mumps

Monday, November 24, 2014

In today’s world, most doctors will only know about many childhood illnesses from textbooks. Aggressive immunization strategies have mostly eradicated measles, mumps, rubella and whooping cough, so imagine being an NHL team doctor and wondering why a player is feeling fatigued and has extra-large swollen glands in his throat. That’s is the story surrounding the locker rooms of the Minnesota Wild, St. Louis Blues and the Anaheim (used to be Mighty) Ducks. The latest Duck Is Corey Stoner, who has now joined teammates Corey Perry and François Beauchemin with the diagnosis.

Outbreaks of mumps happen in clusters and often younger adults who live in clusters are affected. Mumps virus spreads by droplet infection from coughing, sneezing or even talking, as the virus hangs out in saliva and mucus. It is contagious enough to be passed on from cups and eating utensils or even from counters and other surfaces. It’s not surprising that if one hockey player were to be infected that others on the team would be at risk. Colleges are also hot spots for transmission and the University of Idaho is now sorting out how many dozen students are infected.

parotid-gland

Mumps causes inflammation of the parotid gland, located at the angle of the jaw and is responsible for making saliva. The infection is self-limiting and causes symptoms one would expect from a virus, malaise, fatigue, fever and chills in addition to the swelling. There is no treatment except for supportive care including rest, drinking lots of fluids and controlling fever. It’s hard to avoid a person who has mumps because the incubation period, where the virus has invaded the body but symptoms have yet to surface, is usually a little more than 2 weeks but can be almost a month. And after the mumps symptoms are noted, the patient is infectious for another 9-10 days

The best treatment is immunization. Mumps was prevalent before the routine MMR immunization was licensed in 1967 in the United States and is more than 99% effective. The first immunization is given at age 12-15 months and the second at 4-6 years. But even those who have been immunized may be exposed to the disease and not have enough antibodies to fight it off. This is where herd immunity comes into play. If not enough people participate in getting their kids immunized, the potential for infection outbreaks exists. There are many personal reasons that parents have not to immunize their children, from religious belief to fear that permanent complications will occur. However, each decision to avoid immunization affects the rest of the population as a whole and if the percentage of non-immunized people increases, so does the risk of disease spread. For most childhood infections, including mumps, at least 85% of the population needs to be immunized but for measles and whooping cough, that number climbs to almost 95%.

But if the treatment of mumps is just supportive and the patient gets better, then why the big worry? It’s all about the side effects. Before immunizations, mumps was the most common cause of viral meningitis. Other major complications include temporary or permanent deafness, pancreatitis and inflammation of the ovaries or testicles. The latter two may result in sterility, especially if they occur in younger adults.

It comes as no surprise then, that NHL teams are scouring their locker rooms whenever a team comes to town that has a player with mumps. If it takes a month for symptoms to surface, the player may not know that they are contagious and for that reason, it may be that more people on the three affected teams could get sick, even if their immunizations are up to date. Patients ask that question all the time. I’ve done everything right and yet I’ve become ill…why? Unfortunately, the answer is outside the realm of medicine and it is less than satisfying when the doctor answers… just because. Perhaps the question of the wrong expert but it’s hard to get an emergency consult from a theologian.

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