MMR Adult Vaccination Schedule
Adults born in 1957 or later without documented immunity 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
Evidence of Immunity
Adults are considered immune to measles, mumps, and rubella if they meet any of the following criteria:
- Birth before 1957 (except healthcare personnel, who require additional evaluation) 1
- Documentation of age-appropriate MMR vaccination 1
- Laboratory evidence of immunity to each disease 1
- Laboratory confirmation of disease (provider diagnosis alone is NOT acceptable evidence) 2, 3
Single-Dose Requirements
One dose of MMR is recommended for:
- All adults born in 1957 or later without evidence of immunity 1
- Women of childbearing age without evidence of rubella immunity, regardless of birth year 1
- Healthcare personnel born before 1957 should be considered for vaccination (1 dose for rubella protection) if they lack laboratory evidence of immunity 4
Two-Dose Requirements (28-Day Minimum Interval)
A second MMR dose, administered at least 28 days after the first, is required for:
- Healthcare personnel born in 1957 or later (2 doses for measles/mumps protection) 4, 2, 1
- Students in postsecondary educational institutions 2, 1
- International travelers 2, 1
- Adults in outbreak settings or recently exposed to measles or mumps 2, 1
- Adults vaccinated with killed measles vaccine or unknown vaccine type between 1963-1967 2, 1
- Adults vaccinated with mumps vaccine before 1979 who are at high risk for mumps infection 2
Critical Dosing Interval
The minimum interval between MMR doses is 28 days (4 weeks). 2, 1 If the second dose is inadvertently administered before 28 days have elapsed, it 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
Absolute Contraindications
MMR vaccine is contraindicated in:
- Pregnancy: Women should avoid pregnancy for 4 weeks after vaccination 1
- Severe immunodeficiency (including severe HIV with CD4 <200 cells/μL) 1, 3
Special Population: Pregnant Women
Women without evidence of immunity should receive MMR immediately upon completion or termination of pregnancy, before discharge from the healthcare facility. 1 Pregnancy testing is not required before vaccination, but if pregnancy is discovered after vaccination, no intervention is needed—simply delay remaining doses until after delivery. 4
Special Population: HIV-Infected Persons
Adults with HIV infection aged ≥12 months without current severe immunosuppression should receive MMR vaccination. 3 Those with perinatal HIV infection who were vaccinated before effective antiretroviral therapy should be revaccinated with 2 appropriately spaced doses once effective therapy is established. 3
Common Pitfalls
- Do not assume immunity based on birth year alone for healthcare workers—they require documented evidence regardless of birth before 1957 2
- Provider-diagnosed disease is NOT acceptable evidence of immunity; laboratory confirmation is required 2, 3
- If dosing interval is incorrect (given before 28 days), the dose does not count and must be repeated 2
- Recent data suggest waning immunity: Neutralizing antibody titers 2 years after booster vaccination may be significantly lower than after natural infection, suggesting serologic screening may be beneficial for young healthcare workers in outbreak settings 5