What are the recommendations for MMR (Measles, Mumps, Rubella) vaccine administration in adults?

MMR Vaccination Recommendations for Adults

Adults born in 1957 or later should receive at least one dose of MMR vaccine unless they have evidence of immunity through documentation of age-appropriate vaccination, laboratory evidence of immunity, or laboratory confirmation of disease. 1, 2

Evidence of Immunity

• Adults are considered immune to measles, mumps, and rubella if they have:

  • Documentation of age-appropriate vaccination 2, 3
  • Laboratory evidence of immunity or laboratory confirmation of disease 2, 3
  • Birth before 1957 (generally considered presumptive evidence of immunity, except for healthcare personnel) 1, 2

• Documentation of provider-diagnosed disease is no longer considered acceptable evidence of immunity for measles and mumps 2, 4

Indications for Second MMR Dose in Adults

Adults who should receive a second dose of MMR vaccine (administered at least 28 days after the first dose) include:

• Students in postsecondary educational institutions 1, 2
• Healthcare workers 1, 2
• International travelers 1, 2
• Adults in outbreak settings or recently exposed to measles 1, 2
• Adults previously vaccinated with killed measles vaccine or measles vaccine of unknown type during 1963-1967 1, 2
• Adults vaccinated with mumps vaccine before 1979 who are at high risk for mumps infection 1, 2

Special Populations

Healthcare Personnel

• For unvaccinated healthcare personnel born before 1957 who lack laboratory evidence of immunity or disease confirmation, healthcare facilities should consider vaccinating with:
  • 2 doses of MMR vaccine for measles and mumps protection 1, 2
  • 1 dose of MMR vaccine for rubella protection 1, 2

Women of Childbearing Age

• Rubella immunity should be determined for all women of childbearing age, regardless of birth year 1
• Women who are not pregnant and lack evidence of immunity should be vaccinated 1
• Pregnant women without evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility 1
• Women should avoid pregnancy for 4 weeks following MMR vaccination 5

Immunocompromised Persons

• MMR vaccine is contraindicated in severely immunocompromised individuals 4
• For persons with HIV infection who do not have evidence of severe immunosuppression, MMR vaccination is recommended 4
• Persons with perinatal HIV infection who were vaccinated before establishment of effective antiretroviral therapy should receive two appropriately spaced doses of MMR vaccine once effective antiretroviral therapy has been established 4

Vaccine Administration

• MMR vaccines from different manufacturers are considered fully interchangeable 3
• Additional live virus vaccines not administered on the same day should be separated by at least 4 weeks 3
• For adults requiring protection against varicella in addition to measles, mumps, and rubella, separate MMR and varicella vaccines should be administered, as MMRV vaccine is not licensed for use in adults 5

Common Pitfalls and Considerations

• Birth before 1957 should not be assumed as evidence of immunity for healthcare workers; testing for immunity or vaccination should be considered 2
• MMR vaccine should not be administered to pregnant women or those planning to become pregnant within 4 weeks 5
• The effectiveness of MMR vaccine in preventing measles is approximately 95% after one dose and 96% after two doses 6
• The effectiveness of MMR vaccine containing Jeryl Lynn strain in preventing mumps is approximately 72% after one dose and 86% after two doses 6