Management of Non-Immune MMR Components and Hepatitis B
This 55-year-old female healthcare worker should receive one dose of MMR vaccine immediately to address her lack of mumps and rubella immunity, and should initiate the complete 3-dose hepatitis B vaccine series.
MMR Vaccination Strategy
Immediate Action Required
Administer one dose of MMR vaccine now, regardless of her measles immunity status. 1 Since she works in healthcare and lacks laboratory evidence of immunity to mumps and rubella, she requires vaccination even though she is immune to measles. 2
Why One Dose of MMR is Appropriate
- For healthcare workers born after 1957 (which applies to this 55-year-old): A second dose of MMR is specifically recommended for adults who work in healthcare facilities, administered at least 28 days after the first dose 1, 2
- For rubella specifically: Women of childbearing age who lack laboratory evidence of immunity should receive MMR vaccine, with particular emphasis on counseling regarding congenital rubella syndrome 2
- For mumps specifically: Healthcare workers require a second dose of MMR for adequate mumps protection 2
Important Considerations
- The MMR vaccine contains all three components together, so administering it will boost her measles immunity while establishing immunity to mumps and rubella 1, 3
- Do not attempt to give separate mumps or rubella vaccines - MMR is the vaccine of choice when recipients may be susceptible to more than one component 2
- If she is pregnant or planning pregnancy within 4 weeks, defer vaccination until after pregnancy completion 1
Hepatitis B Vaccination Strategy
Complete Primary Series Required
A "non-reactive" hepatitis B result indicates no immunity, requiring initiation of the complete 3-dose hepatitis B vaccine series. 2
Vaccination Schedule
- Dose 1: Administer immediately
- Dose 2: Administer 2 months (minimum 4 weeks) after the first dose 2
- Dose 3: Administer 6 months after the first dose 2
Post-Vaccination Testing
- Recheck hepatitis B surface antibody (anti-HBs) titers 1-2 months after completing the series to confirm adequate immune response, which is particularly important for healthcare workers who have occupational exposure risk
- If non-responsive after the initial series, she may require additional doses or an alternative vaccination strategy
Clinical Pitfalls to Avoid
- Do not assume birth before 1957 confers immunity for healthcare workers - this assumption does not apply to healthcare personnel, who require documented immunity or vaccination 2, 1
- Do not delay MMR vaccination waiting to give mumps and rubella separately - they are not available as individual vaccines in routine practice 2
- Do not skip hepatitis B vaccination - healthcare workers have mandatory vaccination requirements in most facilities due to occupational exposure risk
- Do not forget to document - her employer will require written proof of vaccination and post-vaccination titers for occupational health records