Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Mumps Vaccination for Outdoor Travelers

Mumps (a viral infection) is making a comeback in the U.S. and other countries because of failure to vaccinate. It is not a trivial disease, particularly in adults, and is highly communicable. In children, mumps typically causes fever, headache, muscle aching, fatigue, loss of appetite, and swelling of salivary glands, in particular the parotid glands, which are located in the cheeks directly in front of the ears. In all age groups, patients suffer from fever and inflamed salivary glands, which causes the "chipmunk" appearance, as if the person was a small animal storing nuts in his or her cheeks. In male adults, mumps can cause inflammation of the testicles (orchitis), which can become quite painful and debilitating. In other cases, mumps can cause deafness and inflammation of the brain and sensitive tissues around the brain. It can also cause ovarian or breast inflammation, miscarriage, and deafness. The severity of infection tends to increase with age.

In an article entitled "Recent Resurgence of Mumps in the United States" (New England Journal of Medicine 2008;358:1580-9), Gustavo H. Dayan, M.D. and his co-authors describe that the largest mumps outbreak in two decades in the U.S. occurred in the year 2006. This was in a population that received the proper immunization regimen of two doses of vaccine. Their conclusions were that it may be necessary to develop a more effective mumps vaccine or to make a change(s) in mumps vaccination policy (e.g., institution of a recommendation for a third dose of vaccine).

Why did the incidence of mumps increase? Some factors cited by the authors include declining immunity, high population density and contact rates among college students, the possibility that the vaccine did not provide sufficient immunity against certain ("wild") strains of the virus, and that perhaps the virus was transmitted by persons with very mild ("subclinical") disease or vaccine-modified disease.

What does this mean for the wilderness or foreign traveler? Outbreaks have certainly occurred in other countries, such as Canada. For now, it is just a reminder that all childhood immunizations should be brought up to date prior to travel, because exposure to mumps and other normally childhood diseases may periodically be higher in countries outside the U.S.

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.