Mumps in Wikipedia
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(Source - Retrieved 2006-09-07 14:06:42 from http://en.wikipedia.org/wiki/Mumps)
Mumps or epidemic parotitis is a viral disease of humans. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide, and is still a significant threat to health in the third world.
Painful swelling of the salivary glands (classically the parotid gland) and fever is the most typical presentation. Painful testicular swelling and rash may also occur. While symptoms are generally not severe in children, the symptoms, in teenagers and adults, can be more severe and complications such as infertility or subfertility are relatively common, although still rare in absolute terms.,, The disease is generally self-limiting, and there is no specific treatment apart from controlling the symptoms with painkillers.
Causes and risks
The mumps are caused by a paramyxovirus, and are spread from person to person by saliva droplets or direct contact with articles that have been contaminated with infected saliva. The parotid glands (the salivary glands between the ear and the jaw) are usually involved. Unvaccinated children between the ages of 2 and 12 are most commonly infected, but the infection can occur in other age groups. Orchitis (swelling of the testes) occurs in 10–20% of infected males, but sterility only rarely ensues; a viral meningitis occurs in about 5% of those infected. In older people, the central nervous system, the pancreas, the prostate, the breasts, and other organs may be involved.
The incubation period is usually 18 to 21 days, but may range from as few as 12 to as many as 35 days. Mumps is generally a mild illness in children in developed countries. After adolescence, mumps tends to affect the ovary, causing oophoritis, and the testes, causing orchitis. The mature testis is particularly susceptible to damage from mumps which can lead to infertility. Adults infected with mumps are more likely to develop severe symptoms and complications.  
Comparison of a person before and after contracting mumps
The more common symptoms of mumps are:
- Swelling of the parotid gland (or parotitis) in more than 90% of patients, and pain behind the lower jaw when chewing.
- Sore throat
- Orchitis, referring to painful inflammation of the testicle.
Signs and tests
A physical examination confirms the presence of the swollen glands. Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, serology or a saliva test for the virus may be carried out.
There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck area and by acetaminophen (paracetamol) for pain relief (aspirin is discouraged in children with a viral illness because of the risk of Reye's syndrome). Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms.
Patients are advised to avoid fruit juice or any acidic foods, since these stimulate the salivary glands, which can be painful.
- A research group published a 1996 report on a chemical extracted from Spirulina platensis, a species of blue-green algae, which inhibited Mumps virus in a viral plaque assay.
- A University of Tokyo group reported in 1992 that research compound TJ13025 ((6'R)-6'-C-methylneplanocin A) had an antiviral effect on four Mumps virus strains cultured in Vero cells.(see 16526604, tables 1 and 2) Additional research improved the synthesis of a particular isomer, RMNPA, of TJ13025 from the racemic product.
- A 2005 publication in a Russian journal reports that Myramistin has antiviral activity against Mumps virus in Vero cells culture.
Death is very unusual. The disease is self-limiting, and general outcome is good, even if other organs are involved. Sterility in men from involvement of the testes is very rare. After the illness, life-long immunity to mumps generally occurs.
Known complications of mumps include:
- Infection of other organ systems
- Sterility in men (this is quite rare, and mostly occurs in older men)
- Mild forms of meningitis (rare, 40% of cases occur without parotid swelling)
- Encephalitis (very rare, rarely fatal)
- Profound (91 dB or more) but rare sensorineural hearing loss, uni- or bilateral
The most common preventative measure against mumps is immunisation with a mumps vaccine. This has been a component of the MMR immunization vaccine which also protects against measles and rubella and is now being supplanted by a combination of the three with Varicella vaccine - MMRV - which adds protection against Chickenpox. The WHO recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 15 months. The American Academy of Pediatrics recommends the routine administration of MMR vaccine at ages 12-15 months and 4-6 years.  The vaccination is repeated in some locations between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. Efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%. ,
Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. Disagreeing, the WHO, the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the British Medical Association and the Royal Pharmaceutical Society of Great Britain currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.
Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000). In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%). The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968; in 1998 there were only 666 cases reported.
United Kingdom (2004–2006)
In the United Kingdom over the last two years, a mumps outbreak has involved more than 70,000 patients. The cause of the outbreak is low immunity in those too old to have received MMR, but young enough to have not developed natural immunity through exposure. A catch-up programme of immunisation of under twenty five year olds, particularly in university towns such as Exeter was implemented.
- $12 November$ 2004: The University of Bath Internal News reports that twenty three students have presented to the University of Bath Medical Centre with Mumps. A "Mumps Vaccination programme" is announced, to commence $15 November$ 2004.
