Pediatric Mumps

eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Cem S Demirci, MD, Fellow in Endocrinology, Children's Hospital of Pittsburgh
Walid Abuhammour, MD, FAAP, Professor of Pediatrics, Michigan State University, Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center

Background

Mumps is a single-stranded RNA virus and a member of the family Paramyxoviridae, genus Paramyxovirus. It has 2 major surface glycoproteins: the hemagglutinin-neuraminidase and the fusion protein. Mumps virus is sensitive to heat and ultraviolet light.

Mumps vaccine was licensed in the United States in December 1967, and the Advisory Committee on Immunization Practices (ACIP) recommended that its use be considered for children approaching puberty, for adolescents, and for adults.
At that time, the public health community considered mumps control a low priority, and the ACIP stated that mumps immunization should not compromise the effectiveness of established public health programs.
However, in 1972, the ACIP recommendations were strengthened to indicate that mumps vaccination was particularly important for the initially targeted age groups;
in 1977, the ACIP recommended the routine vaccination of all children aged 12 months or older.

The use of mumps vaccine in young children was facilitated by the introduction (in 1977) and extensive use of the measles-mumps-rubella (MMR) vaccine.
In 1980, stronger recommendations called for the vaccination of susceptible children, adolescents, and adults, unless such vaccination was contraindicated. Following these increasingly comprehensive recommendations and the enactment of state laws requiring mumps vaccination for school entry and attendance, the reported incidence of mumps steadily declined.
However, during 1986 and 1987, large outbreaks occurred among underimmunized cohorts of persons born during 1967-1977, resulting in a shift in peak incidence from persons aged 5-9 years to persons aged 10-19 years.1
In 1989, the ACIP recommended that a second dose of measles-containing vaccine be administered to children aged 4-6 years (at time of entry to kindergarten or first grade) and designated MMR as the vaccine of choice.1,2

The incidence of mumps during 1988-1998 decreased among all age groups.
The greatest decrease occurred among persons aged 10-19 years, which was the same age group in which the greatest increases had occurred during 1986 and 1987, when a resurgence of outbreaks occurred among susceptible adolescents and young adults. Subsequent outbreaks have occurred among highly vaccinated populations.
During 1989-1990, a large outbreak occurred among students in a primary and a secondary school; most of the students in these schools had been vaccinated, suggesting that vaccination failure, in addition to failure to vaccinate, might have contributed to the outbreak.
In 1991, another outbreak occurred in a secondary school where most of the students had been vaccinated; this outbreak was also mostly attributed to primary vaccination failure.

The shift in higher risk for mumps to these other age groups (ie, from younger children of school ages to older children, adolescents, and young adults), which occurred after the routine use of the mumps vaccine was initiated, has persisted despite minimal fluctuations in disease incidence that occurred in recent years among the various age groups.

Pathophysiology

Mumps virus produces a generalized infection. After entry into the oropharynx, viral replication occurs, causing subsequent viremia and involving glands or nervous tissue.

The virus may be isolated from saliva, blood, urine, and cerebrospinal fluid (CSF). Affected glands show edema and lymphocyte infiltration.

for rest of article refer:
http://emedicine.medscape.com/article/966678-overview