Should a 59-year-old male receive the Measles, Mumps, and Rubella (MMR) vaccine?

MMR Vaccination for a 59-Year-Old Male

A 59-year-old male does not need an MMR vaccine as adults born before 1957 are generally considered immune to measles and mumps, and for men, rubella immunity is not a critical concern. 1

Assessment of Immunity Status

Adults born before 1957 are presumed to have natural immunity to measles and mumps due to widespread circulation of these viruses during their childhood:

• The ACIP guidelines clearly state that "adults born before 1957 generally are considered immune to measles and mumps" 1
• For rubella, men born before 1957 are also generally considered immune 1
• This presumption of immunity is based on the high likelihood of natural infection before vaccines were widely available

Special Circumstances Where Vaccination Might Be Considered

While generally not needed, there are specific situations where MMR vaccination might be considered for a person born before 1957:

1. Healthcare workers: Unvaccinated healthcare personnel born before 1957 who lack laboratory evidence of immunity may be considered for vaccination 1

2. International travel: If planning to travel to areas with high measles prevalence 1

3. During outbreaks: During measles outbreaks, evidence of immunity becomes more important 1

4. Uncertain immunity status: If there's no documentation of immunity and the individual is concerned 1

Potential Side Effects of MMR in Adults

If the patient strongly desires vaccination despite not meeting criteria, be aware of potential side effects:

• Non-serious reactions in adults per 100,000 doses include 2:

  • Arthropathy (263.0 cases)
  • Injection site reactions (157.0 cases)
  • Rash (112.9 cases)

• Serious adverse events are rare (≤6 per 100,000 doses) 2

Algorithm for Decision Making

1. Determine birth year: If born before 1957 → presumed immune
2. Assess risk factors:
   • Healthcare worker? → Consider vaccination
   • International travel to high-risk areas? → Consider vaccination
   • Current measles outbreak in community? → Consider vaccination
3. Check documentation: If concerned despite birth year, check for:
   • Laboratory evidence of immunity
   • Documentation of prior vaccination
   • History of physician-diagnosed disease (though this is no longer considered reliable evidence of immunity) 3

Conclusion

For this 59-year-old male born before 1957, MMR vaccination is not routinely indicated unless he falls into a special risk category. The ACIP guidelines are clear that persons born before 1957 are generally considered immune to measles, mumps, and rubella based on the likelihood of natural infection prior to widespread vaccination.