Mumps

Infection Control in Healthcare Personnel: Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients (2024)

At a glance

Mumps from the Infection Control in Healthcare Personnel: Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients (2024) guideline.

Recommendations

Recommendations
  1. For asymptomatic healthcare personnel with presumptive evidence of immunity to mumps (https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm#Tab3)1 who have an exposure to mumps:
  • Work restrictions are not necessary.
  • Implement daily monitoring for signs and symptoms of mumps from the 10th day after their first exposure through the 25th day after their last exposure.
  1. For asymptomatic healthcare personnel without presumptive evidence of immunity to mumps who have an exposure to mumps:
  • Exclude from work from the 10th day after their first exposure through the 25th day after their last exposure.
  • Work restrictions are not necessary for healthcare personnel who received the first dose of MMR vaccine prior to exposure:
    • They should receive their second dose of the MMR vaccine as soon as possible (at least 28 days after their first dose).
    • Implement daily monitoring for signs and symptoms of mumps infection from the 10th day after their first exposure through the 25th day after their last exposure.
  1. For healthcare personnel with known or suspected mumps, exclude from work for 5 days after the onset of parotitis.
  1. For healthcare personnel with known or suspected mumps, but without parotitis, exclude from work for 5 days after onset of their first symptom.
  1. During a mumps outbreak, administer mumps vaccine to healthcare personnel in accordance with CDC and ACIP recommendations (https://www.cdc.gov/acip-recs/hcp/vaccine-specific/mmr.html).2

Background

Mumps is an acute viral illness caused by a paramyxovirus. Mumps was a common childhood illness prior to the introduction of the mumps vaccine and the implementation of mumps vaccination policies in 1977. Since then, reports of mumps cases in the US declined significantly. Starting in 2006, there has been an increase in the number of mumps cases and outbreaks reported in the United States. Most of the cases have occurred in fully vaccinated adolescents and young adults, mainly driven by outbreaks on college campuses, close-knit communities, and other congregate settings.345 In the post-vaccination era, mumps transmission in healthcare settings among healthcare personnel (HCP) and patients has been reported.678910 Although transmission of mumps in healthcare settings is infrequent, it may be under-reported because approximately 20% of infected persons can be asymptomatic. The frequency of asymptomatic infection among vaccinated people is unknown.391112131415

Prevention of transmission of the mumps virus in healthcare settings involves (a) ensuring HCP have presumptive evidence of immunity16; (b) using infection prevention and control practices as recommended by CDC (https://www.cdc.gov/infection-control/hcp/isolation-precautions/appendix-a-type-duration.html#M)17; and (c) excluding potentially infectious HCP from work.31819 The criteria for presumptive evidence of immunity to mumps and recommendations for mumps vaccination of HCP are maintained by CDC and ACIP (https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mmr.html).2

Occupational Exposures

Transmission of mumps virus occurs through deposition of respiratory, oral, or nasal secretions from an infected source person on the mucus membranes of a susceptible host.3 An exposure to mumps is generally defined as being within close proximity of an infectious source person (e.g., within approximately 6 feet of the patient) while unprotected (i.e., not wearing recommended personal protective equipment) or having mucous membrane contact with their secretions.3 The risk of virus transmission may increase depending on a number of factors (e.g., decreased room ventilation, increased exposure time, closer proximity to an infectious source person).18

Clinical Features

The symptoms of mumps are fever and parotitis (or other salivary gland swelling), involving pain, tenderness, and swelling in one or both parotid or other salivary glands.39 Mumps infection may present only with nonspecific or primarily respiratory symptoms, or may be asymptomatic; serious complications from mumps infection can occur in the absence of parotitis.39 Complications of mumps include orchitis, oophoritis, mastitis, pancreatitis, hearing loss, meningitis, and encephalitis. Death from mumps is exceedingly rare. Mumps that occurs in pregnant women is not more severe than in women who are not pregnant.20

