Epidemic mumps (mumps)

Epidemic parotitis (parotitis epidemica; synonyms: mumps infection, mumps, mumps, "trench" disease, "soldier's" disease).

Mumps is an acute, contagious, systemic viral infection typically causing enlargement and tenderness of the salivary glands, most commonly the parotid. Complications include orchitis, meningoencephalitis, and pancreatitis. Diagnosis is clinical; treatment is symptomatic. Vaccination is highly effective.

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Epidemiology

Epidemic mumps (mumps) is traditionally considered a childhood infection. At the same time, epidemic mumps in infants and children under 2 years of age occurs rarely. From 2 to 25 years of age, the disease is very common, it again becomes rare after 40 years. Many doctors classify epidemic mumps as a disease of school age and military service. The incidence rate in the US troops during World War II was 49.1 per 1000 servicemen. In recent years, epidemic mumps in adults has been more common due to mass vaccination of children. In most of the vaccinated, after 5-7 years, the concentration of protective antibodies is significantly reduced. This contributes to an increase in the susceptibility of adolescents and adults to the disease.

The source of the pathogen is a person with epidemic mumps, who begins to excrete the virus 1-2 days before the first clinical symptoms appear and up to the 9th day of the disease. The most active excretion of the virus into the environment occurs in the first 3-5 days of the disease. The virus is excreted from the patient's body with saliva and urine. It has been established that the virus can be found in other biological fluids of the patient: blood, breast milk, cerebrospinal fluid and in affected glandular tissue.

The virus is transmitted by airborne droplets. The intensity of virus release into the environment is low due to the absence of catarrhal phenomena. One of the factors accelerating the spread of the mumps virus is the presence of concomitant acute respiratory infections, in which the release of the pathogen into the environment increases due to coughing and sneezing. The possibility of infection through household items (toys, towels) contaminated with the saliva of the patient cannot be ruled out. A vertical route of transmission of mumps from a sick pregnant woman to the fetus has been described. After the disappearance of symptoms of the disease, the patient is not contagious. Susceptibility to infection is high (up to 100%). The "sluggish" mechanism of transmission of the pathogen, long incubation, a large number of patients with latent forms of the disease, which complicates their detection and isolation, leads to the fact that outbreaks of mumps in children's and adolescent groups are long-term, wave-like over several months. Males suffer from this disease 1.5 times more often than women.

Seasonality is typical: the maximum incidence occurs in March-April, the minimum - in August-September. Among the adult population, epidemic outbreaks are most often recorded in closed and semi-closed communities - barracks, dormitories, ship crews. Increases in incidence are noted with a frequency of 7-8 years. Epidemic parotitis (mumps) is classified as a controllable infection. After the introduction of immunization into practice, the incidence rate has significantly decreased, but only in 42% of countries in the world is vaccination against epidemic parotitis included in national vaccination calendars. Due to the constant circulation of the virus v 80-90% of people over 15 years of age have anti-parotitis antibodies. This indicates a wide spread of this infection, and it is believed that in 25% of cases, epidemic parotitis occurs inapparently. After the disease, patients develop persistent lifelong immunity, recurrent diseases are extremely rare.

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Causes mumps

The cause of epidemic parotitis (mumps) is the Pneumophila parotiditis virus, pathogenic for humans and monkeys.

Belongs to paramyxoviruses (family Pammyxoviridae, genus Rubulavirus). Antigenically close to parainfluenza virus. The genome of the mumps virus is represented by single-stranded helical RNA surrounded by a nucleocapsid. The virus is characterized by pronounced polymorphism: in shape it represents round, spherical or irregular elements, and the size can vary from 100 to 600 nm. It has hemolytic. neuraminidase and hemagglutinating activity associated with glycoproteins HN and F. The virus is well cultivated on chicken embryos, guinea pig kidney culture, monkeys, Syrian hamster, and human amnion cells, is unstable in the environment, inactivated by high temperatures, ultraviolet radiation, drying, and is quickly destroyed in disinfectant solutions (50% ethyl alcohol, 0.1% formalin solution, etc.). At low temperatures (-20 °C), it can persist in the environment for up to several weeks. The antigenic structure of the virus is stable. Only one serotype of the virus is known, which has two antigens: V (viral) and S (soluble). The optimal pH of the environment for the virus is 6.5-7.0. Of laboratory animals, monkeys are the most sensitive to the mumps virus. in whom it is possible to reproduce the disease by introducing virus-containing material into the salivary gland duct.

