Who should receive the measles, mumps, and rubella (MMR) vaccine?

MMR Vaccine Recommendations

All children should receive two doses of MMR vaccine, with the first dose administered no earlier than the first birthday and the second dose typically before school entry, while adults born in 1957 or later should receive at least one dose of MMR vaccine unless they have documentation of vaccination or other evidence of immunity. 1

Recommendations for Children

• All children should receive their first dose of MMR vaccine at 12-15 months of age 1
• A second dose of MMR vaccine should be administered before school entry, with at least 28 days between doses 1
• Children who do not have documentation of adequate vaccination or other acceptable evidence of immunity should be admitted to school only after receiving their first dose of MMR vaccine 1
• Approximately 5% of children who receive only one dose of MMR vaccine fail to develop immunity to measles, which is why a second dose is recommended 1

Recommendations for Adults

• Adults born in 1957 or later who are aged ≥18 years should receive at least one dose of MMR vaccine unless they have documentation of vaccination or other acceptable evidence of immunity 1
• Persons born before 1957 generally can be considered immune to measles and mumps, except for healthcare workers 1, 2
• Adults at increased risk for exposure and transmission should receive special consideration for vaccination, including:
  • International travelers 1, 2
  • College students and those in other post-high school educational institutions 1, 2
  • Healthcare workers 1, 2

Adults who should receive a second dose of MMR:

• Students in postsecondary educational institutions 2
• Healthcare workers 2
• International travelers 2
• Adults previously vaccinated with killed measles vaccine or measles vaccine of unknown type between 1963-1967 2
• Adults in outbreak settings or recently exposed to measles 2

Special Populations

Women of Childbearing Age

• All women of childbearing age should be considered susceptible to rubella unless they have received at least one dose of MMR vaccine on or after the first birthday or have serologic evidence of immunity 1
• MMR vaccine should be offered to all women of childbearing age who lack evidence of immunity whenever they make contact with the healthcare system 1
• MMR vaccine should not be administered to pregnant women or those planning to become pregnant within 4 weeks 2

HIV-Infected Persons

• MMR vaccination is recommended for all asymptomatic HIV-infected persons who do not have evidence of severe immunosuppression 1
• MMR vaccination should also be considered for all symptomatic HIV-infected persons who do not have evidence of severe immunosuppression 1
• HIV-infected infants without severe immunosuppression should receive MMR vaccine at 12 months of age 1
• Consideration should be given to administering the second dose of MMR vaccine as soon as 28 days after the first dose for HIV-infected children 1
• Measles vaccine is not recommended for HIV-infected persons with evidence of severe immunosuppression 1

Post-Exposure Prophylaxis

• MMR vaccine, if administered within 72 hours of initial measles exposure, may provide some protection 1, 3
• For most persons aged ≥12 months exposed to measles, administration of MMR vaccine within 72 hours is preferable to using immune globulin 1
• For susceptible infants aged 6-11 months who are household contacts of measles patients, MMR vaccine within 72 hours of exposure is acceptable 1
• Immune globulin should be considered for susceptible contacts who cannot receive the vaccine, including infants <6 months, pregnant women, and immunocompromised individuals 1, 3

Evidence of Immunity

Acceptable evidence of immunity to measles, mumps, and rubella includes:

• Documentation of age-appropriate vaccination 2
• Laboratory evidence of immunity 2
• Laboratory confirmation of disease 2
• Birth before 1957 (except for healthcare workers) 2

Common Pitfalls and Considerations

• Healthcare workers born before 1957 should not be assumed to be immune and consideration should be given to testing for immunity or vaccinating 2
• Documentation of provider-diagnosed disease is not considered acceptable evidence of immunity for rubella 2
• As vaccination coverage increases, the average age of measles infection can shift to adolescents and young adults 4
• Protective antibodies derived from vaccination might decrease gradually over time, potentially increasing the risk of measles infection in young adults 4
• The MMR vaccine has been shown to be highly immunogenic, with seroconversion rates of 95-100% for each component vaccine 5