Parotitis onset is typically 16-18 days after exposure. The incubation period for mumps ranges from 12-25 days.3 Mumps virus has been isolated from seven days before through 14 days after parotitis onset,1921 but most transmission likely occurs 2 days before and within five days of parotitis onset.3 Mumps transmission can occur from persons with asymptomatic infection.315222324

Testing and Diagnosis

Reverse-transcription polymerase chain reaction (RT-PCR) on buccal specimens is the laboratory testing method of choice to confirm mumps.25 The presence of serum mumps IgM can also be used to aid in the diagnosis of mumps infection but is not confirmatory. Laboratory confirmation of mumps in previously vaccinated or infected individuals is challenging because the viral load may be lower and less easily detected and the IgM response may be absent, delayed, or short-lived compared with unvaccinated people.3 More detailed information on testing individuals for mumps is available on the CDC website (https://www.cdc.gov/mumps/php/laboratories/index.html).26

Postexposure Considerations

There is no postexposure prophylaxis (PEP) for mumps. HCP with presumptive evidence of immunity to mumps may have additional doses of vaccine recommended for them during outbreaks.2728 Guidance on outbreak use of the vaccine, including when to administer a third or additional dose of mumps vaccine, are provided on the CDC website (https://www.cdc.gov/mumps/php/public-health-strategy/index.html).29

