Management of Mumps

Immediate Isolation and Infection Control

The American College of Physicians recommends implementing droplet precautions immediately upon diagnosis, as patients are contagious from 7 days before through 8 days after parotitis onset 1
Isolate patients for 5 days after onset of parotitis to prevent transmission to susceptible contacts 1
Educate patients and family members that transmission occurs through respiratory droplets and direct contact with saliva 1

Provide pain and fever control with acetaminophen or NSAIDs to manage fever, headache, and parotid gland pain 1
Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful 1
Recommend soft foods and avoidance of acidic foods that may stimulate salivary flow and worsen parotid pain 1

Watch for aseptic meningitis, which occurs in 4-6% of cases, characterized by severe headache, neck stiffness, photophobia, or altered mental status 1
Monitor for signs of encephalitis including seizures, paralysis, or cranial nerve palsies, which can cause permanent sequelae 1
Assess for hearing loss, including sudden sensorineural deafness, which was a major cause of childhood deafness in the pre-vaccine era 1
In postpubertal males, assess for orchitis (occurs in up to 38% of cases), characterized by testicular pain and swelling 1
Reassure patients that sterility is rare despite the high incidence of orchitis 1
Monitor postpubertal females for oophoritis (ovarian inflammation) 1
Watch for pancreatitis, characterized by severe abdominal pain, nausea, and vomiting 1

If facial nerve inflammation with weakness develops, initiate corticosteroid therapy promptly with prednisone 1-2 mg/kg/day for 5-7 days followed by a taper over 5-7 days 1
Provide eye protection to prevent corneal damage in patients with facial weakness 1
Reassure patients that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1

Adults born during or after 1957 without documentation of vaccination, laboratory evidence of immunity, or physician-diagnosed mumps should receive MMR vaccine after recovery 2, 3
A second dose of MMR is recommended for adults who live in a community experiencing a mumps outbreak, are students in postsecondary institutions, work in healthcare facilities, or plan to travel internationally 2, 3
Do not administer MMR vaccine during acute illness; wait until recovery is complete 4
Recognize that mumps can occur in highly vaccinated populations due to waning immunity, particularly in crowded environments like college dormitories 5
The Centers for Disease Control and Prevention notes that the 2006 U.S. outbreak demonstrated that 44% of cases occurred in persons who had received at least 2 doses of vaccine 5
Consider a third dose during outbreak settings for high-risk populations, though this is not routinely recommended by the Centers for Disease Control and Prevention 5

Only 30-40% of mumps infections produce typical acute parotitis; 15-20% are asymptomatic and up to 50% present with nonspecific or respiratory symptoms 1, 6
Complications are more common and severe in adults than children, making age an important consideration in monitoring intensity 1
The disease is generally self-limiting, with most patients recovering without intervention beyond supportive care 1