Mumps( mumps) symptoms

Parotitis( mumps) is an acute infectious viral disease, a disease of the salivary glands, especially of the parotid glands, which are located in the cavities under the auricles. In the beginning, the glands fill the entire cavity, and then swells up the face. This raises the auricle. If you hold your fingers under the jaw, you can feel the hard swelling that runs along it. This disease is accompanied by the defeat of glandular organs, having a common embryonic origin, and / or the nervous system - soft meninges or peripheral nerves.

When a child develops a swelling on the neck, the question always arises: mumps ( a special parotid gland disease) is one of the more rare parotid glands( which can be repeated many times), or are these swollen glands( lymphatic glandslocated on the sides of the neck)?Ordinary lymph glands swelling after the angina are located lower in the neck and not under the auricles. A solid tumor does not pass under the jaw.

When a child gets sick with mumps, it is usually first noticed the swelling behind the ears. The older child may complain of pain around the ears or in the throat, especially when swallowing and chewing, the day before the onset of the tumor. He can generally feel bad. Initially, the temperature is usually low, but on the second or third day it can rise. Usually the tumor starts on one side, but after a day or two it appears on the other. Sometimes it takes a week or more to spread to the other side, and, of course, in some cases it does not appear on the second side.

There are also other salivary glands, in addition to parotid, and sometimes mumps captures them. There are submandibular glands located under the lowest part of the lower jaw. The hyoid gland is located behind the tip of the chin. Sometimes there are complications after mumps, and none of the salivary glands swells.

With a mild form of mumps, the swelling disappears in three to four days. On average, it lasts from a week to ten days.

The causative agent of mumps epidemic is a virus belonging to the genus Paramyxovirus, family. Paramyxoviridae, morphologically typical for large-sized para-mixoviruses( 120-300 nm), rounded. The shell contains 3 layers - the protein membrane, the lipid layer and the outer glycolipid projections. Single-stranded RNA is not segmented, contains RNA-dependent RNA polymerase. The nucleocapsid of the viral particle forms the main component of the soluble( 5) -complement-binding antigen. Has hemagglutinating, hemolyzing and neuraminidase activity. The virus is found in the first days of the disease in saliva, in the salivary gland, specific antibodies appear in the blood. Immunity persists for a long time.

The antigenic structure of the virus is stable. Contains antigens that can cause the formation of neutralizing, complement-binding and anti-hemagglutinating antibodies, as well as an allergen, which in some cases can be used for setting an intradermal test.

The virus is relatively stable in the external environment, at 18-20 ° C it persists for several days, at low temperatures - up to 6 months. Hemagglutinin, hemolysin and infectious activity of the virus are lost when heated at 56 ° C for 20 minutes. Allergen and KS-antigen are more resistant to heat, withstand temperatures of 65 ° C and 80 ° C, respectively, up to 30 minutes.

The attenuated vaccine virus remains in the lyophilized state for at least a year, after dissolution it loses activity for 8 hours at 40 ° C.

1% solution of lysol, 2% formalin solution, ultraviolet irradiation rapidly inactivate the virus.

Epidemiology. The source of the infection is a patient both in manifest and erased forms, man. The mumps virus begins to stand out with saliva from the 4th-6th day of the incubation period. After the 9th day from the moment of illness the patient is considered to be non-contagious.

The main transmission path is airborne. The possibility of infection through contaminated saliva is not excluded.

Infected primarily with children near the source of infection. Attachment of respiratory infection significantly facilitates the spread of the virus of mumps infection.

Susceptibility varies from 30 to 50%.The greatest incidence is observed at the age of 3 to 6 years. Children of the first year of life are ill very rarely, because they receive from the mother transplacental antiviral antibodies.

After the infection, a stable immunity is formed. Repeated cases of diseases do not occur.

Class M immunoglobulins are found in the patient's blood at the end of the first week of the disease and are recorded for 60-120 days. Somewhat later, immunoglobulins of class G are detected, the titer of which increases by the 3-4th week and persists throughout life. A certain role in the formation of immunity belongs to the cellular link of immunity, as well as to secretory immunoglobulins.