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  1. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP): TABLE 3. Acceptable presumptive evidence of immunity to measles, rubella, and mumps. Updated June 14, 2023. Accessed April 4, 2023. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm#Tab3
  2. Centers for Disease Control and Prevention. MMR Advisory Committee on Immunization Practices (ACIP) Vaccine Recommendations (Measles, Mumps and Rubella). Updated November 28, 2022. Accessed December 16, 2022. https://www.cdc.gov/acip-recs/hcp/vaccine-specific/mmrv.html
  3. Marlow M, Leung J, Marin M, et al. Chapter 9: Mumps. Centers for Disease Control and Prevention. Updated December 15, 2021. Accessed October 4, 2022, https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-9-mumps.html
  4. Control and Prevention. Mumps Cases and Outbreaks. Updated April 4, 2023. Accessed April 4, 2023. https://www.cdc.gov/mumps/outbreaks/index.html
  5. Centers for Disease Shah M, Quinlisk P, Weigel A, et al. Mumps Outbreak in a Highly Vaccinated University-Affiliated Setting Before and After a Measles-Mumps-Rubella Vaccination Campaign—Iowa, July 2015–May 2016. Clinical Infectious Diseases. 2017;66(1):81-88. doi:10.1093/cid/cix718
  6. Bonebrake A, Silkaitis C, Monga G, et al. Effects of mumps outbreak in hospital, Chicago, Illinois, USA, 2006. Emerging infectious diseases. 2010;16(3):426-432.
  7. Fischer PR, Brunetti C, Welch V, Christenson JC. Nosocomial mumps: report of an outbreak and its control. American journal of infection control. 1996;24(1):13-18.
  8. Gilroy SA, Domachowske JB, Johnson L, et al. Mumps exposure of a health care provider working in a neonatal intensive care unit leads to a hospital-wide effort that prevented an outbreak. Am J Infect Control. Oct 2011;39(8):697-700. doi:10.1016/j.ajic.2010.12.011
  9. Centers for Disease Control and Prevention. Mumps: For Healthcare Providers. Updated March 8, 2021. Accessed October 4, 2022, https://www.cdc.gov/mumps/hcp/clinical-overview/index.html
  10. Wharton M, Cochi SL, Hutcheson RH, Schaffner W. Mumps transmission in hospitals. Archives of Internal Medicine. 1990;150(1):47-49. doi:10.1001/archinte.1990.00390130063006
  11. Mumps epidemic--Iowa, 2006. MMWR Morbidity and mortality weekly report. 2006;55(13):366-368.
  12. Update: mumps outbreak - New York and New Jersey, June 2009-January 2010. MMWR Morbidity and mortality weekly report. 2010;59(5):125-129.
  13. Clemmons NS, Redd SB, Gastañaduy PA, Marin M, Patel M, Fiebelkorn AP. Characteristics of Large Mumps Outbreaks in the United States, July 2010-December 2015. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. May 2 2019;68(10):1684-1690. doi:10.1093/cid/ciy779
  14. Kutty PK, Lawler J, Rausch-Phung E, et al. Epidemiology and the economic assessment of a mumps outbreak in a highly vaccinated population, Orange County, New York, 2009-2010. Human vaccines & immunotherapeutics. 2014;10(5):1373-81. doi:10.4161/hv.28389
  15. Marin M, Quinlisk P, Shimabukuro T, Sawhney C, Brown C, Lebaron CW. Mumps vaccination coverage and vaccine effectiveness in a large outbreak among college students--Iowa, 2006. Vaccine. Jul 04 2008;26(29-30):3601-7. doi:10.1016/j.vaccine.2008.04.075
  16. Centers for Disease Control and Prevention. CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings. Updated November 29, 2022. Accessed April 4, 2023. https://www.cdc.gov/infection-control/hcp/core-practices/index.html
  17. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions: Mumps. Updated July 22, 2019. Accessed February 28, 2023. https://www.cdc.gov/infection-control/hcp/isolation-precautions/appendix-a-type-duration.html#M
  18. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports. Nov 25 2011;60(Rr-7):1-45.
  19. Kutty PK, Kyaw MH, Dayan GH, et al. Guidance for isolation precautions for mumps in the United States: a review of the scientific basis for policy change. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Jun 15 2010;50(12):1619-28. doi:10.1086/652770
  20. Centers for Disease Control and Prevention. Mumps: For Healthcare Providers: Complications. Updated March 8, 2021. Accessed October 4, 2022, https://www.cdc.gov/mumps/hcp/clinical-signs/index.html#cdc_hcp_clinical_complications-complications
  21. Cooney MK, Fox JP, Hall CE. The Seattle Virus Watch. VI. Observations of infections with and illness due to parainfluenza, mumps and respiratory syncytial viruses and Mycoplasma pneumoniae. American journal of epidemiology. Jun 1975;101(6):532-51.
  22. Updated recommendations for isolation of persons with mumps. MMWR Morbidity and mortality weekly report. Oct 10 2008;57(40):1103-5.
  23. Brunell PA, Brickman A, O'Hare D, Steinberg S. Ineffectiveness of isolation of patients as a method of preventing the spread of mumps. Failure of the mumps skin-test antigen to predict immune status. The New England journal of medicine. Dec 19 1968;279(25):1357-61. doi:10.1056/nejm196812192792502
  24. Henle G, Henle W, et al. Isolation of mumps virus from human beings with induced apparent or inapparent infections. The Journal of experimental medicine. Aug 1948;88(2):223-32.
  25. Roush S, Beall B, McGee L, et al. Chapter 22: Laboratory Support for Surveillance of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention. Updated January 11, 2023. Accessed April 4, 2023. https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-22-laboratory-support.html
  26. Centers for Disease Control and Prevention. Mumps: Laboratory Testing for Mumps Infection. Updated March 8, 2021. Accessed October 6, 2022, https://www.cdc.gov/mumps/php/laboratories/index.html
  27. Centers for Disease Control and Prevention. Strategies for the Control and Investigation of Mumps Outbreaks: Recommend a third dose of MMR vaccine for groups at increased risk. Updated June 30, 2021. Accessed October 19, 2022, https://www.cdc.gov/mumps/php/public-health-strategy/index.html#cdc_public_health_strategy_planning_and_prevention-prevention-strategies
  28. Marin M, Marlow M, Moore KL, Patel M. Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus-Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR Morbidity and mortality weekly report. Jan 12 2018;67(1):33-38. doi:10.15585/mmwr.mm6701a7
  29. Centers for Disease Control and Prevention. Strategies for the Control and Investigation of Mumps Outbreaks. Updated June 30, 2021. Accessed October 19, 2022, https://www.cdc.gov/mumps/php/public-health-strategy/index.html