Mumps
| Mumps | |
|---|---|
| Classification and external resources | |
 Child with mumps. | |
| ICD-10 | B26 |
| ICD-9 | 072 |
| DiseasesDB | 8449 |
| MedlinePlus | 001557 |
| eMedicine | emerg/324 emerg/391 ped/1503 |
| MeSH | D009107 |
Mumps (epidemic parotitis) is a viral disease of the human species, caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide. It is still a significant threat to health in the third world, and outbreaks still occur sporadically in developed countries.[1]
Painful swelling of the salivary glands (classically the parotid gland) is the most typical presentation.[2] Painful testicular swelling (orchitis) and rash may also occur. The symptoms are generally not severe in children. In teenage males and men, complications such as infertility or subfertility are more common, although still rare in absolute terms.[3][4][5] The disease is generally self-limiting, running its course before receding, with no specific treatment apart from controlling the symptoms with pain medication.
Contents[hide] |
Signs and symptoms
The more common symptoms of mumps are:
- Parotid inflammation (or parotitis) in 60–70% of infections and 95% of patients with symptoms.[2] Parotitis causes swelling and local pain, particularly when chewing. It can occur on one side (unilateral) but is more common on both sides (bilateral) in about 90% of cases.[6]
- Fever
- Headache
- Pancreatitis, referring to inflammation of the affected pancreas.
- Orchitis, referring to painful inflammation of the testicles.[7] Males past puberty who develop mumps have a 30 percent risk of orchitis.[8]
Other symptoms of mumps can include dry mouth, sore face and/or ears and occasionally in more serious cases, loss of voice. In addition, up to 20% of persons infected with the mumps virus do not show symptoms, so it is possible to be infected and spread the virus without knowing it.[9]
Fever and headache are prodromal symptoms of mumps, together with malaise and anorexia.
Cause
Mumps is a contagious disease that is spread from person to person through contact with respiratory secretions such as saliva from an infected person. When an infected person coughs or sneezes, the droplets aerosolize and can enter the eyes, nose, or mouth of another person. Mumps can also be spread by sharing food and drinks. The virus can also survive on surfaces and then be spread after contact in a similar manner. A person infected with mumps is contagious from approximately 6 days before the onset of symptoms until about 9 days after symptoms start.[10][11] The incubation period (time until symptoms begin) can be from 14–25 days but is more typically 16–18 days.[12]
Diagnosis
A physical examination confirms the presence of the swollen glands. Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, a test of saliva, or blood may be carried out; a newer diagnostic confirmation, using real-time nested polymerase chain reaction (PCR) technology, has also been developed.[13] An estimated 20%-30% of cases are asymptomatic.[14] As with any inflammation of the salivary glands, serum amylase is often elevated.[15][16]
Prevention
The most common preventative measure against mumps is a vaccination with a mumps vaccine, invented by Maurice Hilleman at Merck.[17] The vaccine may be given separately or as part of the MMR immunization vaccine which also protects against measles and rubella. In the US, MMR is now being supplanted by MMRV, which adds protection against chickenpox. The WHO (World Health Organization) recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 13 months with a booster at 3-5 years(preschool) This confers lifelong immunity. The American Academy of Pediatrics recommends the routine administration of MMR vaccine at ages 12–15 months and at 4–6 years.[18] In some locations, the vaccine is given again between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. The efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%.[19][20] The Jeryl Lynn strain is most commonly used in developed countries but has been shown to have reduced efficacy in epidemic situations. The Leningrad-Zagreb strain commonly used in developing countries appears to have superior efficacy in epidemic situations.[21]
Because of the outbreaks within college and university settings, many governments have established vaccination programs to prevent large-scale outbreaks. In Canada, provincial governments and the Public Health Agency of Canada have all participated in awareness campaigns to encourage students ranging from grade 1 to college and university to get vaccinated.[22]
Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. There is no evidence whatsoever to support the claim that the wild disease is beneficial, or that the MMR vaccine is harmful. Claims have been made that the MMR vaccine is linked to autism and inflammatory bowel disease, including one study by Andrew Wakefield[23][24] (the paper was discredited and retracted in 2010 and Wakefield was later stripped of his license after his work was found to be an "elaborate fraud" [25]) that indicated a link between gastrointestinal disease, autism, and the MMR vaccine. However, all further studies[citation needed] since that time have indicated no link between vaccination with the MMR and autism. Since the dangers of the disease are well known, while the dangers of the vaccine are quite minimal, most doctors recommend vaccination.