Parotitis infection is registered throughout the year with an increase in the incidence rate in the winter-spring period.

Pathogenesis of mumps infection. The entrance gates for parotitis infection are the mucosa of the upper respiratory tract, where it is reproduced and accumulated. Primary viremia can be manifested clinically only by damage to the parotid salivary glands. Repeated more massive release of viruses into the blood( secondary viremia) causes the defeat of numerous organs and systems: the nervous system, pancreas, gonads and other glandular formations. And the corresponding clinical manifestations are found in later terms of the disease.

Pathomorphological changes in mumps infection. Morphological changes in parotitis infection occur mainly in the interstitial tissue of the salivary glands. Foci of inflammation are localized mainly near the excretory ducts, around the blood vessels. The glandular tissue of the organ in the pathological process is practically not involved.

However, with orchitis inflammatory degenerative changes can be quite pronounced, moreover, there may be foci of necrosis of glandular tissue with congestion of tubules followed by testicular atrophy.

When meningitis is observed, cerebral edema, hyperemia, lymphocytic infiltration of the soft meninges.

If you suspect a mumps, call a doctor. It is important to establish the diagnosis accurately. If it turns out that the lymph glands are swollen, the treatment will be completely different.

The child is usually kept in bed until the swelling subsides. Some in the pig can not eat or drink anything sour or tart, for example lemon juice( it pains the swollen glands), but others can eat such food. Therefore, the rejection of lemon or marinade is not an indication of mumps.

The incubation period for mumps infection is 11 to 23 days( an average of 15-19 days).Very rarely it is shortened to 9 days or extended to 26 days.

For epidemic mumps typical, characterized by an acute onset, fever to subfebrile or febrile digits, the appearance of symptoms of intoxication.

Occasionally a prodromal period is observed. In the last 1-2 days of the incubation period, weakness, sleep disorder, headache, pain in the muscles and joints, evening temperature rises. There may be a decrease in appetite, abdominal pain, vomiting, dry mouth, soreness at the site of the projection of the affected gland - a symptom of Filatov.

By the end of the first, less often the second day from the onset of the disease, there is an increase in parotid salivary glands. Usually the process starts on one side, and then after 1-2 days the second gland is affected. This marks a new rise in body temperature.

Inflammation of the parotid gland in parotitis infection is accompanied by the appearance of soft tissue edema, located in front of the ear, at the apex of the angle formed by the ascending branch of the lower jaw and the upper 1/3 of the sternocleidomastoid muscle. In the center, the swelling is elastic-elastic, and to the periphery - a dough-like consistency, so in most cases there are no clear boundaries. The skin above it is not changed, palpation causes a moderate soreness. Sometimes swelling spreads to the face, neck, subclavian area. The cases of its spreading to the pharynx and larynx are described.

During examination of the inner surface of the patient's cheek with epidemic parotitis, hyperemia and edema of the mouth of the excretory duct of the parotid salivary gland can be detected - a symptom of Moursou. The latter is not specific for mumps infection, but in combination with other symptoms it makes it possible to diagnose, since it appears already in the prodromal period.

Clinical picture of submaxillitis. Submaxitylite is rarely the only manifestation of mumps infection and, as a rule, develops against the background of the existing parotid gland lesion. At the same time in the submandibular region appears a round infiltrate of a dough-like consistency, moderately painful upon palpation. Under the tongue, one can observe flushing and edema of the mouth of the excretory duct of the affected gland. The development of edema of the subcutaneous tissue and its spread to the neck occurs in severe forms of the disease.

Clinical picture of orchitis

In males and boys during puberty, mumps can spread to the testicles. Usually it affects only one testicle. But even if both testicles become inflamed, it rarely leads to sterility( inability to have children).However, it is preferable for boys to have a mole before puberty, and some doctors recommend a conscious infection. Teenagers and men should beware of infection.