The virus enters the respiratory tract and mouth. It is present in saliva for up to 6 days, until the salivary gland swells. It is also found in blood and urine, in the cerebrospinal fluid when the central nervous system is affected. The disease leads to permanent immunity.

Mumps is less contagious than measles. The disease is endemic in densely populated areas, and outbreaks may occur in organized communities. Epidemics are more common in non-immunized populations, with a peak in early spring and late winter. Mumps occurs at any age, but most often between 5 and 10 years of age; it is uncommon in children under 2 years of age, especially under 1 year of age. 25-30% of cases are inapparent forms.

Other causes of enlarged salivary glands:

• Purulent mumps
• HIV-mumps
• Other viral mumps
• Metabolic disorders (uremia, diabetes mellitus)
• Mikulicz syndrome (chronic, usually painless mumps and swelling of the lacrimal glands of unknown origin that develops in patients with tuberculosis, sarcoidosis, SLE, leukemia, lymphosarcoma)
• Malignant and benign tumor of the salivary gland
• Drug-mediated mumps (eg, due to iodides, phenylbutazone, or propylthiouracil)

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Pathogenesis

The mumps virus enters the body through the mucous membrane of the upper respiratory tract and conjunctiva. It has been experimentally shown that application of the virus to the mucous membrane of the nose or cheek leads to the development of the disease. After entering the body, the virus multiplies in the epithelial cells of the respiratory tract and is carried with the bloodstream to all organs, of which the most sensitive are the salivary, genital and pancreatic glands, as well as the central nervous system. Hematogenous spread of the infection is indicated by early viremia and damage to various organs and systems remote from each other. The viremia phase does not exceed five days. Damage to the central nervous system and other glandular organs can occur not only after, but also simultaneously, earlier and even without damage to the salivary glands (the latter is observed very rarely).

The nature of morphological changes in the affected organs has not been sufficiently studied. It has been established that the damage to connective tissue predominates, rather than glandular cells. At the same time, the acute period is characterized by the development of edema and lymphocytic infiltration of the interstitial space of the glandular tissue, but the mumps virus can simultaneously affect the glandular tissue itself. A number of studies have shown that in orchitis, in addition to edema, the parenchyma of the testicles is also affected. This causes a decrease in androgen production and leads to a violation of spermatogenesis. A similar nature of the lesion has been described for pancreatic damage, which can result in atrophy of the islet apparatus with the development of diabetes mellitus.

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Symptoms mumps

Epidemic parotitis (mumps) does not have a generally accepted classification. This is explained by the different interpretations of the disease manifestations by specialists. A number of authors believe that the symptoms of epidemic parotitis (mumps) are a consequence of damage to the salivary glands, and damage to the nervous system and other glandular organs are complications or manifestations of an atypical course of the disease.

The position is pathogenetically substantiated, according to which lesions of not only the salivary glands, but also other localizations caused by the epidemic mumps virus should be considered precisely as symptoms of epidemic mumps (mumps), and not complications of the disease. Moreover, they can manifest in isolation without damage to the salivary glands. At the same time, lesions of various organs as isolated manifestations of mumps infection are rarely observed (atypical form of the disease). On the other hand, the erased form of the disease, which was diagnosed before the start of routine vaccination during almost every outbreak of the disease in a child and adolescent group and during routine examinations, cannot be considered atypical. Asymptomatic infection is not considered a disease. The classification should also reflect the frequent adverse remote consequences of epidemic mumps. Severity criteria are not included in this table, since they are completely different for different forms of the disease and have no nosological specificity. Complications of epidemic parotitis (mumps) are rare and do not have characteristic features, therefore they are not considered in the classification.

The incubation period of epidemic parotitis (mumps) is from 11 to 23 days (usually 18-20). Often, the full picture of the disease is preceded by a prodromal period.

