Download - Mumps Update
Dr.T.V.Rao MD 1
MUMPS UPDATE
DR.T.V.RAO MD
MUMPS
HIPPOCRATES 5th
Century BC
A Disease of Children,
Non Suppurative Enlargement of Parotid Gland.
1934 – Good Pasture/ Johnson
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Paramyxoviruses
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Mumps belongs to Parmyxoviridae
Viruses in the family Parmyxoviridae are classified in two subfamilies, Paramyxovirinae and Pneumovirinae. The latter subfamily contains two genera, Pneumovirus and Metapneumovirus.
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Data on Mumps
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Mumps belongs to Parmyxoviridae
Looks similar to Orthomyxovirus,
Larger in size, More Pleomorphic.
Spherical in shape 100 to 300 nm
Some times appear as filamentous,Gaint forms are present.
But contains only single stranded RNA.
Do not contain segmented RNA like Orthomyxoviruses,Antigenic variation absent.
Reassortments like Influenza viruses – ABSENT.
MUMPS - VirusMumps is a single-stranded RNA virus and a member of the family Parmyxoviridae, genus Paramyxoviruses. It has 2 major surface glycoprotein's: the hem agglutinin-neuraminidase and the fusion protein. Mumps virus is sensitive to heat and ultraviolet light
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Properties of MUMPS virus.
Posses HN and F properties.
Growth in Chick Embryos, in the Amniotic cavity, Adopts in allantoic cavity,
Cell cultures – Primary Monkey kidney,
Typical Paramyxoviruses,
produce Cytopathic effects.
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MUMPSMumps is an acute viral infection of the paramyxoviruses family. As its alternative name (infectious parotitis) suggests, the infection is characterized by swelling more commonly bilateral than unilateral of the parotid salivary glands.
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MumpsThe incubation period is 14-21 days and is communicable from 6 days before to 9 days after facial swelling is apparent. It can lead to brain inflammation, deafness or sterility
Mumbling speech - Mumps
Name "mumps" comes from an old word for "lump" or an old word for "mumble."Dr.T.V.Rao MD
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MumpsMumps or epidemic parotitis is a viral disease of the human species, caused by the mumps virus. 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 Developing World
Mumps Clinical Case Definition
Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland lasting more than 2 days without other apparent cause
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Involvement of Salivary Glands
Painful swelling of the salivary glands (classically the parotid gland is the most typical presentation) Painful testicular swelling (orchitis) and rash may also occur
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Involvement of Parotid Gland a Major Manifestation
Swelling of the salivary glands follows these symptoms. Swelling of the glands near the jaw line below the ears may give you "chipmunk cheeks
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Pathogenesis - Mumps
Respiratory transmission of virus
Replication in nasopharynx and regional lymph nodes
Viremia 12-25 days after exposure with spread to tissues
Multiple tissues infected during Viremia
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Mumps Clinical Features
Incubation period 14-18 days
Nonspecific prodrome of myalgia, malaise, headache, low-grade fever
Parotitis in 30%-40%
Up to 20% of infections asymptomatic
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Clinical Features MUMPS
Inhalation / Conjunctiva.
Replicates in URT Cervical Lymph nodes.
Blood stream to other organs
Incubation period 12- 25 days.
Manifest with Parotid swelling
Unilateral or Bilateral.
Fever , Local pain at parotid region and Tenderness.
Subsides In a Week.
ImmunityAntibodies are produced against the S and V surface antigens..
Mumps rare before 6 months of age. Dr.T.V.Rao MD
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Complication with MUMPS.
Epididymo orchids.
May lead to atrophy, sterility, Low sperm counts.
CNS involvement in 60% cases
May manifest with Aseptic meningitis,
Deafness,
Arthritis, Oopharitis,Nephritis and Myocarditis,
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Complication with MUMPS.
Orchitis. This inflammatory condition causes swelling of one or both testicles. Orchitis is painful.
Pancreatitis..
Encephalitis. A viral infection, such as mumps, can lead to inflammation of the brain (encephalitis). Although it's serious, encephalitis is a rare complication of mumps.
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Meningoencephalitis,
In clinically diagnosed Meningoencephalitis, a CSF mononuclear pleocytosis occurs, as does normal glucose, although hypoglycorrhachia has been reported. The mumps virus may be isolated from CSF early in the illness. Mumps Meningoencephalitis carries a good prognosis and is usually associated with an uneventful recovery.
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Laboratory Diagnosis
No Laboratory confirmation needed.
Atypical infection needs laboratory Diagnosis.
Virus isolated from
Saliva
Urine
CSF.
Culturing in Human amnion, He la cells.
Immunofluorescence Methods. Isolation in Chick Embryos
ELISA, Complement fixation tests,
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Mumps Laboratory Diagnosis
Isolation of mumps virus
Detection of mumps antigen by PCR
Serologic testingpositive IgM antibodysignificant increase in IgG antibody between acute and convalescent specimens
CDC recommendsCDC recommends that a blood specimen and buccal /oral swab be collected from all patients with clinical features compatible with mumps.
Recommendations stands mainly for epidemiological surveys
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VaccinationLive attenuated vaccine
Jernyl Lynn Strain
Grown in chick embryo fibroblasts
Vaccine as MMR vaccine
A single dose protects for 10 years.
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Mumps (MMR) Vaccine Indications
One dose (as MMR) for preschool-age children 12 months of age and older and persons born during or after 1957 not at high risk of mumps exposure
Need for second doseSecond dose (as MMR) for school-age children and adults at high risk of mumps exposure (i.e., healthcare personnel, international travelers and students at post-high school educational institutions
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MMR VaccineContraindications and Precautions
Severe allergic reaction to vaccine component or following a prior dose
Pregnancy
Immunosuppression
Moderate or severe acute illness of other etiologies
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MMR Vaccine and Autism
There is no scientific evidence that the risk of autism is higher among children who receive measles or MMR vaccine than among unvaccinated children
“The evidence favors a rejection of a causal relationship at the population level between MMR vaccine and autism spectrum disorders (ASD).”
- Institute of Medicine, April 2001
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MMR combined vaccine is beneficial than separate
component vaccinesSeparate administration of measles, mumps, and rubella vaccines to children provides no benefit over administration of the combination MMR vaccine and could result in delays in immunization.
Paediatricians need to work with families to ensure that children are protected early in the second year of life from these preventable diseases.
Mumps Vaccine and HIV Infection
MMR recommended for persons with asymptomatic and mildly symptomatic HIV infection
NOT recommended for those with evidence of severe immuno- suppression
HIV testing before vaccination is not recommended
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EpidemiologyEndemic – Prevalence all over the world
Immunization . Reduced the incidence.
Epidemics in children between 5-15.
No carriers.
Spread by Direct Contact
Saliva and urine are infective.
One Attack produces life time Immunity.
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Control of Mumps:
Mumps control: The control of mumps can be achieved through high routine coverage with an effective mumps-containing vaccine administered at 12–18 months of age. Children immunized with most mumps vaccines at the age of 12 months or older have excellent serological response rates. Programmes should aim at infant coverage of more than 90%. Low immunization coverage may reduce the number of cases in infants but fails to interrupt circulation of the mumps virus in the community.
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Passive immunization against mumps
– Immune globulin ineffective for post exposure prophylaxis• does not prevent disease or reduce
complications
–Trans placental maternal antibody appears to protect infants for first year of life
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