REVIEW ARTICLE |
https://doi.org/10.5005/jp-journals-10081-1460 |
An Epidemic of Mumps Reported in a Peripheral Charitable Hospital, Bengaluru, Karnataka
1,2Department of Pediatrics, Manav Charitable Hospital, Bengaluru, Karnataka, India
Corresponding Author: Sreepriya Lalitha, Department of Pediatrics, Manav Charitable Hospital, Bengaluru, Karnataka, India, Phone: +91 9886497582, e-mail: dr_sreepriya@yahoo.com
Received: 27 May 2024; Accepted: 06 June 2024; Published on: 20 March 2025
ABSTRACT
Mumps is a highly contagious, vaccine-preventable disease. It is one of the oldest human illnesses known to humans. Mumps is caused by paramyxovirus, which is a single-stranded ribonucleic acid (RNA) virus. It is a self-limited illness. Diagnosis is mainly clinical. Although infrequent in countries with extensive vaccination programs, mumps remains endemic in the rest of the world, warranting continued vaccine protection. Compared to other vaccine-preventable diseases, mumps is more benign. Consequently, topics relating to mumps have been somewhat neglected. Through this article, we are suggesting a wider range of protection through the measles, mumps, and rubella (MMR) vaccine to the susceptible population.
Keywords: Contagious, Incubation period, Isolation, Mumps virus, Parotitis, Prevention, Vaccine
How to cite this article: Lalitha S, R M. An Epidemic of Mumps Reported in a Peripheral Charitable Hospital, Bengaluru, Karnataka. Pediatr Inf Dis 2025;7(2):59–61.
Source of support: Nil
Conflict of interest: None
INTRODUCTION
Mumps is an acute, self-limited systemic viral infection primarily characterized by the swelling of one or more salivary glands, most commonly the parotid glands. Approximately 50% of infected individuals exhibit the classic symptoms of mumps, while around 30% of cases are asymptomatic. Additionally, many children may present with atypical symptoms.
The mumps virus, a single-stranded pleomorphic ribonucleic acid (RNA) virus, belongs to the Paramyxoviridae family and the Rubulavirus genus.1,4 Mumps typically begins with a prodrome of headache, fever (lasting 3–4 days), fatigue, anorexia, myalgia, and general malaise. These symptoms are succeeded by the trademark sign of the disease—parotitis (swelling of the parotid glands).
Transmission occurs via respiratory droplets, with the virus initially replicating in the nasopharynx and regional lymph nodes. Viremia, which is secondary to infection of mononuclear cells, spreads the virus systemically, causing inflammation in various organs like the salivary glands, the central nervous system, pancreas, and testicles.5,6
Inflammation in the affected tissues leads to the characteristic symptoms of parotitis, along with potential complications such as orchitis and aseptic meningitis. Mumps infection typically provides lifelong immunity.7 While the disease can occur at any age, it is rare in children under 2 years, particularly those under 1 year. Glandular swelling usually peaks around the 2nd day and persists for 5–7 days. During the febrile period, the affected glands are extremely tender.7
The average incubation period for mumps is 16–18 days, with a range of 12–25 days. The virus can be detected in the saliva from 7 days before to as long as 7 days after the onset of parotid swelling. Patients are considered contagious from 2 days before until 5 days after the onset of parotitis. Parotitis can be unilateral or bilateral. Sublingual and submandibular glands also may swell.
Parotitis in mumps can be either unilateral or bilateral, and the sublingual and submandibular glands may also become swollen. The parotitis typically lasts for about 5 days, with most cases resolving within 10 days. Nearly all cases completely resolve within 2 weeks. Up to one-third of individuals may remain asymptomatic but are still contagious.
The predisposing factors for mumps include immunodeficiency, lack of vaccination, international travel, and immunodeficiency. Mumps occurs globally, with epidemic outbreaks occurring roughly every 5 years in regions with low vaccination coverage. Contributing factors to these outbreaks include global transmission of mumps in unvaccinated populations, the tapering immunity from the vaccine over time, the absence of the wild-type virus to reinforce immunity in vaccinated individuals, and crowded living conditions that facilitate the spread of respiratory viruses like mumps. Humans are the sole natural hosts for the mumps virus.
During an outbreak, the diagnosis of mumps is primarily clinical, based on the presence of parotid swelling and a history of exposure. In areas with low local incidence, other potential causes of parotitis should be considered and investigated. For recurrent parotid swelling of unknown cause, it is important to explore potential ductal calculi or malignancy.
