Although fairly un­com­mon, mumps out­breaks still oc­cur

The Progress-Index Weekend - - AMUSEMENTS - DR. EL­IZ­A­BETH KO & DR. EVE GLAZIER --Eve Glazier, M.D., MBA, is an in­ternist and as­sis­tant pro­fes­sor of medicine at UCLA Health. El­iz­a­beth Ko, M.D., is an in­ternist and pri­mary care physi­cian at UCLA Health.

Dear Doc­tor: I'm 79 years old and re­cently con­tracted mumps. I've never been so ill, and in fact, I am still suf­fer­ing the af­ter­ef­fects. Please help other older adults un­der­stand whether they should get the mumps vac­cine.

Dear Reader: Although mumps is nowhere near as com­mon in the United States as it once was, out­breaks con­tinue to oc­cur. Last year, mumps cases hit a 10-year high with 6,366 re­ported to the Cen­ters for Dis­ease Con­trol and Prevention. In 2012, there were just 229 cases. By con­trast, prior to 1967, when the mumps vac­ci­na­tion pro­gram was launched, about 186,000 cases were re­ported each year. How­ever, that num­ber is prob­a­bly too low due to un­der­re­port­ing.

Mumps is caused by a virus that spreads via con­tact with saliva or mu­cus from the mouth, nose or throat of an in­fected per­son. It is car­ried via air­borne droplets from the up­per res­pi­ra­tory tract through cough­ing, sneez­ing or even talk­ing. The virus can also be trans­ferred through shared items like plates, cups and cut­lery, and on ob­jects or sur­faces that have been touched by the un­washed hands of the in­fected per­son.

As with many con­ta­gious diseases, the in­fected per­son be­gins shed­ding the virus be­fore symp­toms be­come ap­par­ent. He or she will con­tinue to be con­ta­gious for up to five days af­ter be­com­ing vis­i­bly ill. These symp­toms in­clude fever, headache, body aches and pains, ex­haus­tion and lack of ap­petite. Swollen and ten­der sali­vary glands in front of one or both ears give suf­fer­ers the puffy cheeks and swollen jaw that is as­so­ci­ated with the dis­ease. Some pa­tients ex­pe­ri­ence hear­ing loss, but it is rarely per­ma­nent.

Adults who get mumps are at greater risk for com­pli­ca­tions than are chil­dren. These can in­clude in­flam­ma­tion of: the mem­brane around the brain or spinal cord (known as menin­gi­tis), the tes­ti­cles, breast tis­sue, ovaries or pan­creas. The most se­ri­ous com­pli­ca­tion is en­cephali­tis, which is in­flam­ma­tion of the brain it­self. It can lead to per­ma­nent dis­abil­ity or even death.

Mumps can be pre­vented with the MMR vac­cine, which also con­fers im­mu­nity to measles and rubella.

The CDC rec­om­mends two doses of the vac­cine for chil­dren, the first at 12 to 15 months of age, and the sec­ond at 4 to 6 years of age. Teens and adults should also stay cur­rent on MMR vac­ci­na­tions. Preg­nant women should not get the vac­cine, and women should wait at least four weeks af­ter vac­cine ad­min­is­tra­tion be­fore be­com­ing preg­nant.

Be­cause a num­ber of cases of mumps have oc­curred in peo­ple who have had the two-dose vac­cine, there is now a de­bate about whether im­mu­nity con­fers through adult­hood. A re­cent study in the New Eng­land Jour­nal of Medicine an­a­lyzed data from a mumps out­break at the Univer­sity of Iowa dur­ing the 2015-2016 school year. Stu­dents who had a mumps booster had a 78.1 per­cent lower risk of mumps than those with the just the two­dose vac­cine. To ad­dress wan­ing im­mu­nity, re­searchers sug­gest that a mumps booster may be called for.

We ad­vo­cate for vac­ci­na­tion and help our pa­tients stay cur­rent. And for any­one with ques­tions or con­cerns about the vac­cine, please do talk to your pri­mary care physi­cian.

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