On the resurgence of mumps in Kerala 

GS Paper III

News Excerpt:

A resurgence in Mumps cases was being reported from several States, including Maharashtra, Telangana, Kerala and Andhra Pradesh.

About the news:

  • Mumps has been spreading like wildfire in Kerala, for the past few months. 
    • Cases that began appearing sporadically around November 2023 in the Malappuram and Kozhikode districts of Kerala have since then spread to Palakkad and Thrissur, resulting in major community outbreaks. 

About Mumps:

  • Mumps is a viral and contagious infection primarily transmitted by respiratory secretion like droplets and saliva, as well as direct contact with an infected person. 
  • Although mumps is common in children, it also occurs among pregnant women and can lead to complications. 
  • It is caused by paramyxovirus, a member of the Rubulavirus family.
  • Mumps is a self-limiting, airborne viral disease and presents as fever and headache in mostly children and adolescents, with painful swelling of the salivary glands (parotid glands) on both sides of the face. 
  • There is no specific treatment and the patient recovers with rest and symptomatic management in about two weeks. 

Reasons for Concern:

  • With only half of the infected children developing the classical disease and close to 30% remaining asymptomatic, cases mostly go unreported, indicating that the reported cases are a gross underestimation of the actual cases in the community.
  • With cases being reported in epidemic proportions, several cases arising from the complications of mumps like encephalitis, epilepsy, aseptic meningitis and acute pancreatitis, have been reported. 
  • The other significant complication mumps brings is the virus’s effect on the gonads (reproductive glands) in both males and females
    • In males, it presents the rare yet distinct possibility of infertility or a drop in sperm count in the long term.

Why is the mumps vaccine not part of the national immunization schedule?

  • Despite being a vaccine-preventable disease, mumps has never been a part of the Universal Immunisation Programme (UIP) because of the disease’s no-mortality profile and the perception that it has low public health significance. 
  • However, the Indian Academy of Paediatrics (IAP) has always maintained that the public health significance of mumps has been underestimated mainly because of the poor documentation of clinical cases, its complications and patients’ follow-up data as well as the lack of published studies. 
  • There is no nationally representative data on incidence of the disease. 
  • There is very little information on the actual long-term morbidity profile of the disease, even though the disease is known to have some impact on reproductive organs.

How can the transmission of the disease and the current outbreaks be controlled?

  • Creating public awareness about the disease. 
  • Importance of isolation:  
    • Transmission of the disease begins before the symptoms actually manifest and isolation of the patient for a full three weeks is necessary to limit the spread of the disease.
    • A large number of school-based outbreaks in Kerala occurred because children were allowed back to school as soon as there was symptomatic relief before the three-week isolation period was up. 
  • Mumps is primarily being reported in un-immunised children and adolescents and hence improving general immunisation coverage is important. 
  • Routine immunisation is crucial for maintaining herd immunity.

Way Forward:

  • According to the World Health Organization (WHO), vaccination strategies targeting mumps control should be closely integrated with existing measles elimination and rubella control. 
  • The Indian Academy of Paediatrics (IAP) also advocates the use of the MMR (Mumps-Measles-Rubella) vaccine in UIP
  • There are no studies from India on the effectiveness of the mumps vaccine. 
    • Hence proper studies are needed for the making of an effective vaccine of mumps.
    • But globally, the protection from two doses is estimated to be between 70-95%, if the coverage is high.

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