Orchitis usually develops in boys older than 11 - 12 years. His symptoms may appear on the 5th-8th day of the disease. At the same time, a new rise in body temperature to 38-39 ° C is observed, general malaise, abdominal pain radiating to the scrotum and testicle, then the latter rapidly increases, thickens, and sharp pain arises. The skin of the scrotum becomes tense, hyperemic, cyanotic. Most often, children complain of a feeling of heaviness in the testicle, pain that increases with walking and urination.

Only the right testicle is affected most often, which is related to the peculiarities of the blood supply. However, in 15% of patients the process can be bilateral. In addition, the development of epididymitis.

The expressed pathological changes in the testicle persist for 5-7 days, then a slow recovery occurs. Signs of organ atrophy are observed after 1-2 months. Manifestations of left-sided orchitis are more persistent.

Clinical picture of serous meningitis

Pig sometimes causes a special form of meningitis. The child's fever rises, the neck looses flexibility, he raves. This is rarely dangerous. Infection of the pancreas can cause severe pain in the abdomen and vomiting.

Pig is a contagious disease. Some doctors, including myself, believe that you can get sick again, so do not expose yourself to excessive risk. If a person has a tumor on both sides, it does not matter: he can still get sick again.

The defeat of the soft meninges often develops on the 3rd-5th day from the moment of the defeat of the salivary glands. At the same time, against the background of mictitating symptoms of mumps,

Meningeal signs quickly appear: stiff neck, symptoms of Brudzinsky and Kernig. However, in some children, meningeal signs may be absent( "meningitis without meningitis").The presence of persistent focal symptomatology indicates the involvement of the brain substance in the pathological process( meningoencephalitis).

The diagnosis is confirmed by the results of a lumbar puncture. In mumps, the cerebrospinal fluid is transparent, flows under pressure, lymphocytic pleocytosis( hundreds or thousands of cells), cell-protein dissociation, glucose and chloride content does not differ from the norm.

Usually the course of the disease is favorable, however, the sanation of the CSF can occur within 3-5 weeks.

Clinical picture of pancreatitis. Pancreatitis with parotitis infection usually develops sharply, on the 5-9th day from the onset of the disease. In this case, the following are observed:

In young children, a fatty liquid stool may appear, in the elder - constipation. With palpation of the abdomen, soreness, flatulence, positive symptoms of Mayo-Robson and Voskresensky are noted. A biochemical blood test reveals a significant increase in the activity of amylase, lipase, and trypsin. Increases the activity of diastase in the urine.

The course of the disease is favorable. Acute manifestations abate in the 1st-2nd day of the disease, complete restoration of the pancreas function occurs at the 3rd-4th week.

Complications of mumps infection .Complications of mumps infection are rare. However, there may be pneumonia, deafness, persistent paresis or paralysis of the muscles of the extremities, testicular atrophy, otitis, sinusitis.

Clinical picture of polyneuropathy in parotitis infection. The defeat of peripheral nerves in mumps infection is rare and can occur both at the height of the disease and in the period of convalescence. Thus, an increase in parotid gland sometimes leads to compression of the facial nerve, which is accompanied by a violation of the function of facial muscles. Poliradiculoneuropathy develops after the stifling of acute manifestations of parotitis infection and is characterized by flaccid paralysis of the lower extremities, pain syndrome. In this case, the increase in protein content and lymphocytic pleocytosis takes place in the cerebrospinal fluid.

The course of the disease is usually favorable. At the same time, it is possible to kill the cochlear nerve with a permanent hearing loss.

Syndromes of mumps infection. In addition to the general infection symptoms in the clinical picture of mumps infection, the following syndromes can occur:

Differential diagnosis of mumps infection taking into account the syndrome of sialoadenitis.

In epidemic parotitis, the list of infectious diseases subject to differential diagnosis for sialoadenitis syndrome should include:

Whereas among the non-communicable diseases to be excluded, the most common are:

Symptoms that distinguish secondary purulent parotitis from the epidemic. Because purulent parotitis is usually a complication of an infectious disease, in addition to signs of a salivary gland lesion, the patient has other symptoms characteristic of the underlying infection. In addition, purulent parotitis is characterized by pronounced local inflammatory changes: severe pain( up to pain trism), skin hyperemia, dense consistency of the gland with the subsequent appearance of fluctuations, purulent discharge from the excretory duct of the affected gland.