United States (2005-2006)
Although there may not be a direct link with the mumps outbreak in Ireland, United States CDC Director Dr. Julie Gerberding has been quoted stating that the genotype from the U.S. outbreak, "in the early cases of this outbreak, was the same genotype of virus that was associated with the United Kingdom outbreak."  Entrez Gene contains a placeholder database record for a new Mumps gene; the record is dated $23 Feb$ 2006.
For an interesting comparison on the number of cases in past epidemics, see SUMMARY OF VACCINE PREVENTABLE DISEASES, ILLINOIS 1965-2005 
- $10 May$ 2006: Mumps appears to be in at least twelve states with at least 3183 confirmed, probable, or suspect cases reported.
In early 2006, for reasons still not fully understood, the state of Iowa experienced a large surge in the number of reported mumps infections. According to the New York Times, college students accounted for about a quarter of the 245 cases , while about half of the cases are people aged seventeen to twenty five. Doctors are attributing the rise in mumps case frequency to low vaccination rates in Iowa's youth, coupled with the close quarters in dormitories, classrooms and cafeterias.
When you expect five and you get 245, this is pretty serious... We're trying to get ahead of it and get it stopped... It could be that on some of these college campuses, they were not as well vaccinated as we'd like them to be, [but] our law does not allow us to identify entities associated with outbreaks.
— Patricia Quinlisk, state epidemiologist at the Iowa department of public health
Still more cases are being reported from this outbreak, the majority of them in Dubuque County.
According to Canadian media reports , there may be something novel about this mumps strain which indicates a standard MMR-series vaccination is not 95% effective, as was thought.
- $14 April$ 2006: Iowa has experienced more than 600 suspected cases since December. Other states reporting cases are California, Illinois, Kansas, Minnesota, Missouri, Nebraska, South Dakota, and Wisconsin. The Centers for Disease Control and Prevention agency has not yet released the name of the ninth Midwestern state, however there have been confirmed cases in Michigan . The mumps outbreak is the nation's largest in twenty years.
- $18 April$ 2006: 815 cases have been reported  in Iowa alone, representing a caseload reporting increase of 200 in the last week.
- $25 April$ 2006: There are over 1,120 confirmed, probable and suspected cases of mumps. Over 1000 of the cases are confirmed.
- $2 May$ 2006: Iowa reports 1,487 cases.
- $11 May$ 2006: Iowa reports 1,184 confirmed, 253 probable, and 237 suspect cases, or 1674 total. 
- $28 April$ 2006: A confirmed case of mumps is reported in a college student at the Georgia Institute of Technology campus in downtown Atlanta.
There have been three confirmed cases of the mumps at Southern Illinois University-Carbondale, and has spread to three other neighboring counties in the Southern Illinois area. There has also been one confirmed case at Knox College, in Galesburg (Western Illinois).
- $9 May$ 2006: Illinois reports 279 total cases.
- $21 April$ 2006: A case is reported in a college student at the Indiana University Bloomington campus.
- $2 May$ 2006: With 340 mumps cases now reported in Kansas, state health officials have asked the U.S. Centers for Disease Control and Prevention to help.
- $10 May$ 2006: Kansas reports 546 cases.
- $4 May$ 2006: Two cases diagnosed by Doctor Roach in Paducah,KY, a border town to Southern Illinois.
- $20 April$ 2006: A woman in Saginaw County was diagnosed with mumps, with another pending results . Cases in Oakland County and Delta County were previously confirmed, and results in neighboring Bay County came back negative.
- $04 May$ 2006: A case of the mumps is reported in Plymouth-Canton High School, Canton. The three high schools in Canton are requiring students to provide documentation of vaccination.
- May 2006: The Minnesota Department of Health has confirmed eleven mumps cases in Minnesota in 2006. Four of the eleven cases may be linked to Iowa. Please continue to check back for updates. 
- $10 May$ 2006: Missouri reports twenty one confirmed, eighty eight probable, for a total of 109 cases 
- $10 May$ 2006: Nebraska reports sixty four confirmed, 193 probable, twenty two suspect, for a total of 279 cases in forty three counties. Officials say many people with mumps in Nebraska had connections to Iowa.
North Carolina (2006)
- $4 May$ 2006: An 8-year-old in Mecklenburg County is diagnosed with the mumps, the first case in the county since 2002.  NOTE: This case may not be related to the current epidemic in the Midwest.
- $16 Aug$ 2006: A Duke University student is diagnosed with a highly contagious case of the mumps.
- $18 May$ 2006: three cases in Lane County are confirmed, including a potential of four more at the University of Oregon alone. 
- $6 June$ 2006: twenty four confirmed and four presumptive cases in Lane County, two cases in Multnomah County, one each in Douglas, Hood River, and Linn Counties. 
