26 INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE | 2019 | www.elitecme.com imately seven days after symptom onset and persist for several weeks, or months. However, like measles and rubella, IgM may be missing in patients who have received any mumps-containing vaccinations; therefore, negative test results should not be used to rule out mumps (CDC, 2016-1). TREATMENT OF MUMPS There are no FDA-approved medications to slow or reverse the viral progression of mumps. Treatment of mumps should be focused on relieving symptoms through supportive care and preventing or addressing complications. Patients should be encouraged to maintain adequate hydration. Acidic foods and liquids should be avoided as they may contribute to difficulty swallow- ing. Analgesics, such as ibuprofen or acetamin- ophen, may be used to alleviate headaches or discomfort associated with salivary gland swelling. Cold or warm packs can be applied topically to the salivary glands for comfort. Patients with orchitis may require stronger analgesics. They may also use scrotal supports, ice packs, and bed rest to help control pain. Patients with severe complications may need to consult with specialists based on their con- dition. For example, patients with encephalitis should consult with a neurologist for treat- ment. Since mumps is a contagious illness, the CDC recommends that mumps patients be isolated for five days after swelling of the salivary glands begins. Hospitalized mumps patients should be on droplet precautions to prevent the spread of disease (McLean, 2013). Patients who are infected with mumps are considered to be contagious for several days before and after the onset of parotitis onset (CDC, 2016-1). Nursing Consideration: Since there are no available therapies to treat infection with the mumps virus, nurses and ANPs are recom- mended to focus their efforts on strategies designed to relieve symptoms or treat com- plications. Nurses are well qualified to provide such care and may, in fact, be the optimal cli- nician on the health care team to lead these efforts. POST-EXPOSURE PROPHYLAXIS Ig is not considered to be effective as post-ex- posure prophylaxis for mumps. Vaccination post-exposure is not thought to be harmful and may work to prevent subsequent infec- tion (CDC, 2016-1). Evidence-Based Practice: A study assessing the effectiveness of a third dose of MMR vac- cine as post-exposure prophylaxis to mumps was conducted during the 2009 New York outbreak among Orthodox Jewish patients. A third dose of MMR vaccine was admin- istered to household contacts of infected patients within five days of onset of mumps in the infected patient; attack rates were com- pared between three-dose recipients and two- dose recipients. Attack rates were zero among recipients of three doses of MMR vaccine, compared to 5.2% attack rates among two- dose recipients. These results, however, were not found to be statistically significant. Study authors concluded that although a third dose did not produce significant effects, it might show some benefits in the context of certain outbreaks (Fiebelkorn, et al. 2013). SELF-ASSESSMENT QUESTION Answers are listed on the last page of the course. 6. Which of the following statements about the treatment of mumps is FALSE? a) Clinicians have a variety of therapeu- tic options to reverse the viral progression of mumps. b) Treatment of mumps should be focused on relieving symptoms through support- ive care and preventing or addressing complications. c) Acidic foods and liquids should be avoided as they may contribute to difficulty swallowing. d) Immunoglobulin is not considered to be effective as post-exposure prophylaxis for mumps. VACCINATION AGAINST MUMPS Following the release of the live attenuated mumps vaccine in 1967, the mumps vaccine was initially considered a low priority by the ACIP. Their recommendations were changed in 1972 to indicate that the vaccine was important for teenagers and adults who were highly affected by outbreaks. In 1977, the ACIP recommended that all children 12 and older should receive the mumps vaccine to ensure that teenagers and adults would be protected. The 1980s saw further changes to mumps vaccine recommendations to accommodate changes to the recommenda- tions for measles vaccination, found in the combination MMR vaccine. Single-entity mumps vaccinations are no longer available in the U.S. (CDC, 2016-1). EFFICACY OF MUMPS VACCINATION Mumps outbreaks in the United Kingdom (UK) raised concerns about the effectiveness of vaccines in its prevention. In an attempt to quantify the impact of the MMR vaccine on the transmission of the mumps virus, a screening method was employed by Cohen et al. to examine data obtained in an UK outbreak. Between January 2004 and March 2005, a total of 312 cases of mumps were recorded in children that would have been eligible to receive a normal two-adminis- tration series of MMR vaccine. Of this identified population, nearly 17% had received a single dose of MMR vaccine; 31% had completed the two-dose regimen. Based on these findings, investigators con- cluded that the MMR vaccine was effective 88% of the time when a single dose was admin- istered. When the recommended two-dose regimen was administered, the effectiveness rate increased to 95%. It is critical to note that the immuniza- tion’s effectiveness decreased with increasing age. For example, the effectiveness of a single dose was 96% in two-year-old children. This decreased to 66% in 11 to 12-year-olds. When the full two-dose sequence was administered, an effectiveness of 99% was reported in five- to six-year-olds and 86% in 11- to 12-year- olds. These analyses suggest that immunity to MMR vaccine for the prevention of mumps may wane over time (Cohen, et al. 2013). Evidence-Based Practice: Demicheli con- ducted a systematic review of clinical trials that examined the efficacy of the MMR vac- cine product in preventing the occurrence of mumps in children. The effectiveness of the one dose administration of MMR was shown to prevent mumps in 69% to 81% of cases. They reported a minimal difference in effectiveness based on the mumps strain used to produce the vaccine: slightly higher levels of effective- ness were noted on Jeryl Lynn-based products than with those based on the Urabe strain (Demicheli, et al. 2012). RUBELLA: DEFINITION CONTINUING EDUCATION  |