Which client/parent education would the nurse include about a potential complication of mumps?

Pathophysiology

Mumps is caused by a paramyxovirus, which is a single-strand RNA virus in the Rubulavirus genus in the family Paramyxoviridae, order Mononegavirales. Paramyxoviruses have a negative-sense nonsegmented RNA genome, which means they first must be transcribed into a positive-sense RNA that acts as an mRNA. It is an animal virus that is unable to replicate outside a living animal cell.5 These viral particles spread to other organs through the circulatory and lymphatic systems. Two immune defenses

Epidemiology

Historically a young childhood illness, many patients currently being diagnosed with mumps are now school-age or college students.3 Globally, there were more than 560,000 cases reported between 2005 and 2010.11 In 2006, a multistate mumps outbreak in the United States, affected more than 6,500 college students clustering in the Midwest. In 2009 and 2010, 2 large outbreaks occurred, 1 in high school students in New York City and the other affecting school-age children in the US territory of

Transmission

Respiratory droplets or saliva containing the mumps virus enters through the nose or mouth, with an incubation period of 12–25 days.3, 10 Parotitis, the hallmark of mumps, typically develops between 16 and 18 days postexposure.3, 10 The mumps virus in excreted in the saliva 1 week before and up to 1 week after the onset of parotitis, although the period of maximal transmissibility occurs before parotitis.10 Although one-third to one-half of infected individuals may be asymptomatic, the virus

Prevention

Immunity is the most effective way to prevent mumps.12 Before routine vaccination, 90% of all children had acquired mumps by age 15 months, resulting in lifelong immunity,2, 10 This lifelong immunity was demonstrated in 95% of adults who had the mumps virus as a child and were noted to have serological markers to mumps.10 The mumps vaccination was initially licensed in 1967 as a stand-alone vaccine. Despite the vaccine, the incidence of mumps remained high, occurring in annual or biannual

Clinical Presentation

Mumps is characterized by painful, unilateral, or bilateral swelling of the salivary glands, in particular, the parotid glands.10 The most common form of parotitis is called “epidemic parotitis” and is more commonly referred to as “mumps.” There are 2 distinct phases of mumps, the prodromal phase and swelling phase. The prodromal phase typically presents with initial onset of mild systemic symptoms such as low-grade fever, headache, myalgia, neck pain, malaise, and poor appetite.16, 17 Fever

Differential Diagnoses

Although mumps should be at the top of the list of differential diagnoses when a client presents with fever and unilateral or bilateral parotitis, there are other viral and bacterial illnesses that can cause fever and parotitis.5, 18, 19 Influenza, echovirus, adenovirus, cytomegalovirus, and coxsackievirus A are examples of viral illnesses that symptomatically may mimic mumps.19 Other infections such as strep throat and mononucleosis may be initially confused with mumps but can be quickly ruled

Diagnosis and Reporting

Mumps is often diagnosed primarily on clinical evaluation. A careful history of present illness and immunization verification is necessary for any patient presenting with parotitis and fever. Laboratory testing is not necessary to make a diagnosis but is strongly recommended for public health purposes. The CDC recommends providers collect a buccal swab specimen and a blood specimen for viral detection via reverse transcription polymerase chain reaction and serologic testing from all patients

Treatment

As with most viral infections, treatment consists mainly of antipyretics and pain relief. This is often achieved by using over-the-counter nonsteroidal antiinflammatory drugs.2 Warm salt-water gargles may assist in reducing pain. Intermittent application of heat or ice to affected areas may also assist in alleviating pain from parotitis. Dietary modifications include soft foods and avoidance of food and liquids that are sour or highly acidic. Increasing fluids and maintaining electrolyte

Complications

Most cases of mumps are self-limiting and resolve within 10 days. However, complications from the mumps can occur in 10%–40% of infected individuals.20, 21 The most common complication is orchitis, followed by meningitis. Less common complications include pancreatitis, encephalitis, deafness, mastitis, oophoritis, and facial Bell palsy (Table).22 Individuals who have received a single mumps vaccine have a lower incidence of complications than those who have not been vaccinated. Additionally,

Patient Education

Prevention of mumps through vaccination is currently the best protection. Nurse practitioners must be willing to listen to parent’s concerns regarding safety of the mumps vaccine and adequately address those concerns. Although most individuals with mumps only experience symptoms of mild to moderate pain and fever with no sequela, complications from mumps can occur in up to 40% of individuals infected. Individuals not fully immunized against mumps are at a higher risk of complications than those

Conclusion

Mumps remains a common disease in many areas of the world.3 Global travel can contribute to the spread of the virus among vaccinated and unvaccinated populations alike, but vaccination is still our best defense for prevention and eradication of the mumps. There are several important things for nurse practitioners to remember about the mumps virus as it relates to primary care practice. The paramyxovirus is transmitted by respiratory droplets and thus is a reportable illness. Mumps has a 2- to

Marilou Shreve, DNP, CPNP, is an assistant professor at Eleanor Mann School of Nursing, University of Arkansas, Fayetteville, Arkansas. Dr Shreve is available at [email protected].

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