- $6 July$ 2006: one presumptive case in Jackson County
South Dakota (2006)
- $12 May$ 2006: SD Department of Health reports thirty three confirmed cases, fifty three probable cases, and six suspect cases for a total of ninety two cases. 
- $20 March$ 2006: First laboratory confirmed case in Grant County.
- $19 April$ 2006: There are fourteen confirmed cases in Wisconsin, and half of these are at the University of Wisconsin-Milwaukee campus. A vaccination clinic is being held at UWM in response to this as questions rise as about the cause of the outbreak.
- $21 April$ 2006: Twenty cases are confirmed at the University of Wisconsin-Milwaukee campus, and the number of people in contact with this group has expanded to 1000. Three more vaccination clinics have been scheduled.
- $26 April$ 2006: One case has been confirmed at the Marquette University campus.
- $26 April$ 2006: One case has been confirmed at the University of Wisconsin-Platteville campus.
- $4 May$ 2006: Six cases have been confirmed at the University of Wisconsin, Madison campus.
- $10 May$ 2006: 185 confirmed cases, at least one case in one out of three counties. 
- ^ Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ, Eds. (2004). Harrison's Principles of Internal Medicine, 16th, McGraw-Hill Professional. ISBN 0-07-140235-7.
- Enders G (1996). Paramyxoviruses–Mumps virus. In: Barron's Medical Microbiology (Barron S et al, eds.), 4th ed., Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1.
- ^ Preveden T, Jovanovic J, Ristic D (1996). "[Fertility in men after mumps infection without manifestations of orchitis]". Med Pregl 49 (3-4): 99-102. PubMed.
- ^ Shakhov EV, Krupin VN (1990). "[The clinico-statistical characteristics of the testicular generative function in male subfertility following mumps]". Urol Nefrol (Mosk) (2): 46-50. PubMed.
- ^ Tsvetkov D (1990). "[Spermatological disorders in patients with postmumps orchitis]". Akush Ginekol (Sofiia) 29 (6): 46-9. PubMed.
- ^ Manson AL (1990). "Mumps orchitis". Urology 36 (4): 355-8. PubMed.
- ^ Hayashi T, Hayashi K, Maeda M, Kojima I (1996). "Calcium spirulan, an inhibitor of enveloped virus replication, from a blue-green alga Spirulina platensis". J Nat Prod 59 (1): 83-7. PubMed.
- ^ Shuto S, Obara T, Yaginuma S, Matsuda A (1997). "New neplanocin analogues. IX. A practical preparation of (6'R)-6'-C-methylneplanocin A (RMNPA), a potent antiviral agent, and the determination of its 6'-configuration. Diastereoselective deamination by adenosine deaminase". Chem Pharm Bull (Tokyo) 45 (1): 138-42. PubMed.
- ^ Shuto S, Minakawa N, Niizuma S, Kim HS, Wataya Y, Matsuda A (2002). "New neplanocin analogues. 12. Alternative synthesis and antimalarial effect of (6'R)-6'-C-methylneplanocin A, a potent AdoHcy hydrolase inhibitor". J Med Chem 45 (3): 748-51. PubMed.
- ^ Agafonov AP, Ignat'ev GM, Svistov VV, Smirnov IV, Krivoshein IuS (2005). "[In vitro study of antiviral activity of Myramistin against measles and mumps viruses]". Antibiot Khimioter 50 (5-6): 17-9. PubMed.
- ^ Schlegel M, Osterwalder JJ, Galeazzi RL, Vernazza PL (1999). "Comparative efficacy of three mumps vaccines during disease outbreak in Eastern Switzerland: cohort study". BMJ 319 (7206): 352. PubMed.
- ^  Summary]. WHO: Mumps vaccine. Retrieved on 2006-04-18.
- ^ Atkinson W, Humiston S, Wolfe C, Nelson R (Editors). (2006). Epidemiology and Prevention of Vaccine-Preventable Diseases, 9th, Centers for Disease Control and prevention. Fulltext.
- ^ Kanra G, Isik P, Kara A, Cengiz AB, Secmeer G, Ceyhan M (2004). "Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination". Pediatr Int 46 (6): 663-8. PubMed.
- ^ BMJ Mumps epidemic in UK 2005
- ^ CDC (2006). "Mumps epidemic--United kingdom, 2004-2005". MMWR Morb Mortal Wkly Rep 55 (7): 173-5. PubMed.
- ^ ["http://www.bath.ac.uk/internal/news/mumps04.htm" "University of Bath Internal News"]. "University of Bath Public Relations" ("$26 November$ 2004").
- ^ CDC (2006). "Exposure to mumps during air travel--United States, April 2006". MMWR Morb Mortal Wkly Rep 55 (14): 401-2. PubMed.
- ^  Wisconsin Immunization Program - Laboratory Confirmed Mumps Cases
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