MMR Vaccination in Adults
Direct Recommendation
All adults born in 1957 or later without evidence of immunity should receive at least one dose of MMR vaccine, with specific 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 documentation regardless of birth year) 2, 1
- Documentation of age-appropriate vaccination with MMR vaccine 1
- Laboratory evidence of immunity to each disease 1
- Laboratory confirmation of disease (provider-diagnosed disease without laboratory confirmation is NOT acceptable for rubella) 3, 4
Indications for Single Dose (One Dose)
All adults born in 1957 or later without evidence of immunity require at least one dose of MMR vaccine 1. This includes:
- All women of childbearing age without evidence of rubella immunity, regardless of birth year 2, 1
- Adults not in high-risk categories who lack documentation of immunity 2
Indications for Two Doses (28 Days Apart Minimum)
A second dose of MMR vaccine, administered at least 28 days after the first dose, is required for: 3, 1
High-Risk Occupational/Educational Groups:
- Healthcare personnel born in 1957 or later 2, 1
- Students in postsecondary educational institutions (colleges, universities) 2, 3
- International travelers 2, 3
Outbreak and Exposure Settings:
Historical Vaccination Issues:
- Adults vaccinated with killed measles vaccine (1963-1967) 2, 3
- Adults vaccinated with measles vaccine of unknown type (1963-1967) 2, 3
Special Consideration for Healthcare Personnel:
- For unvaccinated healthcare workers born before 1957 who lack laboratory evidence of immunity, healthcare facilities should consider routinely vaccinating with 2 doses of MMR vaccine 3
Dosing Schedule
- Minimum interval between doses: 28 days (4 weeks) 3, 1, 5
- Route of administration: Intramuscular or subcutaneous injection 5
- Dose volume: Approximately 0.5 mL per dose 5
Critical Dosing 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 28-day interval 3, 1
Contraindications
Absolute contraindications to MMR vaccination include: 5
- Pregnancy (avoid pregnancy for 1 month following vaccination) 1, 5
- Severe immunosuppression (including HIV infection with current severe immunosuppression) 1, 5
- Hypersensitivity to any vaccine component 5
- Moderate or severe febrile illness (defer until recovery) 5
- Active untreated tuberculosis 5
Special Populations and Precautions
Women of Childbearing Age:
- MMR is contraindicated during pregnancy 1, 5
- Women without evidence of immunity should receive MMR immediately upon completion or termination of pregnancy, before discharge from the healthcare facility 2, 1
- Avoid pregnancy for 1 month (4 weeks) after vaccination 1, 5
Individuals with History of:
- Febrile seizures: Use caution 5
- Thrombocytopenia: Use caution 5
- Anaphylaxis or immediate hypersensitivity to egg ingestion: Use caution 5
Family History of Immunodeficiency:
- Evaluate individuals for immune competence prior to administration if there is a family history of congenital or hereditary immunodeficiency 5
Drug Interactions
- Immune globulins (IG) and other blood products should not be given concurrently with MMR vaccine, as they may interfere with the expected immune response 2, 5
- MMR vaccination may cause temporary depression of tuberculin skin test (PPD) sensitivity 5
Key Clinical Pitfalls
- Do not assume healthcare workers born before 1957 are immune—they require documentation of immunity or vaccination 3
- Provider-diagnosed disease without laboratory confirmation is NOT acceptable evidence of immunity for rubella 3, 4
- The second dose is not a booster—it addresses primary vaccine failure in the 5% who do not respond to the first dose 3
- MMRV (combined measles-mumps-rubella-varicella) vaccine is contraindicated in adults due to licensing restrictions; adults requiring varicella protection should receive separate MMR and varicella vaccines 6