Who should receive the Measles, Mumps, and Rubella (MMR) vaccine in adulthood?

MMR Vaccination Recommendations for Adults

Adults born in 1957 or later who do not have evidence of immunity to measles, mumps, and rubella should receive at least one dose of MMR vaccine. 1

Who Needs MMR Vaccination in Adulthood

Adults need MMR vaccination if they:

1. Were born in 1957 or later AND lack evidence of immunity through:

   • Documentation of adequate vaccination
   • Laboratory evidence of immunity
   • Laboratory confirmation of disease
   • Provider-diagnosed disease (not acceptable for measles, mumps, or rubella) 1

2. Specific high-risk groups who should receive special consideration:

   • Healthcare personnel
   • Students in postsecondary educational institutions
   • International travelers
   • Women of childbearing age without evidence of rubella immunity 1, 2

Evidence of Immunity

Acceptable evidence of immunity includes:

• Documentation of adequate vaccination
• Laboratory evidence of immunity
• Laboratory confirmation of disease
• Birth before 1957 (except for healthcare personnel and women of childbearing age for rubella) 1

Dosing Recommendations

One dose of MMR is recommended for:

• Most adults born in 1957 or later without other evidence of immunity

Two doses of MMR are recommended for:

• Healthcare personnel
• Students in postsecondary educational institutions
• International travelers
• Persons previously vaccinated with killed measles vaccine or vaccine of unknown type between 1963-1967
• Persons in outbreak settings 1

The second dose should be administered at least 28 days after the first dose 1.

Special Considerations

Women of Childbearing Age

• Should have documented rubella immunity
• If not immune, should receive MMR vaccine
• Should avoid pregnancy for at least 4 weeks after vaccination 2
• If pregnant and susceptible, should receive MMR vaccine upon completion or termination of pregnancy 1

Healthcare Personnel

• Those born before 1957 without laboratory evidence of immunity should be considered for vaccination with 2 doses of MMR vaccine 1
• Vaccination is particularly important due to potential exposure to infected patients 3

International Travelers

• Should ensure immunity before travel
• Represent a significant risk for measles importation to the US 4
• Should receive MMR if no evidence of immunity exists

Common Pitfalls and Caveats

1. Assuming immunity based solely on age: While those born before 1957 are generally considered immune, healthcare personnel and women of childbearing age should not rely on this assumption for rubella 1.

2. Accepting verbal history: Providers should not accept verbal history of disease as evidence of immunity for measles, mumps, or rubella 1.

3. Vaccination during pregnancy: MMR vaccine is contraindicated during pregnancy due to theoretical risk to the fetus, though accidental vaccination during pregnancy has not been associated with congenital defects 5.

4. Missed opportunities for vaccination: Many eligible adult travelers refuse MMR vaccination during pretravel consultations, representing missed opportunities for prevention 4.

5. Incomplete school requirements: While school requirements have helped increase coverage, not all states require second doses for all grade levels, potentially leaving gaps in immunity 6.

By ensuring appropriate MMR vaccination in adults, we can reduce the risk of disease outbreaks and protect vulnerable populations, including pregnant women and infants too young to be vaccinated.