Laboratory confirmation of parotitis can be achieved by demonstrating elevated serum amylase levels. Leukopenia with relative lymphocytosis may also be observed. Other diagnostic methods include isolating the virus in cell culture, detecting viral antigens via direct immunofluorescence, and identifying viral nucleic acids through reverse transcriptase polymerase chain reaction (RT-PCR). The virus can be isolated from upper respiratory tract secretions (such as buccal or oropharyngeal mucosa), cerebrospinal fluid (CSF), or urine during the acute phase of illness.
For early presentation of a mumps case, it is recommended to collect two specimens: a buccal or oral swab for RT-PCR and an acute-phase serum sample to test for IgM and IgG antibodies, as well as serum for viral RT-PCR. Oral specimens should be obtained within 3 days of the onset of parotid swelling, and no later than 8 days.5,9
Treatment
Mumps treatment primarily involves supportive care tailored to the presenting symptoms. Analgesics and warm or cold compresses can help alleviate parotid swelling. The patient should be isolated until the swelling subsides, with the CDC recommending segregation of active cases for 5 days after the beginning of parotid swelling. It is important to educate the child on the necessity of hand washing and isolation until symptoms resolve. A soft diet can reduce pain associated with chewing, and acidic substances, such as citrus juices, which may cause discomfort, should be avoided.
There is no proven benefit from using glucocorticoids or performing surgical drainage for mumps-related parotitis or orchitis. Mumps immunoglobulin is ineffective in preventing the disease and is not recommended for either treatment or postexposure prophylaxis.
Complications of mumps can include encephalitis, sensorineural hearing loss, Guillain–Barré syndrome, thyroiditis, mastitis, polyneuritis, pancreatitis, orchitis, pneumonia, and arthritis, as well as complications resulting from inflammation of glandular tissue (e.g., orchitis, oophoritis, and pancreatitis). Orchitis is unilateral and occurs in 20–30% of postpubertal males. Testicular atrophy may develop, but sterility is rare.1,2,5,9,10
Maternal mumps infection during the first trimester of pregnancy is associated with an increased risk of fetal loss. However, no fetal malformations have been linked to intrauterine mumps infection. Pancreatitis occurs in about 4% of mumps cases, typically presenting as mild. Central nervous system involvement is seen in 50–60% of patients, often presenting as cerebrospinal pleocytosis. A rare complication of mumps is sensorineural hearing loss, which results from cochlear damage caused by the virus. This occurs in approximately 0.5 cases per 1,000 mumps infections. Deafness can develop suddenly or gradually, is usually unilateral, and can be either transient or, more often, permanent.
Differential Diagnosis
Other viral illnesses that should be considered in the differential diagnosis include parainfluenza types 1 and 3, influenza A, cytomegalovirus, Epstein–Barr virus, enterovirus, lymphocytic choriomeningitis virus, and HIV. Purulent parotitis, typically caused by Staphylococcus aureus, is usually unilateral and extremely tender. Noninfectious causes of parotitis include obstruction of the Stensen duct, Sjögren’s syndrome, systemic lupus erythematosus, immunological disorders, tumors, and certain drugs.10
Maternal mumps infection during the first trimester of pregnancy is associated with an increased risk of fetal wastage, although no fetal malformations have been linked to intrauterine mumps infection.10
Prevention
The best approach to prevent mumps infection is by MMR vaccine (measles, mumps, rubella). The Indian Academy of Pediatrics and the Advisory Committee on Vaccines and Immunization Practices (IAP-ACVIP) recommend administering three doses of the MMR vaccine in children: at 9 months, 15 months, and between 4 and 6 years of age. In contrast, the Government of India (GOI) recommends administering the MR vaccine at 9 months and at 16–24 months, along with the first booster dose of the diphtheria, tetanus, and pertussis (DTP) vaccine.
The MMR vaccine is considered safe. Common unwanted effects include soreness at the injection site, a generalized rash, fever, and swelling of the neck glands. As with any vaccine, there is a small risk of a serious allergic reaction. Contraindications for the MMR vaccine include individuals with a history of moderate to severe allergic reactions to a previous dose, hypersensitivity to any vaccine component, pregnancy, moderate to severe immunosuppression due to drugs, radiation, advanced leukemia or lymphoma, or certain congenital immune disorders.
