Call for public health awareness of the resurgence of mumps in adults

Mumps has generally been regarded as an uncommon and mild self-limiting illness of early childhood. However, a new study¹ has shown that there has been a resurgence of the highly infectious disease, and that it is now presenting in adolescents and young adults.

In 2007, 76 per cent of the mumps cases in Australia presented in people aged 20 or older. During the period 1999-2007, the notification rates of mumps among people born between 1978–1982 was more than threefold higher, and they had significantly higher mean hospitalisation rates than others born pre-1978 and post-1982. This is important as mumps tends to be more severe in this older age group compared to childhood infections, and/or with more complications such as inflammation of the testes, epididymis or ovaries.

A viral infection that can be caught by anyone at any age, mumps is much more dangerous for adult men rather than for children. Besides causing swelling of the salivary glands, fever and headaches, it can also cause inflammation and pain in the testes. While permanent loss of fertility is a rare complication, 50 per cent of males will develop testicular atrophy and sperm production can be reduced in one in eight men. Mild cases will still stop sperm production, but only for a short time of six to 12 months².

The disease is transmitted rapidly through droplets and enters the body through the respiratory tract. People are infectious from about a week before the onset of the swelling for about nine days or until symptoms have resolved, whichever comes first.

In Australia, the measles-mumps-rubella (MMR) vaccine is currently recommended for children at the ages one and four years. The MMR vaccine is provided free of charge for all age groups in many Australian jurisdictions. The vaccine’s effectiveness after one dose is about 88 per cent and approaches 95 per cent after two doses.

With the current outbreak identified, the priority is to target young adults born between the years 1978–1982, now aged 25–30 years, as this group is shown to have an increased susceptibility and occurrence of mumps. This group and any general public who are unsure if they are immunised, should visit their GP’s to check their level of immunisation or to have a second dose of MMR vaccine.

The recommendations made in these recent publications, being:

• Young adults, particularly those born during the late 1970s and early 1980s should visit their doctor’s to check if their MMR vaccination is valid, and if not, to be vaccinated

• As nominated by the study, GPs need to be more aware of the disease and to be familiar with the available tools for diagnosis

• As the specified age group at risk are a well travelled group, it is an important opportunity for GPs to give a second dose of MMR at the time before the young adult travels overseas

• To prevent spreading the disease, people with mumps should stay at home for nine days after the onset of swelling

In addition Andrology Australia and the Fertility Society of Australia strongly recommend that:

• Young boys should be vaccinated against the mumps virus to protect their fertility and health for the longer-term

The general public and GPs can be regularly updated with independent and accurate information through the Andrology Australia website at www.andrologyaustralia.org.

References:
1. Aratchige PE, McIntyre PB, Quinn HE, Gilbert GL. Recent increases in mumps incidence in the 1998 Australian Measles Control Campaign. MJA 2008; 189: 434–437.
2. Senanayake SN. Mumps: a resurgent disease with protean manifestations. MJA 2008; 189: 456–459.