Mumps is not a benign illness...Bilateral Mumps-Associated Retinitis in an Unvaccinated Male

A16-year-old Indian male presented with sudden bilateral painless vision loss, occurring 4 days after a recent fever episode. His visual acuity (VA) was counting fingers (CF) at 20 cm OU. Retinal examination displayed bilateral multifocal retinitis in a cerebriform pattern with whitish abnormality along, but not contiguous with, the vessels across all quadrants, alongside a normal optic disc (Figure, A and B).¹ Optical coherence tomography depicted distortion of the inner and outer retinal architecture with diffuse hyperreflectivity, particularly in the outer layers (Figure, C and D). Mumps-associated retinitis was confirmed with positive serum mumps immunoglobulin M and G tests. Subsequent treatment included local and systemic antivirals, oral corticosteroids, plasmapheresis, and hyperbaric oxygen therapy ² Follow-up VA with eccentric fixation was CF at 40 cm OU. The Indian national immunization schedule currently excludes the mumps vaccine, and this patient had not received it. The mumps-associated vision loss in this case underscores the critical public health importance of including this vaccine.

Presently our school system requires Mumps, Measles and Rubella (MMR) vaccination for entry into the public school system.

Despite the controversy created by some well-known politicians, parents are advised to vaccinate their children as scheduled by the CDC.

The MMR (Measles, Mumps, and Rubella) vaccine is overwhelmingly safe and effective. It has been extensively studied for decades, and the scientific consensus is that the benefits far outweigh any potential risks.

Safety of the MMR Vaccine

1. No Link to Autism

   • A now-debunked 1998 study falsely claimed a connection between the MMR vaccine and autism. The study was retracted, and its author lost his medical license due to ethical violations and data manipulation.
   • Large-scale studies involving hundreds of thousands of children have proven that there is no link between MMR and autism.

2. Mild, Temporary Side Effects

   • Some people experience minor side effects such as fever, mild rash, or swelling at the injection site.
   • A small percentage may have temporary joint pain (more common in adults).
   • In rare cases, there may be mild febrile seizures, but these do not cause long-term harm.

3. Extremely Rare Serious Reactions

   • Severe allergic reactions (anaphylaxis) are exceedingly rare, occurring in about 1 in a million doses.
   • The vaccine does not cause long-term health problems in the vast majority of people.

Benefits of the MMR Vaccine

1. Prevents Deadly Diseases

   • Measles can cause pneumonia, brain swelling (encephalitis), and death.
   • Mumps can lead to deafness, meningitis, and infertility.
   • Rubella is extremely dangerous during pregnancy, leading to severe birth defects.

2. Herd Immunity

   • High vaccination rates protect those who cannot be vaccinated (e.g., newborns, and immunocompromised individuals).
   • Outbreaks occur in communities with low vaccination rates, putting vulnerable populations at risk.

Conclusion

The MMR vaccine is one of the most well-studied, safe, and effective vaccines available. The risks are minimal compared to the dangers of measles, mumps, and rubella. Choosing to vaccinate is choosing to protect both individuals and the community.

Signs and Symptoms of Mumps

Symptoms usually appear 12 to 25 days after exposure and can range from mild to severe.

Common Symptoms:

1. Swelling of the Parotid Glands (Most Characteristic Symptom)

   • Causes puffy cheeks and a swollen jaw.
   • Can affect one or both sides.
   • Tender and painful, especially while chewing or swallowing.

2. Fever

   • Typically low to moderate (around 101–104°F or 38–40°C).

3. Headache

   • General discomfort and pain in the head.

4. Muscle Aches (Myalgia)

   • The feeling of muscle stiffness and soreness.

5. Fatigue and Weakness

   • A general feeling of being unwell (malaise).

6. Loss of Appetite

   • Reduced desire to eat, leading to weakness.

7. Pain While Chewing or Swallowing

   • Due to swelling of the salivary glands.

Less Common but Serious Symptoms:

1. Orchitis (Testicular Inflammation in Males)

   • Affects post-pubertal males (common in teenagers and adults).
   • Causes severe testicular pain, swelling, and tenderness.
   • Can lead to infertility in rare cases.

2. Oophoritis (Ovary Inflammation in Females)

   • Occurs in post-pubertal females.
   • Causes abdominal pain, fever, and nausea.

3. Meningitis (Brain and Spinal Cord Inflammation)

   • Severe headache, stiff neck, and light sensitivity.
   • Rare but can be serious.

4. Encephalitis (Brain Inflammation)

   • Extremely rare but can cause seizures, confusion, and neurological damage.

5. Hearing Loss (Rare Complication)

   • Can be temporary or permanent in one or both ears.

When to Seek Medical Attention?

• Severe swelling or pain in the jaw or testicles.
• High fever (above 104°F/40°C).
• Severe headache or stiff neck (possible meningitis).
• Difficulty breathing or swallowing.

Prevention & Treatment

• Vaccination (MMR Vaccine): The best prevention method.
• Supportive Care (No specific antiviral treatment):
  • Rest and fluids.
  • Pain relievers (acetaminophen or ibuprofen, not aspirin for children).
  • Cold or warm compresses on swollen glands.

Mumps is highly contagious, so isolation is necessary to prevent spreading, typically for at least 5 days after symptoms appear

Bilateral Mumps-Associated Retinitis in an Unvaccinated Male | Ophthalmology | JAMA Ophthalmology | JAMA Network