Mumps
Mumps is a contagious viral disease that causes painful enlargement of the salivary glands, most commonly the parotids. Mumps is sometimes known as epidemic parotitis and occurs most often in children between the ages of 4 and 14.
Mumps was first described by Hippocrates (c.460–c.370 B.C.), who observed that the diseases occurred most commonly in young men, a fact that he attributed to their congregating at sports grounds. Women, who were inclined to be isolated in their own homes, were seldom taken ill with the disease. Over the centuries, medical writers paid little attention to mumps. Occasionally, mention was made of a local epidemic of the disease, as recorded in Paris, France, in the sixteenth century by Guillaume de Baillou (1538–1616). Most physicians believed that the disease was contagious, but no studies were made to confirm this suspicion. The first detailed scientific description of mumps was provided by the British physician Robert Hamilton (1721–1793) in 1790. Hamilton's paper in the Transactions of the Royal Society of Edinburgh finally made the disease well known among physicians. Efforts to prove the contagious nature of mumps date around 1913. In that year, two French physicians, Charles-Jean-Henri Nicolle (1866–1936) and Ernest Alfred Conseil, attempted to transmit mumps from humans to monkeys, but were unable to obtain conclusive results. Eight years later, Martha Wollstein injected viruses taken from the saliva of a mumps patient into cats, producing inflammation of the parotid, testes, and brain tissue in the cats. Conclusive proof that mumps is transmitted by a filterable virus was finally obtained by two American researchers, Claude D. Johnson and Ernest William Goodpasture (1886–1960), in 1934.
The mumps virus has an incubation period of 12-28 days with an average of 18 days. Pain and swelling in the region of one parotid gland, accompanied by some fever, is the characteristic initial presenting feature. About five days later, the other parotid gland may become affected while the swelling in the first gland has mainly subsided. In most children, the infection is mild and the swelling in the salivary glands usually disappears within two weeks. Occasionally, there is no obvious swelling of the glands during the infection. Children with mumps are infectious from days one to three before the parotid glands begin to swell, and remain so until about seven days after the swelling has disappeared. The disease can be transmitted through respiratory droplets. There are occasional complications in children with mumps. In the central nervous system (CNS), a rare complication is asceptic meningitis or encephalitis. This usually has an excellent prognosis. In about 20% of post-pubertal males, orchitis may arise as a complication and, rarely, can lead to sterility. A very rare additional complication is pancreatitis, which may require treatment and hospitalization.
The diagnosis of mumps in children is usually made on the basis of its very characteristic symptoms. The virus can be cultured, however, and can be isolated from a patient by taking a swab from the buccal (mouth) outlet of the parotid gland duct. The swab is then broken off into viral transport medium. Culture of the virus is rarely necessary in a straightforward case of mumps parotitis. Occasionally, it is necessary to isolate the virus from the cerebro-spinal fluid (CSF) of patients with CNS complications such as mumps meningitis. Also, serological investigations may be useful in aseptic meningitis and encephalitis.
A vaccine for mumps was developed by the American microbiologist, John Enders, in 1948. During World War II, Enders had developed a vaccine using a killed virus, but it was only moderately and temporarily successful. After the war, he began to investigate ways of growing mumps virus in a suspension of minced chick embryo and ox blood. The technique was successful and Enders' live virus vaccine is now routinely used to vaccinate children. In the U.S.A., the live attenuated mumps vaccine is sometimes given alone or together with measles and/or rubella vaccine. The MMR vaccine came under investigation with regard to a possible link to autism in children. The United States Centers for Disease Control concludes that current scientific evidence does not support any hypothesis that the MMR vaccine causes any form of autism. The hypothetical relationship, however, did discourage and continues to discourage some parents from allowing their children to receive the triple vaccine.
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