Mumps: what are the symptoms of mumps? Transmission and vaccination

Mumps is an acute infectious viral disease. It is also known by the synonymous names epidemic parotitis or parotid glanditis.

The disease is caused by the paramyxovirus, which predominantly infects cells of the nervous system and the external secretion glands.

This explains the manifestations of the virus, such as inflammation of the salivary glands, testicles in boys and ovaries in women, pancreas and nervous system.

Before vaccination, mumps was a common school-age disease. In adulthood, it was rare and only occurred in people who did not get the disease in childhood. Getting mumps leaves a lifelong immunity.

The vast majority of children experienced the disease as parotid gland inflammation or mild aseptic meningitis. Other manifestations of infection, such as testicular or pancreatitis, were rare.

The pathological agent of the infection is a paramyxovirus. It is an RNA virus. This means that its genetic information is carried by a single-stranded ribonucleic acid.

The virus is highly contagious.

It is spread by droplet infection. This means that a person can become infected through normal contact between people, in common areas, talking, sharing personal items, shaking hands, etc.

Infected persons are infectious to their surroundings 3 days before and about 9 days after the first signs of the disease appear.

The incubation period of the virus, i.e. the time from the virus entering the body to the first symptoms, is 14 to 21 days.

An asymptomatic person can be the source of infection. Approximately half of infected persons have no symptoms. Children without symptoms are more common.

Droplets containing the virus enter the body most often through the nose or mouth.

The virus multiplies in the nasopharynx and is transmitted by lymph to the lymph nodes. From the lymph nodes it spreads throughout the body. It spreads mainly to the organs to which it has an affinity, namely the salivary glands, nerve cells, testes, ovaries and pancreas.

The main symptom of infectious parotitis is inflammation of the parotid gland, which is swollen and very painful to the touch. Swollen parotid glands cause swelling of the cheeks and pain when moving the ear, e.g. when chewing, talking or yawning.

The skin over the swollen gland may be taut and paler. It is not red as many people would expect with inflammation.

The disease starts with swelling of one gland. After a few days, the inflammation spreads to the other side. Any salivary gland can be affected, so swelling and swelling may be present elsewhere in the oral cavity.

Painful swelling of the salivary glands is accompanied by a temperature, usually up to 39 °C.

Another possible symptom of mumps is involvement of the nervous system and the development of aseptic meningitis.

This is manifested by the following symptoms:

• fever
• chills
• headache
• nausea
• meningeal symptoms
• convulsions, especially in childhood

Meningitis occurs mostly a week after the swelling of the first salivary gland.

Rarely it may appear as the first symptom of the disease or come on after the swelling of the parotid glands has disappeared. Occasionally it occurs entirely without glandular involvement.

Aseptic meningitis in mumps usually has a benign course. Rarely, however, it may progress to more severe meningoencephalitis with impaired consciousness and development of cranial nerve paresis.

Affection of the auditory nerve may result in deafness, which is usually unilateral. Death in this severe form of aseptic meningoencephalitis is rare.

About 20 % of infected boys and men suffer from inflammation of the testicles (orchitis) or epididymitis.

As with the salivary glands, the disease begins with a unilateral painful swelling. After a few days, the swelling spreads to the other testicle. The affected scrotum is greatly enlarged by the swelling, to three to four times its normal size.

The disease is accompanied by high fever and severe pain lasting about 5 days.

After bilateral involvement, testicular atrophy and oligospermia, which is a reduced sperm count, may occur. Complete sterility as a consequence of mumps disease is very rare.

Testicular inflammation occurs when the salivary glands are simultaneously affected. In rare cases, it occurs after the parotid gland inflammation has subsided.

Women, however, are no less at risk from a complicated course of mumps.

They may develop ovarian inflammation after salivary gland inflammation, which is accompanied by fever, abdominal pain and vomiting. A severe course of ovarian inflammation may result in sterility and infertility.

Pregnant women should beware of mumps. This is especially true until the end of the third month of pregnancy, when infection can lead to fetal death.

In the later months, the virus no longer poses a risk and there is no evidence of congenital developmental defects associated with contracting the infection.

The rarest manifestation of mumps is pancreatitis. Pancreatitis presents with abdominal pain, vomiting and diarrhoea.

Diagnosis of viral parotitis is based on the characteristic clinical picture, especially during an epidemic in the area. If the patient's main symptom is orchitis or meningitis outside the epidemic period, diagnosis is more difficult.

Elevated serum and urine amylase values are present in the basic laboratory blood tests. Despite ongoing inflammation, inflammatory parameters such as erythrocyte sedimentation rate or high CRP levels are not elevated in the blood.

When the pancreas is affected, elevated levels of pancreatic enzymes such as lipase or pancreatic amylase may be found in the blood.

The disease can be confirmed by serological examination of the blood. The examination reveals the presence of specific IgM and IgG antibodies and, more recently, IgA antibodies.

A quadruple titre of IgG and IgM antibodies is indicative of acute infection approximately 14 days after infection. Positivity of IgG antibodies and negativity of IgM antibodies is indicative of earlier recovery from the disease or previous mumps vaccination.

In the differential diagnosis, the bacterial causative agent comes into consideration. In childhood, it can cause inflammation of the parotid gland, which needs to be treated with antibiotics.

Another viral agent may be cytomegalovirus, which mainly affects immunocompromised children and adults.

For meningitis, it is particularly important to distinguish between tick-borne encephalitis virus and Lyme disease.

The course of the disease is usually acute, without permanent consequences for the patient's health.

After an incubation period of 2-3 weeks, the first mild symptoms appear, such as increased fatigue, malaise, increased body temperature and a feeling of swelling of the salivary glands.

For the first 2-3 days, the salivary gland involvement is unilateral. Gradually, they become enlarged and painful, especially during salivary gland movements such as chewing, laughing, yawning, etc.

On the fourth day, the swelling is transferred to the opposite side. At the same time, the fever rises, the swelling, swelling and soreness of the glands worsen.

On average, about a week after the salivary glands are affected, other organs - testicles, ovaries, pancreas or nervous system - may become affected and inflamed.

Vaccinations

The only effective prevention against mumps is active immunisation, i.e. vaccination.

Children as young as 15 months of age are vaccinated against mumps.

The mumps vaccine is usually given together with measles and rubella vaccines.

Vaccination is given during the 11th year of life.

After vaccination, effective antibody levels are present in the body after 2-3 weeks.

Common side effects in the post-vaccination period include a slightly increased temperature, redness and soreness at the injection site and, rarely, meningitis.

This condition can occur 1-2 weeks after vaccination and lasts for a maximum of 3 days.