In some patients (more often in adults), 1-2 days before the development of a typical picture, prodromal symptoms of epidemic parotitis (mumps) are observed in the form of fatigue, malaise, hyperemia of the oropharynx, muscle pain, headache, sleep and appetite disorders. Acute onset, chills and an increase in temperature to 39-40 ° C are typical. Early symptoms of epidemic parotitis (mumps) are pain behind the earlobe (Filatov's symptom). Swelling of the parotid gland often appears by the end of the day or on the second day of the disease, first on one side, and after 1-2 days in 80-90% of patients - on the other. In this case, tinnitus, pain in the ear area, increasing with chewing and talking, trismus is possible are usually noted. The enlargement of the parotid gland is clearly visible. The gland fills the fossa between the mastoid process and the lower jaw. With a significant increase in the parotid gland, the auricle protrudes and the earlobe rises upward (hence the popular name "mumps"). The swelling spreads in three directions: forward - to the cheek, downward and backward - to the neck and upward - to the mastoid process. The swelling is especially noticeable when examining the patient from the back of the head. The skin over the affected gland is tense, normal in color, when palpated, the gland has a dough consistency, moderately painful. The swelling reaches its maximum on the 3rd-5th day of the disease, then gradually decreases and disappears, usually on the 6th-9th day (in adults on the 10th-16th day). During this period, salivation is reduced, the mucous membrane of the oral cavity is dry, patients complain of thirst. Stenon's duct is clearly visible on the mucous membrane of the cheek as a hyperemic edematous ring (Mursu's symptom). In most cases, not only the parotid, but also the submandibular salivary glands are involved in the process, which are determined as slightly painful spindle-shaped swellings of a doughy consistency; when the sublingual gland is affected, swelling is noted in the chin area and under the tongue. Damage to only the submandibular (submaxillitis) or sublingual glands is extremely rare. Internal organs in isolated mumps are usually unchanged. In some cases, patients experience tachycardia, murmur at the apex and muffled heart sounds, and hypotension. CNS damage is manifested by headache, insomnia, and adynamia. The total duration of the febrile period is usually 3-4 days. In severe cases, up to 6-9 days.

A common symptom of epidemic parotitis (mumps) in adolescents and adults is testicular damage (orchitis). The incidence of mumps orchitis directly depends on the severity of the disease. In severe and moderate forms, it occurs in approximately 50% of cases. Orchitis without damage to the salivary glands is possible. Signs of orchitis are noted on the 5th-8th day of the disease against the background of a decrease and normalization of temperature. In this case, the condition of patients worsens again: the body temperature rises to 38-39 ° C, chills, headache, nausea and vomiting are possible. Severe pain in the scrotum and testicle is noted, sometimes radiating to the lower abdomen. The testicle increases in size 2-3 times (to the size of a goose egg), becomes painful and dense, the skin of the scrotum is hyperemic. often - with a bluish tint. Most often, one testicle is affected. Expressed clinical manifestations of orchitis persist for 5-7 days. Then the pain disappears, the testicle gradually decreases in size. Later, signs of its atrophy can be noted. Almost 20% of patients have orchitis combined with epididymitis. The epididymis is palpated as an elongated painful swelling. This condition leads to a violation of spermatogenesis. Data have been obtained on the erased form of orchitis, which can also be a cause of male infertility. In mumps orchitis, pulmonary infarction due to thrombosis of the veins of the prostate and pelvic organs has been described. An even rarer complication of mumps orchitis is priapism. Women may develop oophoritis, bartholinitis, mastitis. Oophoritis is uncommon in female patients in the postpubertal period, which does not affect fertility and does not lead to sterility. It should be noted that mastitis can also develop in men.

A common symptom of epidemic parotitis (mumps) is acute pancreatitis, which is often asymptomatic and diagnosed only on the basis of increased amylase and diastase activity in the blood and urine. The incidence of pancreatitis, according to various authors, varies widely - from 2 to 50%. It most often develops in children and adolescents. Such a range of data is due to the use of different criteria for diagnosing pancreatitis. Pancreatitis usually develops on the 4th-7th day of the disease. Nausea, repeated vomiting, diarrhea, and girdle-like pain in the middle of the abdomen are observed. With severe pain syndrome, abdominal muscle tension and symptoms of peritoneal irritation are sometimes noted. A significant increase in amylase (diastase) activity is characteristic. persisting for up to one month, while other symptoms of the disease disappear after 5-10 days. Damage to the pancreas can lead to atrophy of the islet apparatus and the development of diabetes.

In rare cases, other glandular organs may be affected, usually in combination with the salivary glands. Thyroiditis, parathyroiditis, dacryoadenitis, and thymoiditis have been described.

