What is the MMR (Measles, Mumps, and Rubella) booster recommendation for a patient born in 1949 with a history of presumed measles infection in childhood?

From the Guidelines

For a patient born in 1949 with a history of presumed measles infection in childhood, MMR booster vaccination is generally not recommended. Adults born before 1957, like this patient, are considered to have natural immunity to measles, mumps, and rubella due to widespread childhood exposure before vaccines became available 1. This natural immunity is presumed to be lifelong, reducing the need for routine MMR vaccination in this age group. The guidelines suggest that adults born during or after 1957 should receive 1 or more doses of MMR unless they have a medical contraindication, documentation of 1 or more doses, history of measles based on health care provider diagnosis, or laboratory evidence of immunity 1.

However, there are specific situations where MMR vaccination might be considered for individuals born before 1957, such as recent exposure to measles, working in a healthcare facility, planning to travel internationally to areas with ongoing outbreaks, or being in an outbreak setting 1. In these cases, serologic testing could be performed to confirm immunity before deciding on vaccination. The decision to vaccinate should be made on a case-by-case basis, considering the individual's risk factors and the potential benefits and risks of vaccination.

Key points to consider include:

• Natural immunity from childhood exposure is presumed to be lifelong for individuals born before 1957.
• Specific risk factors, such as international travel or working in healthcare, may necessitate vaccination or serologic testing.
• The standard MMR vaccine dose for adults who need it is a single 0.5 mL subcutaneous injection.
• Side effects of the MMR vaccine are generally mild and may include soreness at the injection site, low-grade fever, or mild rash. This approach prioritizes the patient's morbidity, mortality, and quality of life by balancing the presumed natural immunity with the risk of disease exposure in various settings, as guided by the most recent and highest quality evidence available 1.

From the Research

MMR Booster Recommendation

• For a patient born in 1949 with a history of presumed measles infection in childhood, the MMR booster recommendation is not explicitly stated in the provided studies.
• However, according to the study 2, ACIP recommends 2 doses of MMR vaccine routinely for children, and 1 dose for adults aged ≥18 years who do not have evidence of immunity.
• The study 2 also states that acceptable evidence of immunity includes laboratory confirmation of disease, but does not specify the recommendations for individuals with a history of presumed measles infection.
• The other studies 3, 4, 5, 6 provide information on the effectiveness and safety of the MMR vaccine, but do not address the specific question of MMR booster recommendations for individuals with a history of presumed measles infection.

Evidence of Immunity

• The study 2 states that documentation of physician-diagnosed disease is no longer an acceptable criterion for evidence of immunity for measles and mumps.
• Laboratory confirmation of disease is now a criterion for acceptable evidence of immunity for measles, rubella, and mumps 2.
• The study 4 provides information on the effectiveness of the MMR vaccine in preventing measles, mumps, and rubella, but does not address the specific question of evidence of immunity for individuals with a history of presumed measles infection.

Vaccine Effectiveness

• The study 4 states that the effectiveness of the MMR vaccine in preventing measles is 95% after one dose and 96% after two doses.
• The effectiveness of the MMR vaccine in preventing mumps is 72% after one dose and 86% after two doses 4.
• The study 5 notes that despite high two-dose coverage rates, mumps has made a resurgence in the US and other countries, suggesting that waning humoral immunity and antigenic variation of circulating wild-type mumps strains may play a role.