MMR Vaccination Schedule for Non-Immune Adults
All non-immune adults born in 1957 or later should receive at least one dose of MMR vaccine, with high-risk groups requiring a two-dose series administered at least 28 days apart. 1
Defining Non-Immune Adults
Adults are considered non-immune and require vaccination if they lack all of the following 1, 2:
- Birth before 1957 (except healthcare personnel, who cannot use birth year as evidence of immunity)
- Documentation of age-appropriate MMR vaccination
- Laboratory evidence of immunity to all three diseases (measles, mumps, and rubella)
- Laboratory confirmation of disease
Important caveat: Provider-diagnosed disease without laboratory confirmation does NOT constitute acceptable evidence of immunity. 3, 2
Standard One-Dose Schedule
One dose of MMR vaccine is recommended for: 1
- All adults born in 1957 or later without evidence of immunity
- Women of childbearing age without evidence of rubella immunity, regardless of birth year 3, 1
Two-Dose Schedule Requirements
A second dose of MMR vaccine, administered at least 28 days after the first dose, is required for the following high-risk groups: 3, 1, 2
Occupational/Educational Risk:
- Healthcare personnel born in 1957 or later (for measles and mumps protection) 3, 2
- Students in postsecondary educational institutions 3, 1, 2
Exposure Risk:
- International travelers 3, 1, 2
- Adults in outbreak settings or recently exposed to measles or mumps 2
Historical Vaccination Issues:
- Adults vaccinated with killed measles vaccine or vaccine of unknown type between 1963-1967 (require 2 doses) 3, 2
- Adults vaccinated with mumps vaccine before 1979 who are at high risk for mumps infection 3, 2
Special Consideration for Healthcare Personnel Born Before 1957
For unvaccinated healthcare personnel born before 1957 who lack laboratory evidence of immunity: Healthcare facilities should consider routinely vaccinating with 2 doses of MMR vaccine for measles and mumps protection, or 1 dose for rubella protection. 3, 2 This represents a departure from the general assumption that birth before 1957 confers immunity.
Dosing Interval
The minimum interval between MMR doses is 28 days (4 weeks). 1, 2, 4
Critical pitfall: If the second dose is inadvertently administered before 28 days have elapsed, it does not count as valid and must be repeated after the appropriate interval. 2 The second dose is not a booster but addresses primary vaccine failure in those who did not respond to the first dose. 2
Contraindications and Special Populations
Pregnancy:
MMR is absolutely contraindicated during pregnancy. 3, 1 Women without evidence of immunity should receive MMR immediately upon completion or termination of pregnancy, before discharge from the healthcare facility. 3, 1 Pregnancy should be avoided for 4 weeks after vaccination. 1