In addition, leukocytosis with neutrophil shift and accelerated ESR occur in the hemogram.

Differences of Mikulich syndrome from mumps .Mikulich syndrome in children is rare, more often people aged over 20 are affected. In this disease, there is a bilateral lesion of the salivary and lacrimal glands. It is characterized by a prolonged course, dry mouth, lack of fever, general infectious symptoms, inflammation of the salivary glands.

Differences in the actinomycosis of salivary glands from mumps. Disease is rare. Characterized by a gradual onset and a prolonged course. In a patient in the parotid or submaxillary region there is a dense, painless infiltrate. However, fever and symptoms of intoxication are absent. In the future, necrosis develops in the gland, which is accompanied by an increase in body temperature, hyperemia of the skin, tenderness in palpation, followed by softening and formation of a long-lasting non-healing fistula with the separation of thick pus, in which dense lumps( actinomycetes druses) are identified. Without specific treatment, the process takes a long time.

Differences in salivary stone disease from mumps. When the common or lobular duct of the parotid gland is clogged, its size increases, pain( salivary colic).After drainage of the duct, this symptomatology disappears, but then it may appear again. General infectious symptoms and inflammatory changes in the general analysis of blood appear only in those cases when the layering of secondary bacterial infection occurs.

For the detection of stones in the ducts of the salivary glands, X-ray, ultrasound or computed tomography can be used.

Differences in tuberculosis of the salivary glands from mumps. The defeat of the salivary glands in tuberculosis usually occurs against the background of pulmonary changes. It is characterized by slow development, prolonged swelling of the gland, lack of soreness, unilateral character of the lesion. In the future, necrotic decay of individual parts of the affected organ can occur and their subsequent calcification, revealed by X-ray examination.

The diagnosis is confirmed definitively after separation of the saliva of the tubercle bacillus.

Differences in syphilitic lesions of salivary glands from mumps. The defeat of the salivary glands with syphilis develops in the late stages of the disease and is characterized by a slow progressing course, the appearance of swelling of the parotid gland, and some soreness. In dynamics, pain with palpation of the body becomes more pronounced, the gland is dense, bumpy. In some cases, the defeat of "parotis" is combined with the restriction of mobility in the temporomandibular joint.

No common infectious symptoms.

Differences of recurrent allergic mumps from mumps. The diagnosis of recurrent allergic mumps is simplified by indicating in an anamnesis for similar episodes, previously occurred, occurring without fever and symptoms of general intoxication. During the recurrence of the parotid salivary gland swells up, over it appears hyperemia of the skin, a positive symptom of Murs is revealed. In the general analysis of blood, there is pronounced eosinophilia, leukocytosis, accelerated ESR.

In addition, allergic lesions of salivary glands are characterized by spring-summer seasonality and pronounced effect from antihistamines.

Differences in the increase of parotid salivary glands in diabetes mellitus due to mumps. In some cases, children with diabetes mellitus develop an increase in parotid salivary glands that disappear after a few days or weeks. Normalization of organ size usually occurs after optimization of insulin therapy. The process can be either unilateral or bilateral, fever and signs of intoxication are absent, palpation of the gland is painful.

Differences in swelling of the salivary gland from mumps. Neoplasms of the salivary glands in children are rare and characterized by a gradual increase in swelling, moderate soreness, lack of local inflammatory changes, symptoms of intoxication, fever.

Diseases for the differential diagnosis of mumps infection, taking into account the syndrome of "neck edema." The appearance of swelling of soft tissues in case of epidemic parotitis and a change in the configuration of the neck require the elimination of such diseases as:

Differences in the toxic diphtheria of the oropharynx from mumps .Toxic diphtheria of the oropharynx is characterized by rapid development of the disease, marked symptoms of intoxication, a sharp increase and soreness of the angular maxillary nodes, the presence of a significant edema of the soft tissues of the oropharynx and dirty-gray fibrinous plaque on the tonsils, a negative Murs symptom, a swelling of the subcutaneous tissue of the neckfrom the degree of toxic diphtheria).

