Frank A. Bures: Incidence of mumps bumps up
A news blurb came out recently about the increase in the incidence of the infectious viral disease, mumps. Last year in the U.S. there were 5,300 cases reported, and this year, per the CDC there are almost 5,000 by Nov. 4, 2017. A lot of times that indicates a lack of, or waning of immunity to the virus. Curiously, it is not compulsory to report the infection to a governmental department. But many doctors still do.
For those of us born before the Great Flood, the memory of either getting mumps or knowing a school friend who did is still relatively vivid. To most of you young whipper-snappers, it’s just a word for which you get a preventive shot or vaccination. It could be time to revisit and review mumps’ story.
Recognition of mumps goes back to Greek and Roman times when Hippocrates described painful swelling in the cheek salivary or parotid glands and testicles (in a male, of course). A killed virus vaccine was derived in 1948 by a doctor Ender. But it didn’t have a long “memory” (I can identify) for the virus so immunity didn’t last. The first “medical” vaccine of the Jerl Lynn live weakened/attenuated virus strain we still use today was created in 1963 by Maurice Hilleman from his daughter, Jerl Lynn’s, infection. It was first used in 1967. Dr. Hilleman was a genius, who worked at Merck Labs as a microbiologist/vaccinologist. Of the 14 vaccines recommended in current vaccine schedules, he developed eight.
The name mumps seems to have derived from the old English dialect word mump meaning lump. It likely tried to characterize the picture of a patient’s cheeks with swollen parotid salivary glands. The saliva glands under your jaw can also swell. The virus is a slightly different breed as it is a single stranded RNA critter, which favors infecting glandular and central nervous system tissues. Highly contagious, it used to be called epidemic parotitis or inflammation of that gland. There is only one type of the virus, and it only infects humans. Animals can’t contract or spread it.
It is spread via coughing or sneezing mucous droplets which are breathed in, or picked up from a surface containing them, and transferred to your mouth. Kissing also works. Finishing your child’s food can do it to you. The incubation period is 14-18 days after exposure, outer limits of 12-25. The infected person is most contagious two days before symptoms begin and in the first five days of swelling.
The classic early signs are fever, headache, muscle aches, and feeling yucky (one of my favorite medical terms), like SO many other infections. Then the kiddo may complain of an earache. About day 2-3 the one side swells painfully and rapidly, soon followed by the other. Often the size fills in the area between ear and jaw, a classic diagnostic tool. Sometime dry mouth and difficulty speaking occur. The swelling and fever subside in about a week. The entire illness generally is gone in 7-10 days. Adults do worse than kids, as is so often the case. Maybe 15-20 percent have no symptoms of the infection, and a third to half will have just non-diagnostic non-specific symptoms.
Because the virus initially is spread throughout a body via bloodstream, it can infect one or both male testicles, mainly of post pubertal guys, pancreas, the brain covering meninges, or brain itself. Ovaries get it about 5 percent of the time, but this is harder to detect. Unilateral or bilateral deafness occurs rarely. Happily, these complications usually resolve without permanent problems. On rare occasions thyroid, tear glands, or vaginal glands can become inflamed.
If symptoms are obvious, diagnosis is made by medical judgment. When an isolated case pops up, it can be confused with other illnesses, necessitating testing for mumps virus or other stuff, especially with a meningitis picture or pancreatitis and belly pain. Treatment is comfort and fever care with acetaminophen or ibuprofen, preferably not aspirin because of concern for Reye’s syndrome.
For prevention, one attack confers lifelong immunity. So we dinosaurs born before 1957 are assumed to have had it. The measles-mumps-rubella vaccine used successfully since the 1970’s provides 88 percent immunity after two injections given just after one year old and at 4-6 years. If an outbreak arises in a community, it’s good medicine to consider a booster, especially if you are in crowded conditions like classrooms, or particularly traveling abroad to areas without immunization like Africa, India, or Southeast Asia. Prior to the MMR vaccine, mumps was the leading cause of viral meningitis/encephalitis in the U.S.
When we become freed from one more malady of humankind, we quickly forget the “good old days,” and how sick that disease can make us. This Hint is merely a reminder to keep up on these vaccinations for good reasons. Mumps is a miserable way to become a “swell guy.”