Damage to the nervous system is one of the frequent and significant manifestations of mumps infection. Serous meningitis is most often observed. Meningoencephalitis, cranial nerve neuritis, and polyradiculoneuritis are also possible. The symptoms of mumps meningitis are polymorphic, so the only diagnostic criterion can be the detection of inflammatory changes in the cerebrospinal fluid.

There may be cases of epidemic parotitis, occurring with meningism syndrome, with intact cerebrospinal fluid. On the contrary, inflammatory changes in the cerebrospinal fluid are often noted without the presence of meningeal symptoms, therefore, according to various authors, the data on the frequency of meningitis vary from 2-3 to 30%. Meanwhile, timely diagnosis and treatment of meningitis and other CNS lesions significantly affects the remote consequences of the disease.

Meningitis is most often observed in children aged 3-10 years. In most cases, it develops on the 4th-9th day of the disease, i.e. at the height of the damage to the salivary glands or against the background of the disease subsiding. However, it is also possible for symptoms of meningitis to appear simultaneously with damage to the salivary glands or even earlier. There are cases of meningitis without damage to the salivary glands, in rare cases - in combination with pancreatitis. The onset of meningitis is characterized by a rapid increase in body temperature to 38-39.5 ° C, accompanied by an intense headache of a diffuse nature, nausea and frequent vomiting, hyperesthesia of the skin. Children become lethargic, adynamic. Already on the first day of the disease, meningeal symptoms of epidemic parotitis (mumps) are noted, which are expressed moderately, often not in full, for example, only the symptom of landing ("tripod"). In young children, convulsions and loss of consciousness are possible; in older children, psychomotor agitation, delirium, and hallucinations. General cerebral symptoms usually regress within 1-2 days. If they persist for a longer period, this indicates the development of encephalitis. Intracranial hypertension with an increase in LD to 300-600 mm H2O plays a significant role in the development of meningeal and general cerebral symptoms. Careful dropwise evacuation of cerebrospinal fluid during lumbar puncture to a normal LD level (200 mm H2O) is accompanied by a marked improvement in the patient's condition (cessation of vomiting, clearing of consciousness, reduction in headache intensity).

Cerebrospinal fluid in mumps meningitis is transparent or opalescent, pleocytosis is 200-400 in 1 μl. Protein content is increased to 0.3-0.6/l, sometimes up to 1.0-1.5/l. Decreased or normal protein levels are rarely observed. Cytosis is usually lymphocytic (90% and above), on the 1-2nd days of the disease it can be mixed. The concentration of glucose in the blood plasma is within normal values or increased. Sanitation of the cerebrospinal fluid occurs later than the regression of the meningeal syndrome, by the 3rd week of the disease, but can be delayed, especially in older children, up to 1-1.5 months.

In meningoencephalitis, 2-4 days after the development of meningitis, against the background of weakening meningeal symptoms, general cerebral symptoms increase, focal symptoms appear: smoothing of the nasolabial fold, deviation of the tongue, increased tendon reflexes, anisoreflexia, muscle hypertonia, pyramidal signs, symptoms of oral automatism, clonus of the feet, ataxia, intention tremor, nystagmus, transient hemiparesis. In young children, cerebellar disorders are possible. Mumps meningitis and meningoencephalitis are benign. As a rule, complete restoration of CNS functions occurs. However, intracranial hypertension may sometimes persist. asthenia, decreased memory, attention, hearing.

Against the background of meningitis, meningoencephalitis, sometimes in isolation, it is possible to develop neuritis of the cranial nerves, most often the VIII pair. In this case, dizziness, vomiting, which intensify with a change in body position, nystagmus are noted. Patients try to lie still with their eyes closed. These symptoms are associated with damage to the vestibular apparatus, but cochlear neuritis is also possible, which is characterized by the appearance of noise in the ear, hearing loss, mainly in the high-frequency zone. The process is usually one-sided, but often complete hearing recovery does not occur. It should be borne in mind that with severe mumps, short-term hearing loss is possible due to swelling of the external auditory canal.

Polyradiculoneuritis develops against the background of meningitis or meningoencephalitis. It is always preceded by damage to the salivary glands. In this case, the appearance of radicular pain and symmetrical paresis, mainly of the distal parts of the limbs, is characteristic, the process is usually reversible, and damage to the respiratory muscles is also possible.

Sometimes, usually on the 10th-14th day of the disease, more often in men, polyarthritis develops. Large joints (shoulders, knees) are mainly affected. Symptoms of epidemic parotitis (mumps) are usually reversible, ending in full recovery within 1-2 weeks.

