Is the Measles, Mumps, and Rubella (MMR) vaccine indicated in adults?

MMR Vaccine Indications in Adults

Yes, MMR vaccine is indicated in adults, with specific requirements based on birth year, occupation, and risk factors—all adults born in 1957 or later should receive at least one dose unless they have documented immunity, while high-risk adults require two doses administered at least 28 days apart. 1

Birth Year-Based Recommendations

Adults Born in 1957 or Later

• All adults born in 1957 or later should receive at least one dose of MMR vaccine unless they have documentation of vaccination with at least one dose of measles-, rubella-, and mumps-containing vaccine or other acceptable evidence of immunity 2, 1
• This birth year cutoff is used because persons born before 1957 are generally considered to have natural immunity from exposure to wild viruses during childhood 2

Adults Born Before 1957

• Generally considered immune to measles and mumps and do not require vaccination 2
• Exception: Women of childbearing age born before 1957 should still be considered susceptible to rubella and should receive MMR vaccine unless they have documented immunity 2
• MMR vaccine may be administered to any person born before 1957 for whom the vaccine is not contraindicated 2

High-Risk Adults Requiring Two Doses

The following adult populations require two doses of MMR vaccine administered at least 28 days apart, regardless of previous vaccination status 3, 1:

Healthcare Personnel

• All healthcare workers born in 1957 or later must receive two doses of MMR vaccine 3, 1
• For unvaccinated healthcare personnel born before 1957 who lack laboratory evidence of immunity, healthcare facilities should consider routinely vaccinating with 2 doses for measles and mumps protection, or 1 dose for rubella protection 3
• This recommendation exists because 29% of healthcare workers who contracted measles between 1985-1989 were born before 1957, demonstrating that birth year alone is insufficient evidence of immunity in this high-risk group 2

Students in Postsecondary Educational Institutions

• College students and those attending other post-high school educational institutions should have documentation of two doses of MMR vaccine 2, 3, 1

International Travelers

• Adults planning international travel should receive two doses of MMR vaccine administered at least 28 days apart 2, 3, 1

Outbreak Settings

• Adults in outbreak settings or recently exposed to measles or mumps should receive a second dose of MMR vaccine 3, 1

Special Populations

Women of Childbearing Age

• MMR vaccine should be offered to all women of childbearing age who do not have acceptable evidence of rubella immunity whenever they make contact with the health-care system 2
• This includes adolescent girls and premenopausal adult women, regardless of birth year 2, 1
• Vaccination should be part of routine general medical and gynecologic outpatient care, provided in all family-planning settings, and offered before discharge from hospitals or birthing centers 2
• Critical caveat: MMR is contraindicated during pregnancy, and pregnancy should be avoided for 4 weeks after vaccination 1
• Women without evidence of immunity should receive MMR immediately upon completion or termination of pregnancy, before discharge from the healthcare facility 1

Adults with Special Vaccination History

• Adults previously vaccinated with killed measles vaccine (available 1963-1967) or measles vaccine of unknown type should receive two doses of live MMR vaccine at least 1 month apart to prevent atypical measles syndrome if exposed to wild measles virus 2, 3, 1
• Adults vaccinated with mumps vaccine before 1979 who are at high risk for mumps infection should receive a second dose of MMR vaccine 3

Acceptable Evidence of Immunity

Adults are considered immune and do not require vaccination if they have 3, 1:

• Documentation of age-appropriate vaccination with MMR vaccine
• Laboratory evidence of immunity to measles, mumps, and rubella
• Laboratory confirmation of disease

Important pitfall: Documentation of provider-diagnosed disease is NOT considered acceptable evidence of immunity for rubella 3, though it is acceptable for measles and mumps 2

Dosing Interval and Administration

• The minimum interval between MMR doses is 28 days (4 weeks) 3, 1, 4
• If the second dose is inadvertently administered before 28 days have elapsed, it should not be counted as valid and must be repeated after the appropriate interval has passed 3, 1
• The second dose is not a booster but addresses primary vaccine failure in the approximately 5% of persons who fail to respond to the first dose 2, 3

Safety Profile in Adults

• Serious adverse events after MMR are rare in adults, with incidence ≤6 per 100,000 doses for outcomes including anaphylaxis, encephalitis, Guillain-Barré syndrome, and seizures 5
• Common non-serious adverse events include arthropathy (263 per 100,000 doses), injection site reactions (157 per 100,000 doses), and rash (113 per 100,000 doses) 5
• Adverse events are more common among female vaccinees compared to males (30.1% vs 19.4%) 6
• No severe adverse events were reported in a prospective cohort of 785 adult travelers 6