MUMPS

Mumps is a viral infection caused by the mumps virus, which belongs to the Paramyxovirus family. It primarily affects the salivary glands, causing swelling and pain around the cheeks and jaw. Mumps is highly contagious and spreads through respiratory droplets or saliva from an infected person. 

Transmission and Contagiousness

• Mumps spreads through respiratory droplets when an infected person coughs, sneezes, or talks. It can also spread through direct contact with saliva or mucus from an infected person.
• The virus can survive on surfaces and objects for several hours, increasing the risk of transmission in close-contact settings like schools, daycares, and crowded areas.
• People infected with mumps are most contagious from a few days before symptoms appear to about five days after the onset of swollen glands.

Symptoms of Mumps

• The hallmark symptom of mumps is swelling and tenderness of the salivary glands, especially the parotid glands located below and in front of the ears. This swelling gives the characteristic "chipmunk cheeks" appearance.
• Other common symptoms include fever, headache, muscle aches, fatigue, loss of appetite, and pain while chewing or swallowing.
• In some cases, mumps can lead to complications such as inflammation of the testicles (orchitis) in males, inflammation of the ovaries (oophoritis) in females, meningitis, encephalitis, and deafness.

Diagnosis and Treatment

• Diagnosis of mumps is usually based on clinical symptoms such as parotid gland swelling and a history of exposure to the virus.
• Laboratory tests, including viral culture, polymerase chain reaction (PCR), and blood tests to detect mumps-specific antibodies, may be conducted to confirm the diagnosis.
• There is no specific antiviral treatment for mumps. Treatment focuses on relieving symptoms through rest, pain relievers (not aspirin for children due to the risk of Reye's syndrome), and staying hydrated.
• Most people recover from mumps without complications within a few weeks.

• The absence of the mumps vaccine from the National Immunization Programme (NIP) in India is a topic of discussion among healthcare experts and policymakers. Despite being a preventable disease through vaccination, several factors contribute to its exclusion.
• One primary reason for mumps not being included in the Universal Immunization Programme (UIP) is its historically low mortality rates and the perception that it has limited public health impact compared to other vaccine-preventable diseases like measles and polio.
• The Indian Academy of Paediatrics (IAP) has emphasised that the true public health significance of mumps may be underestimated due to inadequate documentation of clinical cases, complications, and long-term follow-up data. The lack of nationally representative data on mumps incidence and its morbidity profile further complicates decision-making regarding vaccine inclusion.
• While mumps is generally considered a self-limiting disease with short-term symptoms, there is limited information on its long-term morbidity, especially regarding its impact on reproductive organs. More comprehensive studies and data are needed to understand the full spectrum of mumps-related complications and risks.
• The Indian Academy of Paediatrics (IAP) advocates for a reevaluation of mumps' public health significance, emphasizing the need for better documentation, research studies, and data collection to inform decision-making regarding vaccine inclusion in national immunization schedules. Raising awareness about the potential long-term impact of mumps and its complications, particularly on reproductive health, can also play a role in advocating for its inclusion in vaccination programs.

5. Strategies for Controlling Mumps Outbreaks

To effectively control the ongoing mumps outbreaks and prevent further transmission, health officials are implementing targeted strategies aimed at public awareness and immunization coverage.

• Creating public awareness about mumps, its symptoms, and the necessity of isolation is crucial in reducing disease transmission. Individuals with mumps should be isolated for a full three weeks to prevent spreading the virus, considering that transmission can occur before symptoms appear.
• Since mumps cases are primarily affecting unvaccinated children and adolescents, enhancing general immunization coverage is vital. Encouraging parents to ensure their children receive timely vaccinations can significantly reduce the risk of mumps outbreaks.
• Health officials have observed a high number of school-based outbreaks in Kerala, partly due to children returning to school before completing the necessary isolation period. Implementing strict guidelines to ensure symptomatic individuals stay isolated for the required duration can prevent school-based transmissions. Officials anticipate a decrease in new cases during the summer break when schools are closed, providing a temporary break in transmission.
• Continuous monitoring of mumps cases, tracking outbreaks, and responding promptly with isolation measures and public health campaigns are essential for controlling the current outbreaks and preventing future spikes in infections.

6. Future Strategies for Mumps Control and Vaccination

Moving forward, strategic planning and policy adjustments are necessary to effectively control mumps outbreaks and improve vaccination coverage.

• The World Health Organization (WHO) emphasizes the integration of mumps vaccination strategies with existing efforts for measles elimination and rubella control. This integrated approach can optimize resources and enhance overall vaccine coverage.
• The Indian Academy of Paediatrics (IAP) has consistently advocated for the inclusion of the MMR (Mumps-Measles-Rubella) vaccine in the Universal Immunization Programme (UIP). While the MMR vaccine has been available in the private sector, its incorporation into the national immunization schedule can significantly improve mumps control. Global data suggest that two doses of the MMR vaccine offer protection ranging from 70% to 95% with high coverage rates.
• In 2014, Kerala took the initiative to protect children from Rubella by replacing the second dose of the measles vaccine in UIP with the MMR vaccine. However, in 2017, the introduction of the MR vaccine (Measles-Rubella) by the Centre led to Kerala following suit and using MR instead of MMR. Given the current mumps resurgence and the vaccine's effectiveness, Kerala has urged the Centre to reconsider and switch back to the MMR vaccine in the UIP.
• While there are no specific studies on the effectiveness of the mumps vaccine in India, global data supports its efficacy. Continued research and data collection on vaccine effectiveness, coverage rates, and disease burden are essential to inform vaccination policies and strategies.

By integrating vaccination efforts, emphasising the MMR vaccine, and reviewing vaccination policies based on scientific evidence and local disease patterns, health authorities can develop a comprehensive strategy to address mumps outbreaks and enhance overall immunisation coverage in the population.