Mumps: The Role of the Pharmacist

Six cases of mumps have recently been reported at Harvard University.^1,2

Although mumps has been vastly eliminated through routine vaccination, several hundred cases are still seen annually in the United States, as the vaccine is not 100% effective. Oftentimes, clusters or mini-outbreaks can be seen in close-knit communities such as in those residing in dormitories or playing on the same sports team.

What is mumps?

Mumps is a viral illness caused by a strain of paramyxovirus. The most common symptom of mumps is parotitis or salivary gland swelling, which is present in 30% to 65% of cases. Other common presentations include nonspecific symptoms such as headache, fever, muscle aches and pains, and anorexia.

Mumps is usually a mild illness, but it can lead to severe complications such as meningitis, encephalitis, glomerulonephritis, and hearing loss. It can also have detrimental effects in pregnancy. On rare occasions, mumps is fatal.^2,3

Patients are considered infectious in the 2 days preceding symptoms up through 5 days after symptom onset. It is recommended that patients suspected of mumps remain in isolation for 5 days after swelling onset.

How is mumps diagnosed?

Mumps can be diagnosed by a buccal (cheek) swab or serum (blood) sample. Samples are either transported to state health departments or the US Centers for Disease Control and Prevention for testing.

Testing can be done through pure viral culture, polymerase chain reaction, or immunoglobulin G or M titers. If the patient is within 5 days of symptom onset, a buccal swab may be the preferred sample method. The patient should remain in isolation while the results of the test are pending.²

Different states and territories have different reporting requirements for patients suspected or confirmed of having mumps. In Massachusetts, for example, there is mandatory reporting.

How is mumps treated?

Unfortunately, there is no specific treatment for mumps. No antiviral medication will directly treat the virus. Therefore, treatment remains symptomatic and involves keeping the patient in isolation during the contagious period for 5 days after the onset of symptoms.

How is mumps spread?

Similar to influenza, mumps is spread through contact with respiratory secretions or saliva. Therefore, it is imperative that patients suspected of having mumps or being exposed to mumps practice good hand hygiene and cough etiquette. This includes washing hands after blowing or wiping noses, keeping hands away from the face or mouth, and covering up and sneezing into elbows.

Again, the patient should remain in isolation until 5 days after the onset of symptoms or until the virus is ruled out.

How can mumps be prevented?

The best way to prevent mumps is through vaccination. There are 2 live attenuated vaccines that can confer immunity, both of which are combination vaccines.

The MMR vaccine targets measles, mumps, and rubella, while the MMRV vaccine adds additional protection against varicella. The Advisory Committee on Immunization Practices recommends 2 doses of the MMR or MMRV vaccine to optimally protect the patient.

The first dose is recommended between the ages of 12 and 15 months, while the second dose is recommended between the ages of 4 and 6 years.⁴ Catch-up schedules are available for adults who did not receive these vaccines during childhood.

Because the vaccine is not 100% effective, there is still a chance that even vaccinated individuals may develop the disease if exposed. A single dose of the vaccine is 78% (range 49% to 91%) effective, while 2 doses are 88% (range 66% to 95%) effective.

It is worth noting that the MMR vaccine is usually a requirement for college enrollment.

All 6 students affected at Harvard University have documentation of 2 vaccines, yet still developed the infection.^2,3 Therefore, it is vitally important for patients to be aware of their symptoms and maintain the appropriate duration of isolation.

How can pharmacists help?

The 6 current mumps cases are unique to Harvard University, but it would be ignorant to believe that the disease will not spread. Unrelated cases may also appear elsewhere in the United States. Even with high rates of vaccination, several hundred cases of mumps are seen in the United States annually.³

The pharmacist is one of the most accessible health care providers and can educate a large number of patients. Pharmacists can stay abreast of current mumps cases and counsel patients on signs and symptoms, refer them for viral testing and buccal swabs, and recommend isolation for appropriate durations.

The pharmacist can also encourage appropriate hand hygiene and general illness management. And, most importantly, the pharmacist can educate, promote, and (if allowed) provide vaccinations against the virus(es).

References

1. Freyer FJ. Four more Harvard students get mumps. Boston Globe. https://www.bostonglobe.com/metro/2016/03/02/four-more-harvard-students-get-mumps/Vei0IVkGWjv7v4TlrfsIvM/story.html. Published March 2, 2016. Accessed March 3, 2016.

2. Commonwealth of Massachusetts Department of Public Health. Clinical advisory: mumps. http://www.mass.gov/eohhs/docs/dph/cdc/advisories/mumps-clinical-advisory-3-2016.docx. Published March 2, 2016. Accessed March 3, 2016.

3. Centers for Disease Control and Prevention. Mumps. http://www.cdc.gov/mumps/index.html. Updated May 29, 2015. Accessed March 3, 2016.

4. Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP). http://www.cdc.gov/vaccines/acip/. Updated February 26, 2016. Accessed March 4, 2016.