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Non-mumps Viral Parotitis During the 2014-2015 Influenza Season in the United States
Lina I Elbadawi1,2, Pamela Talley1,3, Melissa A Rolfes1,4
1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
Background:
During the 2014-2015 US influenza season, 320 cases of non-mumps parotitis (NMP) among residents of 21 states were reported to the Centers for Disease Control and Prevention (CDC). We conducted an epidemiologic and laboratory investigation to determine viral etiologies and clinical features of NMP during this unusually large occurrence.
Methods:
NMP was defined as acute parotitis or other salivary gland swelling of >2 days duration in a person with a mumps- negative laboratory result. Using a standardized questionnaire, we collected demographic and clinical information. Buccal samples were tested at the CDC for selected viruses, including mumps, influenza, human parainfluenza viruses (HPIVs) 1-4, adenoviruses, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses (HSVs) 1 and 2, and human herpes viruses (HHVs) 6A and 6B.
Results:
Among the 320 patients, 65% were male, median age was 14.5 years (range, 0-90), and 67% reported unilateral parotitis. Commonly reported symptoms included sore throat (55%) and fever (48%). Viruses were detected in 210 (71%) of 294 NMP patients with adequate samples for testing, ≥2 viruses were detected in 37 samples, and 248 total virus detections were made among all samples. These included 156 influenza A(H3N2), 42 HHV6B, 32 EBV, 8 HPIV2, 2 HPIV3, 3 adenovirus, 4 HSV-1, and 1 HSV-2. Influenza A(H3N2), HHV6B, and EBV were the most frequently codetected viruses.
Conclusions:
Our findings suggest that, in addition to mumps, clinicians should consider respiratory viral (influenza) and herpes viral etiologies for parotitis, particularly among patients without epidemiologic links to mumps cases or outbreaks.
Insights
During the 2014-2015 influenza season, non-mumps parotitis (NMP) was investigated. Influenza A(H3N2), human herpesvirus 6B, and Epstein-Barr virus were common causes, suggesting broader differential diagnoses for parotitis.
Area of Science:
- Virology
- Epidemiology
- Public Health
Background:
- Investigated an unusual increase in non-mumps parotitis (NMP) cases during the 2014-2015 US influenza season.
- Collected data on 320 NMP cases across 21 states reported to the CDC.
Purpose of the Study:
- Determine the viral causes of NMP.
- Characterize the clinical features of NMP cases.
Main Methods:
- Defined NMP as salivary gland swelling with negative mumps testing.
- Collected demographic and clinical data via questionnaire.
- Tested buccal samples for a panel of viruses including influenza, EBV, and HHVs.
Main Results:
- Identified viral etiologies in 71% of NMP patients.
- Influenza A(H3N2) was the most frequent virus (156 cases), followed by human herpesvirus 6B (42 cases) and Epstein-Barr virus (32 cases).
- Coinfections with multiple viruses were observed.
Conclusions:
- Clinicians should consider influenza and herpesviruses as causes of parotitis.
- Differential diagnosis for parotitis should extend beyond mumps, especially in patients without mumps exposure.
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