North Dakota health officials say that the number of mumps cases in the state has risen to nine, according to local media.

North Dakota Image/National Atlas
North Dakota
Image/National Atlas

The cases are in Ward, Stark, McHenry, and Cass County.

Last week,  the North Dakota Department of Health (NDDoH) issued a health advisory over the mumps situation, as all the cases have been reported in recent weeks.

The most recognizable symptom of mumps is parotitis (acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary glands). Other symptoms include fever, headache, earache, muscle or joint pain, painful swelling of the testicles in men and swelling of the ovaries in women, causing abdominal pain.

Mumps vaccination is not 100% effective, so mumps should be suspected in individuals meeting the clinical case definition even with a history of MMR vaccination.

As of March 4, 2016, the Centers for Disease Control and Prevention (CDC) has reported 250 mumps cases nationwide.