From the Guidelines
Elderly patients who are healthcare personnel, international travelers, or students in postsecondary educational institutions may require a second Measles, Mumps, and Rubella (MMR) vaccine, as recommended by the most recent guidelines 1.
Key Considerations
- Elderly patients born before 1957 are generally considered immune to measles and mumps through natural infection during childhood 1.
- However, those who lack evidence of immunity and are at higher risk of exposure or transmission may need to receive one or more doses of MMR vaccine 1.
- A routine second dose of MMR vaccine is recommended for adults who are students in postsecondary educational institutions, work in a healthcare facility, or plan to travel internationally 1.
- Persons who received inactivated (killed) measles vaccine or measles vaccine of unknown type from 1963 to 1967 should be revaccinated with 2 doses of MMR vaccine 1.
Recommendations
- Healthcare personnel born before 1957 who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease should be considered for vaccination with 2 doses of MMR vaccine 1.
- International travelers who lack evidence of immunity should receive one or more doses of MMR vaccine before traveling to areas where these diseases are endemic 1.
- Students in postsecondary educational institutions who lack evidence of immunity should receive one or more doses of MMR vaccine to prevent outbreaks in these settings 1.
From the Research
Eligibility for a Second MMR Vaccine
Elderly patients who may require a second Measles, Mumps, and Rubella (MMR) vaccine include:
- Adults at high risk for exposure and transmission, such as healthcare personnel and international travelers, who should receive two doses of MMR vaccine 2
- Individuals with human immunodeficiency virus (HIV) infection who do not have evidence of current severe immunosuppression, and those who were vaccinated before establishment of effective antiretroviral therapy (ART) 2
- Patients who have undergone chemotherapy, as their immunity to measles and mumps may be compromised 3
- Individuals who received their first MMR vaccine at an early age, as the immunity may wane over time 3
Special Considerations
- Immunosuppressed patients, such as those with inflammatory bowel disease, may still have sustained antibody concentrations comparable to healthy controls, and the immunization record can be used to determine immunity 4
- Live vaccines, including MMR, are usually contraindicated in patients under immunosuppressive therapy and/or in HIV patients with a CD4 count under 200/mm3 5
- The safety and immunogenicity of the MMR vaccine have been consistently demonstrated in clinical trials, with rare serious adverse events reported 6