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HIGH POINT, N.C. — The number of confirmed cases of mumps at High Point University broke 20, according to the university.

Since the first case of mumps was reported on campus on Sept. 18, 21 people with previously confirmed cases of mumps have been cleared.

The university is following four active cases.

“High Point University continues to work closely with the Guilford County Health Department to ensure that all recommendations are followed to maintain the health and safety of the HPU community regarding mumps,” the university said in a statement.

Earlier this month, 11 cases of mumps had been confirmed at the university with another three confirmed by Tuesday.

Mumps is a contagious disease that is caused by a virus, according to the CDC. It typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite. Then most people will have swelling of their salivary glands. This is what causes the puffy cheeks and a tender, swollen jaw.