Differences in infectious mononucleosis from mumps .Distinctive features of infectious mononucleosis are a predominant increase in cervical lymph nodes located in the form of chains along the sternocleidomastoid muscles( possibly an increase in inguinal, axillary groups), angina, hepatosplenomegaly. In addition, infectious mononucleosis is characterized by persistent, prolonged fever.

The diagnosis is confirmed by the detection in the blood of atypical mononuclears and the growth of the antibody titer agglutinating the foreign red blood cells( the reaction of Paul-Bunnel, Tomcheck, Lovrik).

Differences in lymphogranulomatosis from mumps. Lymphogranulomatosis differs from mumps due to lymph node involvement. In this case, the latter is usually preceded by "causeless" weakness, asthenia, increased body temperature, increased sweating. The disease is characterized by a long progressive course.

The final diagnosis of lymphogranulomatosis is confirmed by the results of a lymph node biopsy.

Differences in the deep phlegmon of the neck tissue( angina Ludwig) from mumps. The disease is preceded by a variety of inflammatory diseases from the oral or neck cavity( peritonsillar or pharyngeal abscess, cervical lymphadenitis, tongue phlegmon, epiglottitis).At the same time, the inflammatory process spreads along the tissues of the bottom of the oral cavity, around the pharyngeal space and further along the cellulose of the neck.

Distinctive features of Ludwig's angina are a severe general condition of the patient, febrile fever, severe symptoms of intoxication, rapid spread of the inflammatory process to the neck with the onset of swallowing and breathing disorders.

Diseases for differential diagnosis of parotitis infection with meningeal syndrome.

Due to the fact that in patients with mumps infection, the defeat of the soft meninges can precede the growth of the parotid glands or arise after the extinction of mumps symptoms, the list of diseases to be excluded from meningeal syndrome should include:

In addition, the syndrome of serous meningitis can be observed whenleptospirosis, chlamydia, mycoplasmosis, herpetic infection, tick-borne encephalitis, drop infections( measles, rubella, chicken pox).

Differences in primary purulent meningitis from the neuromuscular form of mumps infection. Primary purulent meningitis in the overwhelming majority of cases has a meningococcal nature. In addition, the primary lesion of the soft meninges can be caused by pneumococci and Afanasyev-Pfeiffer's stick.

Meningococcal meningitis, as a rule, begins violently, suddenly. From the first hours of the disease, the temperature rises to 39-40 ° C, the symptoms of intoxication, cerebral and meningeal signs are rapidly growing. In this case, lesions of the salivary glands, lymph nodes, pancreas are not observed. At the same time, a combination of meningitis and meningococcemia is possible.

It is not always possible to make a differential diagnosis among primary purulent meningitis for the main clinical symptoms, therefore bacteriological and serological research methods play an important role in diagnosis. However, it is possible to clarify the nature of inflammation in the soft meninges and exclude serous meningitis after carrying out lumbar puncture.

Differences in tuberculous meningitis from the neuromuscular form of mumps infection. Early diagnosis of tuberculous meningitis is very important, as the timely initiation of specific therapy significantly improves the prognosis of the disease. It requires a careful collection of anamnesis of life and disease, an analysis of existing clinical symptoms. Thus, for a specific lesion of the soft meninges, a gradual onset of the disease is characteristic, accompanied by increasing weakness, increased fatigue, and a headache that increases with time. Then there is vomiting, meningeal signs, the body temperature rises, often the third and fourth pairs of cranial nerves are involved in the process. In the cerebrospinal fluid there is a lymphocytic-neutrophilic pleocytosis, protein-cell dissociation, a sharp decrease in the glucose content. In addition, when the liquor is left to stand for 1-4 hours, a tender fibrinous film falls out.

An x-ray of the chest, tuberculin tests, detection of tubercle bacilli in cerebrospinal fluid can serve as an aid in the diagnosis of tuberculous meningitis.

