From the Guidelines
For an adult female with a low measles antibody titer (<5.0) indicating inadequate immunity, vaccination with the MMR (measles, mumps, rubella) vaccine is recommended. The patient, born in 1963, is considered to be at risk due to her birth year and low antibody titer. According to the most recent and highest quality study available, adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless they have a medical contraindication, laboratory evidence of immunity to each of the 3 diseases, or documentation of provider-diagnosed measles or mumps disease 1.
The standard regimen consists of two doses of MMR vaccine administered at least 28 days apart. Each dose is 0.5 mL given subcutaneously, typically in the upper arm. If the patient has previously received one documented dose of measles-containing vaccine, only one additional dose is needed. After vaccination, no follow-up antibody testing is necessary as most adults develop adequate immunity after proper vaccination.
Key considerations include:
- The MMR vaccine contains live attenuated viruses and is contraindicated during pregnancy, so ensure the patient is not pregnant before administration and advise avoiding pregnancy for one month after vaccination.
- Side effects are generally mild and may include soreness at the injection site, low-grade fever, and mild rash.
- Vaccination is important because measles is highly contagious and can cause serious complications including pneumonia, encephalitis, and even death.
- Adults with inadequate immunity remain susceptible to infection, especially during outbreaks, and can transmit the virus to vulnerable populations.
It's also worth noting that while other studies provide additional context and recommendations for specific situations, such as the use of immune globulin for postexposure prophylaxis 1, the primary recommendation for an adult female with a low measles antibody titer remains vaccination with the MMR vaccine, as supported by the most recent and highest quality evidence 1.
From the Research
Measles Antibody Titer <5.0: Implications and Recommendations
- The individual in question, an adult female born in 1963 with a measles antibody titer of <5.0, is considered to have inadequate immunity against measles 2, 3.
- Given the low measles antibody titer, the individual may be at risk of contracting measles, especially if exposed to the virus 4.
- There are no specific recommendations for adults with low measles antibody titers, but it is essential to consider vaccination or post-exposure prophylaxis in high-risk individuals 2, 5.
Vaccination and Post-Exposure Prophylaxis
- The measles, mumps, and rubella (MMR) vaccine is the primary means of preventing measles infection 4, 6.
- A third dose of MMR vaccine may not be necessary for most individuals, as it does not provide significant additional protection 3.
- Post-exposure prophylaxis with immunoglobulins may be recommended for high-risk individuals, such as pregnant women, immunocompromised patients, and infants <6 months of age, within six days of exposure to measles 2.
Considerations for Adults with Low Measles Antibody Titers
- Adults with low measles antibody titers may need to consider vaccination or post-exposure prophylaxis if they are at high risk of exposure to measles, such as healthcare workers or travelers to areas with ongoing measles outbreaks 2, 5.
- The decision to vaccinate or provide post-exposure prophylaxis should be made on a case-by-case basis, taking into account the individual's medical history, risk factors, and current immune status 2, 6.