From the Guidelines
For a 55-year-old patient with negative immunity to mumps, I strongly recommend vaccination with the MMR (measles, mumps, rubella) vaccine to prevent potential complications and ensure long-lasting immunity. The patient should receive one dose of MMR vaccine, which contains attenuated mumps virus along with measles and rubella components, administered as a subcutaneous injection, typically in the upper arm 1. According to the recommended adult immunization schedule, all adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless they have a medical contraindication to the vaccine, or laboratory evidence of immunity to each of the 3 diseases 1.
Key Considerations
- The MMR vaccine is a live attenuated vaccine, so it should not be given if the patient is severely immunocompromised, pregnant, or has had a severe allergic reaction to a previous dose or any component of the vaccine 1.
- Side effects are generally mild and may include soreness at the injection site, low-grade fever, or mild rash 1.
- Mumps can cause serious complications in adults, including orchitis, oophoritis, pancreatitis, and meningitis, making vaccination particularly important for those without immunity 1.
Vaccination Recommendations
- A routine second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who are students in postsecondary educational institutions, work in a health-care facility, or plan to travel internationally 1.
- Persons vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection should be considered for revaccination with 2 doses of MMR vaccine 1.
From the Research
Recommendations for a 55-year-old patient with negative immunity to mumps
- The Centers for Disease Control (CDC) recommend 2 documented doses of the MMR (measles-mumps-rubella) vaccine for adequate measles, mumps, and rubella immunity for all children and most adults 2.
- For adults with negative immunity to mumps, the Advisory Committee on Immunization Practices (ACIP) updated criteria for mumps immunity and mumps vaccination recommendations in 2006, which includes documentation of mumps immunity through vaccination consisting of only 1 dose of mumps-containing vaccine for all designated groups, including health-care workers 3.
- However, studies have shown that a third dose of MMR vaccine (MMR3) may be necessary to boost immunity to mumps, especially in populations with high 2-dose MMR vaccine coverage 4.
- A 10-year follow-up study on the long-term immunogenicity of measles, mumps, and rubella-containing vaccines in healthy young children found that a second dose of MMR vaccine had a boosting effect on anti-mumps antibody titers and seropositivity rates 5.
- It is also worth noting that mumps outbreaks can occur in populations with high 2-dose MMR vaccine coverage, and the combined effects of waning of immunity and circulating new strains may contribute to these outbreaks 5.
Considerations for vaccination
- The CDC recommends 2 documented doses of the MMR vaccine for adequate immunity, but the ACIP updated criteria in 2006 allow for documentation of mumps immunity through vaccination consisting of only 1 dose of mumps-containing vaccine 2, 3.
- A third dose of MMR vaccine (MMR3) may be necessary to boost immunity to mumps, especially in populations with high 2-dose MMR vaccine coverage 4.
- The decision to vaccinate should be based on individual risk factors and medical history, and consultation with a healthcare professional is recommended.