The WHO, the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the British Medical Association and the Royal Pharmaceutical Society of Great Britain currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.[citation needed]
Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000).[26] In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%).[27] The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968. Since 2001, the case average was only 265 per year, excluding an outbreak of >6000 cases in 2006 attributed largely to university contagion in young adults.[28][29]
Treatment
There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck/testicular area and by acetaminophen/paracetamol (Tylenol) for pain relief. Aspirin is not used due to a hypothetical link with Reye's syndrome. Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms. According to the Department of Health of Minnesota there is no effective post-exposure recommendation to prevent secondary transmission, as well as the post-exposure use of vaccine or immunoglobulin is not effective.[30]
Patients are advised to avoid acidic foods and beverages, since these stimulate the salivary glands, which can be painful. [31]
Prognosis
Death is very unusual. The disease is self-limiting, and general outcome is good, even if other organs are involved.
Known complications of mumps include:
- Infection of other organ systems
- Mumps viral infections in adolescent and adult males carry an up to 30% risk that the testes may become infected (orchitis or epididymitis), which can be quite painful; about half of these infections result in testicular atrophy, and in rare cases sterility can follow.[32]
- Spontaneous abortion in about 27% of cases during the first trimester of pregnancy.[32]
- Mild forms of meningitis in up to 10% of cases[32] (40% of cases occur without parotid swelling)
- Oophoritis (inflammation of ovaries) in about 5% of adolescent and adult females,[32] but fertility is rarely affected.
- Pancreatitis in about 4% of cases, manifesting as abdominal pain and vomiting
- Encephalitis (very rare, and fatal in about 1% of the cases when it occurs)[32]
- Profound (91 dB or more) but rare sensorineural hearing loss, uni- or bilateral. Acute unilateral deafness occurs in about 0.005% of cases.[32]
After the illness, life-long immunity to mumps generally occurs; reinfection is possible but tends to be mild and atypical.[32]
| http//en.wikipedia.org/wiki/Mumps |
Recommended reading: Vitamin A for measles in children
Measles is a very contagious (easily spread) illness caused by a virus.
Causes, incidence, and risk factors
The infection is spread by contact with droplets from the nose, mouth, or throat of an infected person. Sneezing and coughing can put contaminated droplets into the air.
Those who have had an active measles infection or who have been vaccinated against the measles have immunity to the disease. Before widespread vaccination, measles was so common during childhood that most people became sick with the disease by age 20. The number of measles cases dropped over the last several decades to almost none in the U.S. and Canada. However, rates have started to rise again recently.
Some parents do not let their children get vaccinated because of unfounded fears that the MMR vaccine, which protects against measles, mumps, and rubella, can cause autism. Large studies of thousands of children have found no connection between this vaccine and autism. Not vaccinating children can lead to outbreaks of a measles, mumps, and rubella -- all of which are potentially serious diseases of childhood.
Symptoms
Symptoms usually begin 8 - 12 days after you are exposed to the virus. This is called the incubation period.
Symptoms may include:
Light sensitivity (photophobia)
Rash
Redness and irritation of the eyes (conjunctivitis)
Runny nose
Sore throat
Tiny white spots inside the mouth (Koplik's spots)
Signs and tests
Measles serology
Viral culture (rarely done)
Treatment
There is no specific treatment for the measles.
The following may relieve symptoms:
Acetaminophen (Tylenol)
Bed rest
Humidified air
Some children may need vitamin A supplements. Vitamin A reduces the risk of death and complications in children in less developed countries, where children may not be getting enough vitamin A. People who don't get enough vitamin A are more likely to get infections, including measles. It is not clear whether children in more developed countries would benefit from supplements.