Differences in the meningeal form of poliomyelitis from the neuromuscular form of mumps infection. First of all, one should remember that the children of the first 3 years of life are the victims of poliomyelitis. In addition, the clinical picture of the meningeal form of poliomyelitis has a number of characteristic features that make it possible to distinguish it from mumps meningitis. So, in addition to headache, vomiting, meningeal signs in patients with poliomyelitis, severe hyperesthesia, positive symptoms of tension, pain during palpation of large nerve trunks, fasciculation, horizontal nystagmus are often observed.

The final diagnosis is made after receiving the results of virologic and serological examinations.

Differences in enteroviral meningitis from the neuromuscular form of mumps infection. Differences in the clinic of enteroviral meningitis from mumps are in different seasonality of diseases( summer-fall during enterovirus infection and winter-spring in case of epidemic parotitis), absence of symptoms of lesions of glandular organs, frequent combination of the defeat of the soft meninges with other clinical forms of enterovirus infection - herpetic sore throat,epidemic myalgia, diarrhea syndrome, catarrhal phenomena. In addition, patients with enterovirus infection observed hyperemia of the face, injection of vessels of the sclera.

The results of the virological examination are crucial in the diagnosis.

Methods of specific laboratory diagnostics of mumps. Virological - when isolating a virus, examine the saliva, spinal fluid not later than the 4th-5th day of the disease, or the urine of the patient( and later).

Saliva should be collected near the outlet of the duct. The material for the study is immediately treated with antibiotics and injected into the culture of kidney cells of monkeys.

The virus can be detected after 5-6 days by adsorption on infected red blood cells of chicken or guinea pig by adding a suspension of erythrocytes to the tissue culture. In terms of severity of hemabsorption, the presence of the virus is judged.

Express methods - immunofluorescence allows to detect the virus in tissue cultures after 2 days.

Serological methods are aimed at identifying specific antibodies in serum. In the acute period of the disease, the serum is examined at an earlier time, in the period of convalescence - in 3-4 weeks.

To number of exact on specificity and sensitivity carry RAC.Antibodies against soluble s-antigen are produced in the early days of the disease, sometimes reaching a high level, so they are detected earlier than antibodies against the virus itself( v-antigen).In the early period of convalescence, antibodies to s- and v-antigens are present, soluble s-antibodies disappear, v-antibodies remain as a marker of the transferred disease, which persist for several years in low titers( 1: 4).Intracutaneous administration of an inactivated virus stimulates the formation of v-antibodies in high titers. Viral neutralizing antibodies are also detected during convalescence.

DSC, like RTGA and PH, is paired with paired sera at intervals of 10-14 days. For diagnostic increase take an increase in the level of antibodies in 4 times or more.

ELISA is the most promising method for determining a class-specific immune response. Specific IgM antibodies are detected at the onset of the infectious process and in the acute period, as well as in atypical forms, in isolated localizations( orchitis, meningitis, pancreatitis), specific IgC antibodies indicate a latent period and a period of convalescence, this class of antibodies persists for many years.

Usually patients with a glandular form of parotitis infection are treated on an outpatient basis, however, sometimes there is a need for hospitalization. So, inpatient treatment is usually directed to children with severe and complicated forms of the disease, with signs of involvement of the central nervous system, pancreas, testicle. In addition, hospitalization can be carried out by epidemiological indications.

In the acute period, treatment is carried out according to the following principles:

Especially shown to children 12-14 years due to high risk of pancreatic, soft meninges, testicles in boys;

Viferon is administered rectally for 2 suppositories per day with a 12-hour interval. Children from one year to 7 years are prescribed viferon-1, older than 7 years - viferon-2.In the smooth course of mumps infection, the duration of treatment with viferon is 5 days, in the presence of complications, 7-10 days. The therapeutic effect is higher the earlier the drug is administered.

In the reconvalescence stage for healing, under the control of the immunogram, immunocorrecting drugs can be used.

Antibiotics are used in the development of secondary bacterial complications.

