What MMR (Measles, Mumps, and Rubella) vaccine is recommended for a 27-year-old healthcare worker without immunity to measles and mumps in Canada?

MMR Vaccine Recommendation for 27-Year-Old Healthcare Worker Without Measles and Mumps Immunity in Canada

A 27-year-old healthcare worker without measles and mumps immunity should receive a 2-dose series of MMR vaccine, with doses separated by at least 28 days. 1, 2

Vaccination Protocol

Immediate administration of the first MMR dose is required upon identification of non-immunity, followed by a second dose 28 days later (minimum 4 weeks). 2 This 2-dose requirement applies to all healthcare personnel born in 1957 or later who lack documented immunity. 1

Why Two Doses Are Required

• Healthcare workers require 2 doses of measles-containing vaccine for adequate protection, as this population is at increased risk for exposure and transmission in medical settings. 1
• The 2-dose series provides protection against measles, mumps, and rubella simultaneously through the trivalent MMR vaccine, which is the vaccine of choice. 1
• Vaccine effectiveness for mumps ranges from 66.3% to 88.0% with two doses, compared to only 49.2% to 81.6% with one dose. 3

Pre-Vaccination Considerations

Serologic screening before vaccination is not necessary unless your facility considers it cost-effective. 1, 2 However, screening should only be performed if you can guarantee prompt vaccination of susceptible individuals. 1, 2

For Female Healthcare Workers

• Confirm pregnancy status is negative before administering MMR vaccine, as it contains live attenuated viruses. 1, 4
• Counsel the worker to avoid pregnancy for 3 months after MMR vaccination. 1
• If accidentally administered during pregnancy, this should not be considered a reason for pregnancy termination, as no maternal/fetal complications are known to occur. 1, 4

Work Restrictions During Vaccination Period

Recently vaccinated healthcare workers do not require any restriction in their work activities. 1 The MMR vaccine viruses are not transmitted to others in healthcare settings. 1

If Exposed Before Vaccination

• If exposed to measles before receiving the vaccine, exclude the worker from duty days 5-21 after exposure. 2
• Post-exposure MMR vaccine given within 72 hours may prevent or modify measles disease. 2
• For mumps exposure, exclude unvaccinated workers from day 12 through day 26 after exposure. 1

Critical Implementation Points

Do not accept birth before 1957 as evidence of immunity for healthcare workers, even though this criterion applies to the general population. 1, 2 Healthcare facilities should recommend vaccination for all workers born before 1957 who lack documented immunity or laboratory evidence. 1

Documentation Requirements

Acceptable evidence of immunity includes: 1

• Written documentation of 2 doses of MMR vaccine administered at least 28 days apart
• Laboratory evidence of immunity
• Laboratory confirmation of disease (physician-diagnosed disease is no longer acceptable) 5

Common Pitfalls to Avoid

• Do not delay vaccination for serologic testing unless your facility has a cost-effective screening program with guaranteed follow-up. 1, 2
• Do not allow work during high-risk exposure periods (days 5-21 after measles exposure or days 12-26 after mumps exposure) for unvaccinated personnel. 1, 2
• Do not administer MMR to pregnant women or those who may be pregnant. 1, 4
• Do not consider "indeterminate" serologic results as evidence of immunity—these individuals should be considered non-immune and vaccinated. 1

Vaccine Safety Profile

MMR vaccine has an excellent safety profile after decades of use. 1 Rare adverse events in adults include: 1

• Anaphylaxis (1.0-3.5 per million doses)
• Thrombocytopenia (3-4 per 100,000 doses)
• Acute arthritis from rubella component (10% of susceptible postpubertal females, typically lasting 1 day to 3 weeks)