Expectations (prognosis)
Those who do not have complications such as pneumonia do very well.
Complications
Complications of measles infection may include:
Encephalitis (about 1 out of 1,000 measles cases)
Ear infection (otitis media)
Calling your health care provider
Call your health care provider if you or your child has symptoms of measles.
Prevention
Routine immunization is highly effective for preventing measles. People who are not immunized, or who have not received the full immunization are at high risk for catching the disease.
Taking serum immune globuli 6 days after being exposed to the virus can reduce the risk of developing measles, or can make the disease less severe.
Recommended reading: Acyclovir can reduce the number of days with fever in otherwise healthy children with chickenpox, but its effect on sores and itching is not yet certain
Chickenpox is a viral infection in which a person develops extremely itchy blisters all over the body. It used to be one of the classic childhood diseases. However, it has become much less common since the introduction of the chickenpox vaccine.
Causes, incidence, and risk factors
Chickenpox is caused by the varicella-zoster virus, a member of the herpesvirus family. The same virus also causes herpes zoster (shingles) in adults.
Chickenpox can be spread very easily to others. You may get chickenpox from touching the fluids from a chickenpox blister, or if someone with the disease coughs or sneezes near you. Even those with mild illness may be contagious.
A person with chickenpox become contagious 1 to 2 days before their blisters appear. They remain contagious until all the blisters have crusted over.
Most cases of chickenpox occur in children younger than 10. The disease is usually mild, although serious complications sometimes occur. Adults and older children usually get sicker than younger children.
Children whose mothers have had chickenpox or have received the chickenpox vaccine are not very likely to catch it before they are 1 year old. If they do catch chickenpox, they often have mild cases. This is because antibodies from their mothers' blood help protect them. Children under 1 year old whose mothers have not had chickenpox or the vaccine can get severe chickenpox.
Severe chickenpox symptoms are more common in children whose immune system does not work well because of an illness or medicines such as chemotherapy and steroids.
Symptoms
Most children with chickenpox have the following symptoms before the rash appears:
Fever
Headache
Stomach ache
The chickenpox rash occurs about 10 to 21 days after coming into contact with someone who had the disease. The average child develops 250 to 500 small, itchy, fluid-filled blisters over red spots on the skin.
The blisters are usually first seen on the face, middle of the body, or scalp
After a day or two, the blisters become cloudy and then scab. Meanwhile, new blisters form in groups. They often appear in the mouth, in the vagina, and on the eyelids.
Children with skin problems such as eczema may get thousands of blisters.
Most pox will not leave scars unless they become infected with bacteria from scratching.
Some children who have had the vaccine will still develop a mild case of chickenpox. They usually recover much more quickly and have only a few pox (less than 30). These cases are often harder to diagnose. However, these children can still spread chieckenpox to others.
Signs and tests
Your health care provider can usually diagnose chicken pox by looking at the rash and asking questions about the person's medical history. Small blisters on the scalp usually confirms the diagnosis.
Laboratory tests can help confirm the diagnosis, if needed.
Treatment
Treatment involves keeping the person as comfortable as possible. Here are things to try:
Avoid scratching or rubbing the itchy areas. Keep fingernails short to avoid damaging the skin from scratching.
Wear cool, light, loose bedclothes. Avoid wearing rough clothing, particularly wool, over an itchy area.
Take lukewarm baths using little soap and rinse thoroughly. Try a skin-soothing oatmeal or cornstarch bath.
Apply a soothing moisturizer after bathing to soften and cool the skin.
Avoid prolonged exposure to excessive heat and humidity.
Try over-the-counter oral antihistamines such as diphenhydramine (Benadryl), but be aware of possible side effects such as drowsiness.
Try over-the-counter hydrocortisone cream on itchy areas.
Medications that fight the chickenpox virus are available but not given to everyone. To work well, the medicine usually must be started within the first 24 hours of the rash.
Antiviral medication is not usually prescribe to otherwise healthy children who do not have severe symptoms. Adults and teens, who are at risk for more severe symptoms, may benefit from antiviral medication if it is given early.
Antiviral medication may be very important in those who have skin conditions (such as eczema or recent sunburn), lung conditions (such as asthma), or who have recently taken steroids.
