groups in secondary schools and colleges. This clustered .... Typical ultrasonography (US) features include diffuse ..... 71 Bertschat FL, Alexander M. [Infertility.
2009 THE AUTHORS. JOURNAL COMPILATION Mini Reviews
2009 BJU INTERNATIONAL
MUMPS ORCHITIS: A COMPREHENSIVE REVIEW DAVIS et al.
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The increasing incidence of mumps orchitis: a comprehensive review
BJU INTERNATIONAL
Niall F. Davis, Barry B. McGuire, Jackie A. Mahon, Anna E. Smyth, Kiaran J. O’Malley and John M. Fitzpatrick Department of Urology and Department of Surgery, Mater Misericordiae University Hospital, University College Dublin, Ireland Accepted for publication 22 October 2009
There has been a recent increase in mumps orchitis among pubertal and postpubertal males. These outbreaks can be attributed to a reduction in the uptake of measles-mumpsrubella (MMR) vaccine during the early to mid-1990s in children who have now matured. The mumps virus is commonly
INTRODUCTION Mumps is a contagious viral disease caused by a single-stranded RNA virus belonging to the genus Rubulavirus and the family Paramyxoviridae. Hippocrates described a mild epidemic of an illness in the 5th century BC, characterized by non-suppurative swelling near the ears with occasional swelling of one or both testicles. In fact, the term ‘mumps’ is derived from an old English verb meaning ‘grimace’, reflecting the impact of parotitis on facial expression [1]. The virus has no animal reservoirs and is purely a human disease. There is only one serotype of the virus, which can be further divided into 10–11 genotypes [2]. Individuals almost always acquire lifelong immunity once infected [3]. Complications of mumps include orchitis, oophoritis, aseptic meningitis, encephalitis, deafness and pancreatitis, and at least one of these occurs in up to 42% of patients with mumps [4]. Recently, there has been a resurgence in mumps orchitis, with epidemics being reported more frequently [5–8]. In our institution we are witnessing an alarming increase in the presentations of mumps orchitis in pubertal and postpubertal males. In this article we review the epidemiology, clinical presentation, diagnostic methods, treatment options and complications of mumps orchitis. We place a strong emphasis on testicular atrophy, subfertility and infertility as strong concerns
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associated with extra-salivary complications. Unvaccinated postpubertal males diagnosed with mumps virus frequently develop complications such as mumps orchitis. Therefore, it is important that urologists are familiar with the diagnosis, treatment and complications of this condition. Here we
review the epidemiology, clinical presentation, diagnostic methods, treatment options and complications of mumps orchitis, as a complication of mumps virus, with particular emphasis on testicular atrophy, subfertility and infertility.
currently exist on these potential complications.
linked to Crohn’s disease [24]. Following this, a second paper was published linking the MMR vaccine to autistic spectrum disorders and inflammatory bowel disease in 1998 [25]. These publications received significant media coverage and there was a resulting decrease in vaccine uptake, despite subsequent reviews concluding that no such link exists [26–29]. After the sustained negative media coverage MMR vaccine uptake decreased from 91% [30] to 58% in some urban parts of the UK (Fig. 3) [31–33], and public concern linking MMR to autism remains high today [34].
EPIDEMIOLOGY During the pre-vaccine era mumps was characterized by inter-epidemic periods every 4–5 years that most commonly affected children aged 5–7 years [7,9]. Globally, 290 cases per year per 100 000 population were diagnosed between 1977 and 1985 [10]. Since the introduction of the measles-mumpsrubella (MMR) vaccine in 1968 there has been a 99% reduction in the incidence of the virus in the USA [11]. Recently, there has been a global resurgence of mumps and recent outbreaks have mainly affected adolescents and young adults [12,13]. The resurgence of mumps began in 2004 when >56 000 cases were notified in England and Wales (Fig. 1). These figures corresponded to high numbers in several other countries at that time [1,2,14–19]. Most confirmed cases occurred in those aged 15–24 years who were attending colleges or universities (Fig. 2) [20–22]. It is believed that there are several reasons why this age group are now susceptible to the virus and its complications. Fifteen years ago there was a global shortage of the MMR vaccine. At that time, the main priority was to prevent a measles epidemic, and a measles and rubella vaccine was used instead [23]. During the mid-1990s the MMR vaccine was
The population group who did not receive the MMR vaccine are now collecting in large groups in secondary schools and colleges. This clustered environment provides a perfect breeding ground for the virus. Students are more susceptible to the virus and its complications, including mumps orchitis. The incidence of orchitis in males with postpubertal mumps is as high as 40% [4]. This is very concerning, as sporadic epidemics of mumps orchitis are now being reported more frequently in many countries worldwide [1,6,8,17,35].
AETIOLOGY Historically, outbreaks of the virus occurred in schools, universities, military bases, sports clubs and other crowded settings [36]. This
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FIG. 2. Notifications of mumps virus by age group in 2000–2007 in England and Wales [20], showing the epidemiological change of the virus. Most cases now occur in those aged 15–24 years [22]. 60000
FIG. 3. The percentage of MMR vaccine uptake at 16 months in UK 1994–2003 [30,33]. If current trends continue we expect an increase in the incidence of mumps orchitis. Children from 1998 onwards have matured into the 15–24-year age group where mumps orchitis is now most common.
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