Mumps Testing Job-Aid for Providers
Communication with healthcare providers on appropriate testing procedures, including information on specimen type and timing of specimen collection, is critical to ensure best practices before and during an outbreak. Jurisdictions can use the Mumps testing Job-Aid below as a tool for communicating best testing practices to providers.
Health departments can request a modifiable version of the job-aid by emailing the CDC Mumps Team. (Please include “Mumps Testing Job-Aid” in the subject line). The modifiable version can be edited to include:
- their contact information,
- testing and shipping instructions, and
- outbreak specific guidance.
Sporadic (no epidemiologic-link, not outbreak-related) mumps testing flowchart
For persons presenting with symptoms of mumps without known epidemiologic-linkage, multiplex testing for other infectious etiologies* is recommended concurrent with mumps testing to better interpret the clinical picture alongside laboratory results.
- A negative laboratory result in a person with clinically compatible mumps symptoms does not rule out mumps.
- Persons tested for immunologic screening without symptoms would not be considered a case if IgM+ unless there is documentation that mumps was suspected.
*Consider testing for other infectious etiologies such as influenza, parainfluenza, EBV, & adenovirus that can cause parotitis. If mumps testing is negative and there is a more likely alternative diagnosis with a positive laboratory result, individuals can be classified as not a mumps case.
+For mumps PCR, specimen should be ideally collected 0-3 days after parotitis onset but can be collected up to 10 days. If >10 days since symptom onset, PCR testing no longer recommended. For mumps IgM, collecting specimens >3 days after parotitis onset improves the ability to detect IgM. Additional information: Laboratory Testing for Mumps Infection
- A negative laboratory result in a person with clinically compatible mumps symptoms does not rule out mumps.
- Persons tested for immunologic screening without symptoms would not be considered a case if IgM+ unless there is documentation that mumps was suspected.
- In an outbreak setting, occasionally asymptomatic or persons with atypical presentation may test PCR +, culture +, or show seroconversion, and would be classified as confirmed cases.
- Parotitis after vaccination has been reported in <1% of vaccinees. If epidemiologically-linked/outbreak-associated cases recently received dose of MMR, genotyping can be done to confirm if vaccine strain
+For mumps PCR, specimen should be ideally collected 0-3 days after parotitis onset but can be collected up to 10 days. If >10 days since symptom onset, PCR testing no longer recommended. For mumps IgM, collecting specimens >3 days after parotitis onset improves the ability to detect IgM. Additional information: Laboratory Testing for Mumps Infection
Top of chart begins “Patient has parotitis or other salivary gland swelling”
- Then Q: “Has it been ≤ 3 days+ since symptom onset?”
- If “Yes”, then “Collect buccal specimen for PCR at first contact with patient”
- PCR- (Suspect Case)
- PCR + (Confirmed Case)
- If vaccinated (MMR) within 6-45 days: genotype to determine if vaccine reaction (genotype A) or wild type
- If “No” Collect buccal specimen for PCR and serology for IgM at first contact with patient
- PCR + (Confirmed Case)
- If vaccinated (MMR) within 6-45 days: genotype to determine if vaccine reaction (genotype A) or wild type
- PCR – / IgM + (Probable Case)
- PCR – / IgM – (Suspect Case)
- PCR + (Confirmed Case)
- If “Yes”, then “Collect buccal specimen for PCR at first contact with patient”
Top of chart begins “Patient does not have parotitis but has an acute potential mumps complication of uncertain etiology:”
- Orchitis/Oophoritis
- Mastitis
- Pancreatitis
- Hearing loss
- Meningitis/Encephalitis
- Then Collect buccal specimen for PCR and serology for IgM at first contact with patient
- PCR – / IgM- (Suspect Case)
- PCR – / IgM + (Probable Case)
- PCR + (Confirmed Case)
Sentence for scenarios 1 and 2 below: At the start of a mumps outbreak, persons suspected to have mumps should be tested by RT-PCR to confirm mumps. Once the outbreak is confirmed, testing of subsequent persons is optional depending on volume/resources. Epidemiologically-linked persons with parotitis, orchitis, or oophoritis can be classified as probable cases without testing.
Top of chart begins Scenario 1 “Patient has parotitis or other salivary gland swelling”
- Then Q: “Has it been ≤ 3 days+ since symptom onset?”
- If “Yes”, then “CAN Collect buccal specimen for PCR at first contact with patient”
- PCR- (Probable Case)
- PCR + (Confirmed Case)
- If “No” then “CAN Collect buccal specimen for PCR and serology for IgM at first contact with patient”
- PCR – / IgM – (Probable Case)
- PCR – / IgM + (Probable Case)
- PCR + (Confirmed Case)
- If “Yes”, then “CAN Collect buccal specimen for PCR at first contact with patient”
Top of chart begins Scenario 2 “Patient does not have parotitis but has either orchitis or oophoritis”
- Then “CAN Collect buccal specimen for PCR and serology for IgM at first contact with patient”
- PCR – / IgM – (Probable Case)
- PCR – / IgM + (Probable Case)
- PCR + (Confirmed Case)
Top of chart begins “Patient does not have parotitis, orchitis, or oophoritis, but has an acute potential mumps complication of uncertain etiology:”
- Orchitis/Oophoritis
- Mastitis
- Pancreatitis
- Hearing loss
- Meningitis/encephalitis
- Then “Collect buccal specimen for PCR and serology for IgM at first contact with patient”
- PCR – / IgM – (Probable Case)
- PCR – / IgM + (Probable Case)
- PCR + (Confirmed Case)