Some doctors also give antiviral medicines to people in the same household who also develop chickenpox, because they will usually develop more severe symptoms.
DO NOT GIVE ASPIRIN OR IBUPROFEN to someone who may have chickenpox. Use of aspirin has been associated with a serious condition called Reyes syndrome. Ibuprofen has been associated with more severe secondary infections. Acetaminophen (Tylenol) may be used.
A child with chickenpox should not return to school or play with other children until all chickenpox sores have crusted over or dried out. Adults should follow this same rule when considering when to return to work or be around others.
Expectations (prognosis)
Usually, a person recovers without complications.
Once you have had chickenpox, the virus usually remains dormant or asleep in your body for your lifetime. About 1 in 10 adults will have shingles when the virus re-emerges during a period of stress.
Complications
Rarely, serious bacteria infections such as encephalitis have occured. Other complications may include:
Pneumonia
Transient arthritis
Cerebellar ataxia may appear during the recovery phase or later. This involves a very unsteady walk.
Women who get chickenpox during pregnancy can pass the infection to the developing baby. Newborns are at risk for severe infection.
Calling your health care provider
Call your health care provider if you think that your child has chickenpox or if your child is over 12 months of age and has not been vaccinated against chickenpox.
Prevention
Because chickenpox is airborne and very contagious before the rash even appears, it is difficult to avoid.
A vaccine to prevent chickenpox is part of a child's routine immunization schedule. For information, see: Chickenpox vaccine
The vaccine usually prevents the chickenpox disease completely or makes the illness very mild.
Talk to your doctor if you think your child might be at high risk for complications and might have been exposed. Immediate preventive measures may be important. Giving the vaccine early after exposure may still reduce the severity of the disease.
- Post‐exposure prophylaxis vaccine to prevent varicella (chickenpox) Post‐exposure prophylaxis vaccine to prevent varicella (chickenpox) This review assessed how useful the varicella (also known as chickenpox) vaccine is in preventing chickenpox when given to children or adults who have never been immunised or had chickenpox before, but who receive the vaccine within a short time following exposure to a person with chickenpox. Varicella is a highly contagious viral infection characterised by a widespread pustular rash, fever and generally feeling unwell.
Smallpox is a serious and contagious disease due to a virus.
Causes, incidence, and risk factors
Smallpox was once found throughout the world, causing illness and death wherever it occurred. It mainly affected children and young adults. Family members often infected each other.
Smallpox spreads easily from one person to another from saliva droplets. It may also be spread from bed sheets and clothing. It is most contagious during the first week of the infection. It may continue to be contagious until the scabs from the rash fall off.
Researchers believe that the smallpox infection might be able to stay alive (under the right conditions) for as long as 24 hours. In unfavorable conditions, the virus may only remain alive for 6 hours.
People were once vaccinated against this disease. However, the United States stopped giving the smallpox vaccine in 1972. In 1980, the World Health Organization (WHO) recommended that all countries stop vaccinating for smallpox.
There are two forms of smallpox:
Variola major is a serious illness that can be life threatening in people who have not been vaccinated
Variola minor is a milder infection that rarely causes death
A massive program by the World Health Organization (WHO) wiped out all known smallpox viruses from the world in the 1970s, except for a few samples saved for government research. Researchers continue to debate whether or not to kill the last remaining samples of the virus, or to preserve it in case there may be some future reason to study it.
You are more likely to develop smallpox if you:
Are a laboratory worker who handles the virus (rare)
Are in a location where the virus was released as a biological weapon
It is unknown how long past vaccinations stay effective. People who received the vaccine many years ago may no longer be fully protected against the virus.
THE RISK OF TERRORISM
There is a concern that the smallpox virus could be intentionally spread through a terrorism attack. The virus could be deliberately spread in spray (aerosal) form.
Symptoms
Symptoms usually occur about 12 - 14 days after you have been infected with the virus. They may include:
Signs and tests
Tests include:
DIC panel
Special laboratory tests can be used to identify the virus.
