The University of Missouri, the State University of New York at New Paltz, Harvard University and Syracuse University all have one thing in common. And it’s not what you might think.

Each campus, most recently at Syracuse, have experienced a mumps outbreak within the last couple of years. But it’s not only colleges and universities that have been affected. According to the Centers for Disease Control (CDC), more than 6,000 cases of mumps were reported in the United States last year, the highest number in 10 years.

That begs the question: is mumps making a comeback?

“There are a lot of theories on why mumps is ‘making a comeback,’ said Jon Pangia, MD, emergency medicine director at Grand Strand Medical Center. “Some believe that individual’s refusal to get vaccinated is increasing the ability of the virus to spread. Others believe the vaccine is faulty and not strong enough. And still, others believe another booster is needed in early adulthood when the immune system’s ability to remember the vaccine starts to fade.”

“Most likely, the reason is a combination of the latter. When young adults move to college campuses where they are in close contact with many other people whose vaccines are starting to wear off or were never vaccinated at all,” he said.

Dr. Pangia, who, as an ER physician is often the first line of defense against infectious diseases, sat down to talk about mumps and how to protect ourselves before and during an outbreak.

What is mumps?

Mumps is a viral infection most famous for the way it causes swelling of the saliva glands in the cheeks (parotid glands).

Who’s most at risk of contracting the virus?

Anyone in close contact with large groups of people is at high-risk for contracting mumps or any other virus. The highest risk includes people who are not vaccinated or who have weakened immune systems.

With viruses like mumps, we tend to see the word “outbreak” associated with it more often. How does it spread?

Mumps is an “airborne” virus. This means the tiny particles of saliva that float in the air whenever someone coughs or sneezes holds enough of the virus to infect someone when the saliva droplets land in their mouth, nose, or lungs. In addition, anybody in close contact with an infected person can catch the virus by sharing food and utensils or kissing. Every state has at least a few mumps cases every year so there is always a mumps virus being spread around at a low rate. Once it enters a vulnerable population, living in close contact with each other, an outbreak occurs.

A recent New York Times article says that “we are seeing it in a young and highly vaccinated population” too. Does that mean vaccinations are not working?

Whenever someone catches a disease that a vaccine is meant to prevent, one can say that “it didn’t work”. We know well that vaccines rarely work 100 percent of the time. However, they clearly and without question work very well by making it far less likely for someone who is vaccinated to get sick, compared to someone who was not vaccinated.

We also have learned that the mumps vaccine, in particular, starts to “wear off” or the immune system starts to “forget” the virus after about 10 years. Since most people get their last vaccine dose by age 6, people can begin to become more vulnerable to mumps again at about age 16.

Also, the higher the number of viruses that attack someone at one time, the quicker someone’s immune system needs to act to prevent getting sick. It’s possible to be exposed to such an overwhelming amount of the virus (like during an outbreak) that the vaccine’s preparation of one’s immune system isn’t enough and the person still gets sick.

When or how often should one get a mumps vaccination?

The Centers for Disease Control (CDC) recommends completing the mumps vaccine by age 6. The mumps vaccine is part of the MMR (measles, mumps, rubella) shot that kids typically receive at ages 1 and 4. They do not recommend a booster shot – an additional dose of vaccine needed periodically to “boost” the immune system – in early adulthood. However, some infectious disease experts have started to recommend a booster shot before moving to a college campus.

What are the symptoms?

In the early part of the infection, it feels much like any regular cold or mild flu infection. There can be fever, headache, body aches, or feeling tired. Most famously, mumps are known to sometimes cause swelling of the saliva glands in one or both cheeks (called parotitis). Perhaps, most concerning is the fact that mumps sometimes does not cause any major symptoms; someone can spread the mumps virus but not even feel sick.

How long is someone infectious?

For as long as a week BEFORE the saliva glands start to swell and 5 days after the glands are swollen, an infected person can spread the virus to other people.

What kind of complications can it cause? 

Mumps is rarely very serious. It’s usually just uncomfortable and then goes away. Some unlucky people have serious complications like meningitis (brain inflammation), swollen testicles, swollen ovaries, or become permanently deaf. Even rarer, some men become infertile (never have children).

How can people protect themselves?

The most effective protection is to get vaccinated. Some would suggest getting a booster vaccine if living in a high-risk environment like a college dormitory. The second most effective protection is to be sure that people who have mumps stay secluded and away from other people until at least 5 days after their saliva glands swell up. Avoiding people who are known to have mumps is almost as important as getting vaccinated even though it is not as effective. The best protection is to do both.

How are mumps treated?

There is no medication that causes mumps to go away quicker. It may only be prevented. Once someone is sick with mumps they mostly just need rest and time. Almost all people will recover just fine on their own. However, for anyone who is sick, it is very important that they are watched for something called sepsis – when the infection overtakes the person’s entire body. If someone with mumps is so tired that they cannot get out of bed, gets dizzy when they stand, is confused, in severe pain, or having trouble breathing, they need to be seen by a doctor immediately.

Dr. Jon Pangia is an emergency medicine physician at Grand Strand Medical Center located in Myrtle Beach, South Carolina. Grand Strand Medical is a part of HCA’s South Atlantic Division.

Image courtesy of the Centers for Disease Control.