Symptoms of mumps in meningitis require the hospitalization of a child in a hospital. The therapeutic scheme includes the appointment:

When developing the labyrinthitis, strict bed rest, as well as the administration of drugs of nicotinic acid, B vitamins, ascorbic acid, diuretics and nootropics, physiotherapeutic procedures are necessary.

The recovery of convalescent mumps is carried out after complete clinical recovery, sanation of the cerebrospinal fluid( no more than 100 cells in 1 μl).

The presence of a patient with orchitis requires the hospitalization of the child in the department, where they are appointed:

In addition, a dynamic surgeon's observation is necessary to conduct operational assistance if necessary.

The recovery of convalescent mumps is performed a week after the local inflammation subsides. Over the next 2 weeks, the use of a suspension is indicated.

Patient with mumps pancreatitis must be treated in a hospital. The following is necessary: ​​

Criteria for discharge of convalescent varieties:

Dispensary monitoring of convalescent mumps convalescents. Follow-up of children who have undergone various clinical forms of mumps infection indicates that recovery can be either complete or with residual events. Among the latter there are cerebral, hypertensive syndrome, chronic pancreatitis, type 1 diabetes mellitus, infertility, hearing loss. In this regard, the need for clinical examination of convalescents becomes obvious.

The duration of dispensary follow-up of convalescents of mumps infection and the nature of drug therapy depend on the clinical form of the disease.

For example, children who underwent meningitis( meningoencephalitis) after discharge from the department need:

Conjunctivities of orchitis( oophoritis) need to be monitored by an endocrinologist during the year.

Children who underwent parotitis pancreatitis are observed by the district pediatrician and / or children's gastroenterologist until the disappearance of the clinical manifestations of the disease. The physical load is limited to 6-12 months. In the presence of diabetes mellitus, the closest relatives need consultation of the pediatric endocrinologist.

Activities carried out during non-specific prophylaxis of mumps. Those infected with parotitis infection are isolated from the children's collective until the disappearance of clinical manifestations( for 9 days).Among the contact disconnections are children under 10 years who did not get a mumps infection and did not receive active immunization for a period of 21 days. If you know the exact date of contact, children are to be isolated from the 11th to the 21st day of the incubation period. Final disinfection in the outbreak is not carried out.

Children( who have had contact with a mumps infected woman) are observed( inspection, thermometry) until the end of quarantine.

The only reliable method of prevention is active immunization. For vaccination, a live attenuated mumps vaccine L-3( HPV) is used, except for it, MMR-II vaccines( measles, parotitis, rubella) of Merck Sharp & Dome( USA) and Prioriks( England) have been registered in Russia.

Vaccines are stored at a temperature of 2-8 ° C.Shelf life is 15 months.

Dates, dose and method of administration of vaccines. Vaccination is given to children who have not previously had mumps, twice - at the age of 12 months and at 6 years. The monovaccine is administered simultaneously with measles and rubella vaccines in different parts of the body, using MMR-II trivacin."Priority" reduces the number of injections. Vaccines are administered once in a volume of 0.5 ml subcutaneously under the scapula or in the outer region of the shoulder.

Responses to the administration of vaccines in the child .Vaccines have a low reactogenicity, so most children do not respond. However, sometimes from the 4th to the 12th day after the introduction of the vaccine, there is an increase in body temperature and catarrhal phenomena within 1-2 days. Less likely to increase parotid glands.

A child with a postvaccinal reaction is not contagious.

Vaccination complications. Complications are extremely rare: hyperthermia, febrile convulsions, abdominal pain, vomiting, allergic rashes. Single cases of serous meningitis are described.

Contraindications for vaccination. Contraindications are immunodeficiency conditions, malignant blood diseases, cytostatic therapy, allergic to aminoglycosides and quail( for L-3 vaccine) or chicken( MMR) eggs, anaphylactic reaction to the introduction of measles vaccine. Vaccination is delayed until recovery from an acute period or the onset of remission of a chronic disease. The vaccine is not administered to persons who received an immunoglobulin injection.