Complications (tonsillitis, otitis, laryngitis, nephritis, myocarditis) are extremely rare. Blood changes in epidemic parotitis are insignificant and are characterized by leukopenia, relative lymphocytosis, monocytosis, increased ESR, in adults leukocytosis is sometimes noted.

Forms

The clinical classification of epidemic mumps includes the following clinical forms.

• Typical.
  • With isolated damage to the salivary glands:
    • clinically expressed:
    • erased.
  • Combined:
    • with damage to the salivary glands and other glandular organs;
    • with damage to the salivary glands and nervous system.
• Atypical (without damage to the salivary glands).
  • With damage to glandular organs.
  • With damage to the nervous system.
• Outcomes of the disease.
  • Complete recovery.
  • Recovery with residual pathology:
    • diabetes mellitus;
    • infertility:
    • CNS damage.

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Diagnostics mumps

Diagnosis of epidemic parotitis (mumps) is based mainly on the characteristic clinical picture and epidemiological anamnesis, and in typical cases does not cause difficulties. Of the laboratory methods for confirming the diagnosis, the most reliable is the isolation of the epidemic parotitis virus from blood, parotid gland secretion, urine, cerebrospinal fluid and pharyngeal swabs, but in practice this is not used.

In recent years, serological diagnostics of epidemic parotitis (mumps) has been used more often; ELISA, RSK and RTGA are most often used. A high titer of IgM and a low titer of IgG in the acute period of infection can serve as a sign of epidemic parotitis. The diagnosis can be finally confirmed in 3-4 weeks by repeated testing of the antibody titer, while an increase in the IgG titer by 4 times or more has diagnostic value. When using RSK and RTGA, cross-reactions with the parainfluenza virus are possible.

Recently, diagnostics of epidemic parotitis (mumps) using PCR of the epidemic parotitis virus have been developed. For diagnostics, amylase and diastase activity in blood and urine are often determined, the content of which increases in most patients. This is especially important not only for diagnosing pancreatitis, but also for indirect confirmation of the parotitis etiology of serous meningitis.

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Differential diagnosis

Differential diagnostics of epidemic parotitis is primarily carried out with bacterial parotitis, salivary stone disease. Enlargement of the salivary glands is also noted in sarcoidosis and tumors. Mumps meningitis is differentiated from serous meningitis of enteroviral etiology, lymphocytic choriomeningitis, and sometimes tuberculous meningitis. In this case, an increase in the activity of pancreatic enzymes in the blood and urine in mumps meningitis is of particular importance. The greatest danger is posed by cases when swelling of the subcutaneous tissue of the neck and lymphadenitis, which occurs in toxic forms of diphtheria of the oropharynx (sometimes in infectious mononucleosis and herpesvirus infections), is mistaken by the doctor for parotitis. Acute pancreatitis should be differentiated from acute surgical diseases of the abdominal cavity (appendicitis, acute cholecystitis).

Mumps orchitis is differentiated from tuberculous, gonorrheal, traumatic and brucellosis orchitis.

Symptoms of intoxication

Eat

Pain when chewing and opening the mouth in the area of the salivary glands

Eat

Enlargement of one or more salivary glands (parotid, submandibular)

Eat

Simultaneous damage to the salivary glands and pancreas, testicles, mammary glands, development of serous meningitis

Eat

The study is complete. Diagnosis: epidemic mumps.

If there are neurological symptoms, a consultation with a neurologist is indicated; if pancreatitis develops (abdominal pain, vomiting), a surgeon; if orchitis develops, a urologist.

Signs	Nosological form
	Epidemic mumps	Bacterial mumps	Sialolithiasis
Start	Spicy	Spicy	Gradual
Fever	Precedes local changes	Appears simultaneously or later than local changes	Not typical
One-sidedness of defeat	Bilateral possible damage to other salivary glands	Usually one-sided	Usually one-sided
Pain	Not typical	Characteristic	Stabbing, paroxysmal
Local pain	Minor	Expressed	Minor
Consistency	Dense	Dense in the future - fluctuation	Dense
Stenon's duct	Mursu's Symptom	Hyperemia, purulent discharge	Mucous discharge
Blood picture	Leukopenia lymphocytosis ESR - no changes	Neutrophilic leukocytosis with a left shift. Increased ESR	No characteristic changes
Skin over the gland	Normal color, tense	Hyperemic	Not changed

