Why Mumps, Why Now?

Mumps has been in the news for several years, but is it really occurring more often these days? Mumps is a viral infection that affects the salivary and parotid glands and mostly occurs in children.

The disease spreads through infected saliva by sneezing, coughing, sharing drinks, or touching contaminated surfaces. Symptoms include swollen, painful salivary glands, headache, fatigue, body aches, fever, and loss of appetite, although some people may have no or very few symptoms. Treatment focuses on relief of symptoms. It can take up to two weeks to recover. The disease can be prevented by the MMR (measles, mumps, rubella) vaccine. Mumps is considered a contagious and communicable disease.

The U.S. mumps vaccination program started in 1967, but before that, between 185,000 to 200,000 cases were reported each year. The actual number of cases was probably much higher, but there may have been low or underreporting of cases at that time. So why did mumps cases appear to be escalating in 2016?

According to the Centers for Disease Control and Prevention (CDC), approximately 4,300 cases of mumps were reported in early December 2016. The last time the United States saw such a high volume of mump cases was 2006, with more than 6,000 reported cases per MMWR (Morbidity and Mortality Weekly Reporting), Notifiable Diseases and Mortality Tables (see below).

Let’s look at several potential causes of an outbreak.

Mumps can occur anytime, and outbreaks do not have to be reported to the CDC, but in 2015 and 2016, an outbreak was reported mainly from college-type settings and mostly affected young adults. This trend could be due to close quarters or crowded environment such as dormitories, playing on the same sports teams, and sharing utensils. Certain types of behavior also help spread the virus, such as kissing, or sharing lipsticks and/or cigarettes. Also encountered at universities are foreign students and exchange students. College students also travel a lot these days.

Another reason could be that the vaccine just doesn’t work as well and is not as effective over time. It is recommended that a child get vaccinated at 12-15 months (well-baby check-up) and then get a booster at age 4-6 (when he or she enters school). By the time students grow up and head to college, it’s been about 12 years since their mumps booster. 

An interruption of the recommended temperature for the mumps vaccine at storage could result in the vaccine dying, or it being less effective when administered. The recommended storage temperature is between -58°F and +5°F (-50°C and -15°C), per CDC guidelines.

A number of people (including celebrities) have also spread the false rumor that vaccines have caused autism or conditions in the autism spectrum. This anti-vaccine campaign has led to a number of children not being vaccinated.

Some of the ICD-10-CM codes that are related to mumps are:

          B26.9    Mumps, unspecified
          B26.81  Mumps with hepatitis
          B26.1    Mumps with meningitis
          B26.0    Mumps with orchitis
          B26.2    Mumps with encephalitis
          B26.82  Mumps with myocarditis
          Z23   Encounter for immunization

These diagnosis codes include generic mumps as well as combinations, with identified potential complications associated with mumps. The code for immunization is generic while the specificity is found in the associated CPT code for the actual immunization.

Regardless of the cause, it is important that parents and guardians of small children be informed and know the facts. Be active and be knowledgeable about the vaccine, its effectiveness, its side effects, and potential complications. It is up to each adult who is in charge of a child to make the decision of whether to have the child vaccinated, but also know the consequences that may come with it down the road.