Treatment
If athe smallpox vaccine is given within 1-4 days after a person is exposed to the disease, it may prevent illness or make the illness less severe. Once symptoms have started, treatment is limited.
There is no drug specifically for treating smallpox. Sometimes antibiotics are given for infections that may occur in people who have smallpox. Taking antibodies against a disease similar to smallpox (vaccinia immune globulin) may help shorten the duration of the disease.
People who have been diagnosed with smallpox and everyone they have come into close contact with need to be isolated immediately. They need to receive the vaccine and be monitored.
Emergency measures would need to be taken immediately to protect the general population. Health officials would follow the recommended guidelines from the CDC and other federal and local health agencies.
Expectations (prognosis)
In the past, this was a major illness with the risk of death as high as 30%.
Complications
Arthritis and bone infections
Brain swelling (encephalitis)
Death
Eye infections
Scarring
Severe bleeding
Skin infections (from the sores)
Calling your health care provider
If you think you may have been exposed to smallpox, contact your health care provider immediately. Because smallpox has been wiped out this would be very unlikely, unless you have worked with the virus in a laboratory or there has been an act of bioterrorism.
Prevention
Many people were vaccinated against smallpox in the past. The vaccine is no longer given to the general public because the virus has been wiped out. The possible complications and costs of the vaccine outweigh the benefits of taking it.
If the vaccine needs to be given to control an outbreak, it can have a small risk of complications. Some complications are mild, such as rashes. Others are more serious.
Only military personnel, health care workers, and emergency responders may receive the vaccine today. Smallpox vaccination policies and practices are currently being reviewed.
- Vaccines for preventing smallpox Vaccines for preventing smallpox Smallpox is an acute viral infection unique to humans. A worldwide smallpox campaign (including mass vaccination, patient isolation, and surveillance) contributed to the eradication of the disease by 1980. However, there is growing concern that the virus could now be used as a biological weapon. Smallpox spreads from one person to another by infected saliva droplets. The incubation period is 7 to 17 days. The symptoms begin with severe headache, backache, and fever up to 40 °C, all beginning abruptly. Then a rash appears on the face and spreads, the spots become watery blisters containing pus that form scabs and leave pitted scars when they fall off. The infected person is contagious until the last smallpox scab has fallen off, although most of the transmission occurs in the first week. Most people with smallpox recover, but some do die and the risk depends on the strain of virus. The early vaccines were effective, but they had a number of adverse effects, including headache, fever, and reaction at the infection site, and also the possibility of death. New vaccines continue to be developed. The review identified 10 trials that involved 2412 participants. Overall, the quality of the trials was not high but the review showed that stockpiles of the vaccines maintained their effectiveness even when diluted. New second‐generation vaccines seemed to be effective but still have adverse events. There were too few participants overall to be able to assess rare outcomes. Further research is needed, particularly on the third‐generation vaccines..
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002332/Difference Between Smallpox and Chickenpox
Difference Between Small Pox and Chicken PoxDifference between chickenpox and smallpox is tabulated belowFeatureSmallpoxChickenpoxCaused by:Smallpox is caused by Variola virusChickenpox is caused by Varicella zoster virusIncubation Period:It is 7-17 days for smallpoxIt is 7-21 days for chickenpoxProdromal SymptomsThese are Severe in smallpoxThese are Mild in chickenpoxDistribution Of RashCentrifugal for smallpoxCentripetal for chickenpoxPalms and SolesFrequently Involved in smallpoxSeldom affected in chickenpoxAxillaUsually free in smallpoxAxilla is affected in chickenpoxRashIn smallpox it is Predominant on extensor surface, deep seated, vesicles are multilocular, only one stage of rash is seen at one time and there is no inflammation around the rash.In Chickenpox Predominant on flexor surface, Superficial, Vesicles are unilocular, dewdrop like, different stages of rash can be seen at one time and there is an area of inflammation around the rashEvolution Of RashSlow in smallpoxRapid in chickenpoxFever:In smallpox it Subsides with appearance of rash but temperature may rise again in the pustular stageIn chickenpox Temperature rises with each crop of rash
Chicken Pox Rash 
Small Pox Rash.
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