However, the burden of mumps remains significant in countries that do not offer routine mumps vaccination, with epidemic peaks occurring every 2–5 years. Even with the substantial burden of mumps, the Indian government has excluded it from the Universal Immunization Program due to insufficient data on the burden of mumps, it is not being considered a major public health concern, and the higher cost of the MMR vaccine compared to the MR vaccine.
A recent study reported from Kashmir showed that 82% of nonimmunized children developed mumps.11 A study from Pakistan also showed the reemergence of mumps after the COVID-19 pandemic, where inj. MMR is not given in the government vaccination program.12
CASE DESCRIPTION
Manav Jindal Hospital is a charitable healthcare facility located on Tumkur Road, in the peripheral area of Bangalore. The hospital receives an average of 1,500 outpatient department (OPD) patients daily across various departments, with the pediatric OPD handling approximately 70–90 patients per day. The majority of our patients come from lower socioeconomic backgrounds and depend solely on the government’s immunization program.
In response to the recent rise in mumps cases, a small observational study was conducted to assess factors such as symptoms at presentation, age distribution, sex ratio, and complications. This study covered the period from 25th January to 31st March, 2024, during which 154 children with mumps attended the pediatric OPD.
Of these 154 children, over 98% were vaccinated according to the government’s immunization schedule, receiving two doses of the MR vaccine—one at 9 months and another between 15 and 18 months. Two children’s immunization records were missing, so their vaccination status could not be determined. Additionally, three children above the age of five had not received any vaccinations after the initial dose at 9 months. None of the children had received the MMR vaccine.
Of the 154 children, 88 (57.1%) were male, and 66 (42.9%) were female. The most common symptoms of mumps in the children studied included swelling of the parotid and other cervical glands. Additionally, 4 children (2.5%) presented with ear pain. Fever was the initial symptom in 54 children (35.4%), followed by swelling of the glands, pain while chewing, body aches, headache, sore throat, and nasal discharge. The diagnosis was made through clinical examination. Children were asked to return for follow-up after 4 days.
During follow-up, four children complained of vomiting and abdominal pain. However, clinical examination was normal, and they were prescribed antiemetics and antacids, with advice to return for ultrasonography if symptoms persisted. These children did not return for further review. One child experienced persistent high-grade fever even after 6 days of symptom onset. This child was investigated for other causes of fever, but all investigations returned normal results.
The youngest child with mumps was 3 years old, while the oldest had just turned 18. The majority of the children (103, or 66.8%) were between the ages of 4 and 8 years, with the highest number of cases (31 children, or 20.1%) occurring in 7-year-olds. Most children (90.9%) presented with unilateral parotid gland swelling, while bilateral swelling was noted in only 14 children (9.09%).
By day 4 of the illness, fever and pain had subsided in 98% of the children. All were advised to take simple analgesics, such as paracetamol, and to follow home isolation for 7 days.
DISCUSSION
Mumps is an acute, self-limited viral illness with a low rate of complications. In our observation, the age of affected individuals ranged from 3 to 18 years, with a higher incidence in male children. The most affected age-group was between 4 and 8 years. At presentation, only 35.4% of the children had a fever. The majority of children presented with unilateral swelling of the parotid gland. Notably, no complications were observed in this study.
None of the children in this study had received the MMR vaccine. While the rate of complications was low, we observed that mumps infection resulted in a significant loss of school days. In particular, during the month of March, which coincided with exam time for many schools in South India, numerous children missed their exams due to illness. Many children with mild symptoms, such as minimal fever and swelling, continued attending school without seeking medical attention, meaning the true scale of the outbreak may be even larger. The children we treated in the hospital likely represent only the noticeable part of the problem.
All the children in this study showed symptomatic improvement with only paracetamol. They were advised to follow home isolation and practice good hygiene, including frequent handwashing.
CONCLUSION
Although mumps is generally considered a benign clinical disease, it has emerged as an important reemerging pathogen. Reports indicate that this year’s mumps virus epidemic has affected all southern states. Recent studies, both in India and abroad, have highlighted the reemergence of the mumps virus, emphasizing that mumps has become a significant public health concern. These findings suggest the need for greater investment in prevention, particularly through vaccination. We also advocate for broader protection for vulnerable age-groups by including the MMR vaccine as part of the Universal Immunization Program.
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