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by Dr. Anatoly Belilovsky

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mumps   U.S. health officials have officially declared the current mumps outbreak in the New York and New Jersey area the largest in years. With close to 180 diagnosed cases thus far, it is especially important to take precautions and prevent contraction of the viral disease. Here's what you need to know about mumps.


What is mumps?

   It is a highly contagious viral infection. The mumps virus attacks selected tissues in the body. Its "favorite" is the salivary gland, especially the parotid glands located in front of and below the ear canals, but also all the salivary glands located under the lower jaw. It is the swelling of these glands that produces pain and the characteristic facial changes. The virus also occasionally attacks testicles (especially in postadolescent males), pancreas, and can cause inflammation of the brain (meningoencephalitis) and of the auditory nerve, leading to loss of hearing.


Why is mumps making a comeback?

   Mumps is a bit of a mystery right now. In the past, "comebacks" of vaccine-preventable diseases were due to the "fading" of antibody levels with age (smallpox, diphtheria, and tetanus are known to require boosters every 10 years to maintain protection), high concentrations or crowding of unvaccinated individuals (hemophilus, whooping cough), immunosuppression (TB, polio) and "antigen drift," or mutations of pathogens (flu, pneumococcus). Any of these could be happening here.

   Another explanation is a "mimic" disease: Back in the 70's, Lyme disease was discovered when a doctor noticed far more cases than expected of what appeared to be juvenile rheumatoid arthritis in a small town; investigation of this cluster led to the discovery of Lyme disease. What brings up this possibility is this: The one patient I saw had an absolutely perfect clinical picture of mumps, including contact with other mumps cases-but the blood test did not confirm it. Is this really mumps, or an emerging infection that mimics it perfectly? At this point, I would hesitate to guess.


Why is the vaccine not working? Are people not getting it?

   It IS working; let's not forget that mumps is more contagious than swine flu, and if the vaccines were worthless, we would have more mumps than flu around-not 180 cases, but more than 180,000. As to why it did not work as well as expected, that is a subject of an ongoing investigation. The Health Department is trying to find the common denominator in the affected individuals-down to cross-checking lot numbers of the vaccines administered many years ago to these patients, to see if there may have been a defective batch back then. What we seem to have is vaccine failure in less than one percent of recipients even in the fairly small communities where the cases occurred. Once you realize that people with mumps shopped, worked, and took public transportation while highly contagious (the week before appearance of symptoms), without the epidemic extending beyond this small group, you see how effective the vaccine really was.


How can we protect ourselves from it?

   It wouldn't hurt to get another measles, mumps, rubella (MMR) vaccine. Even if vaccine failure is to blame for this epidemic, isolation is probably impractical, as viral shedding can continue for nearly a month, starting days before any symptoms are present. Treatment is supportive: Drink lots of fluids to let saliva flow freely, and avoid sour foods that cause overstimulation of salivary glands. "Real" treatment, such as IV fluids, is only needed in the fairly small fraction of patients who develop pancreatitis (severe abdominal pain with nausea), meningoencephalitis (severe headache with mental status changes), or other rare complications. Infertility is a possible consequence of testicular inflammation in postadolescent males, but at this time no specific treatment is available to prevent this.



Dr. Anatoly Belilovsky is a renowned New York City based pediatrician with more than 20 years experience in treating children and advising parents. He is a Princeton graduate, a former clinical instructor at Cornell University, and recipient of the Americhoice Quality of Care Award for his groundbreaking work with pediatric asthma patients. 

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