How do I order an MMR (Measles, Mumps, and Rubella) titer?

How to Order an MMR Titer

To order an MMR (Measles, Mumps, and Rubella) titer, request a "Measles, Mumps, and Rubella Antibody Panel" or "MMR IgG Antibody Panel" through your laboratory ordering system to determine immunity status.

When to Order MMR Titers

MMR titers are particularly important for:

• Women of childbearing age, regardless of birth year, to determine rubella immunity status 1
• Healthcare workers and students in healthcare professions 2
• Persons without reliable clinical history of varicella infection or documented vaccination 2
• Individuals planning international travel 2
• Post-secondary educational institution students 2
• Persons with potential exposure to measles, mumps, or rubella

Ordering Process

1. Test Name Options:

   • "Measles, Mumps, and Rubella IgG Antibody Panel"
   • "MMR Immunity Screen"
   • "MMR Titer"

2. Specimen Requirements:

   • Blood sample (serum)
   • Standard venipuncture collection tube (red top or tiger top/SST)
   • No special preparation required for the patient

3. Interpretation of Results:

   • Positive/Reactive: Indicates immunity (either from previous vaccination or natural infection)
   • Negative/Non-reactive: Indicates lack of immunity
   • Equivocal: May require retesting or vaccination

Clinical Applications

For Women of Childbearing Age

The Advisory Committee on Immunization Practices (ACIP) recommends determining rubella immunity status for all women of childbearing age, regardless of birth year 1. This is particularly important because:

• Congenital rubella syndrome can occur if a pregnant woman contracts rubella
• Women found to be non-immune should receive MMR vaccination at least 4 weeks before attempting pregnancy 1

For Healthcare Workers

Healthcare workers should have documented evidence of immunity to measles, mumps, and rubella 2. This can be established through:

• Laboratory evidence of immunity (titers)
• Documentation of appropriate vaccination
• Laboratory confirmation of disease

Post-Titer Actions

Based on titer results:

• If immune to all three diseases: No further action needed
• If non-immune to any component:
  • For non-pregnant individuals: Administer MMR vaccine (one or two doses based on previous vaccination history)
  • For pregnant women: Defer vaccination until postpartum period 2, 1
  • For immunocompromised individuals: Evaluate risk/benefit; MMR is generally contraindicated

Important Considerations

• MMR titers are more reliable than vaccination history for determining immunity status
• ELISA testing is commonly used and is more sensitive than neutralization tests for detecting mumps antibodies 3
• Even with waning antibody levels over time, protection against disease is largely retained in most individuals 4
• If ordering for post-exposure assessment, note that titers may not reflect immunity if exposure was very recent

Common Pitfalls to Avoid

• Don't assume immunity based solely on age or vaccination history - Studies show that immunity can wane over time, particularly for mumps 4
• Don't forget to order individual components if the combined panel is unavailable - request "Measles IgG," "Mumps IgG," and "Rubella IgG" separately
• Don't vaccinate before checking titers in adults with uncertain vaccination status - checking titers first may avoid unnecessary vaccination
• Don't delay vaccination if titers show non-immunity - MMR vaccine has high immunogenicity with seroconversion rates of 95-100% 5