Treatment mumps

Patients from closed children's groups (orphanages, boarding schools, military units) are hospitalized. As a rule, treatment of epidemic parotitis (mumps) is carried out at home. Hospitalization is indicated in severe cases of the disease (hyperthermia over 39.5 ° C, signs of damage to the central nervous system, pancreatitis, orchitis). In order to reduce the risk of complications, regardless of the severity of the disease, patients must remain in bed throughout the entire period of fever. It has been shown that in men who did not remain in bed during the first 10 days of the disease, orchitis developed 3 times more often. In the acute period of the disease (up to the 3-4th day of the disease), patients should receive only liquid and semi-liquid food. Given the salivation disorders, much attention should be paid to oral care, and during the recovery period, it is necessary to stimulate saliva secretion, using, in particular, lemon juice. A dairy and plant-based diet is advisable for the prevention of pancreatitis (table No. 5). Drinking plenty of fluids (fruit drinks, juices, tea, mineral water) is recommended. For headaches, metamizole sodium, acetylsalicylic acid, and paracetamol are prescribed. Desensitizing treatment of epidemic parotitis (mumps) is advisable. To reduce local manifestations of the disease in the area of the salivary glands, photothermotherapy (Sollux lamp) is prescribed. For orchitis, prednisolone is used for 3-4 days at a dose of 2-3 mg / kg per day, followed by a decrease in the dose by 5 mg daily. Wearing a suspensory for 2-3 weeks is mandatory to ensure an elevated position of the testicles. In acute pancreatitis, a gentle diet is prescribed (on the first day - a starvation diet). Cold on the stomach is indicated. To reduce pain, analgesics are administered, aprotinin is used. If meningitis is suspected, a lumbar puncture is indicated, which has not only diagnostic but also therapeutic value. In this case, analgesics, dehydration therapy using furosemide (lasix) at a dose of 1 mg / kg per day, acetazolamide are also prescribed. In case of pronounced general cerebral syndrome, dexamethasone is prescribed at 0.25-0.5 mg / kg per day for 3-4 days; in case of meningoencephalitis - nootropic drugs in courses of 2-3 weeks.

Approximate periods of incapacity for work

The period of incapacity for work is determined depending on the clinical course of epidemic mumps, the presence of meningitis and meningoencephalitis, pancreatitis, orchitis and other specific lesions.

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Clinical examination

Epidemic parotitis (mumps) does not require medical examination. It is carried out by an infectious disease specialist depending on the clinical picture and the presence of complications. If necessary, specialists of other specialties are involved (endocrinologists, neurologists, etc.).

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Prevention

Patients with epidemic mumps are isolated from children's groups for 9 days. Contact persons (children under 10 who have not had epidemic mumps and are not vaccinated) are subject to isolation for a period of 21 days, and in cases where the exact date of contact is established - from the 11th to the 21st day. Wet cleaning of the premises is carried out using disinfectants and ventilation of the premises. Children who have had contact with the patient are placed under medical supervision for the period of isolation.

The basis of prevention is vaccination within the framework of the national calendar of preventive vaccinations. Vaccination is carried out with a mumps culture live dry vaccine taking into account contraindications at 12 months and revaccination at 6 years. The vaccine is administered subcutaneously in a volume of 0.5 ml under the shoulder blade or on the outer surface of the shoulder. After the administration of the vaccine, a short-term fever, catarrhal phenomena for 4-12 days, very rare - an increase in the salivary glands and serous meningitis are possible. For emergency prevention of those not vaccinated against epidemic mumps and those who have not had the vaccine, the vaccine is administered no later than 72 hours after contact with a patient. Mumps-measles culture live dry vaccine and a live attenuated lyophilized vaccine against measles, mumps and rubella (made in India) are also certified.

Mumps immunoglobulin and serum immunoglobulin are ineffective. Vaccination with live mumps vaccine, which does not cause local systemic reactions and requires only one injection, is effective; vaccination against measles, mumps and rubella is carried out. Post-exposure vaccination does not protect against mumps.

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Forecast

Uncomplicated mumps usually resolves, although relapse may occur within 2 weeks. Mumps usually has a favorable prognosis, although sequelae such as unilateral (rarely bilateral) hearing loss or facial paralysis may persist. Rarely, postinfectious encephalitis, acute cerebellar ataxia, transverse myelitis, and polyneuritis occur.

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