How many doses of measles, mumps, and rubella (MMR) vaccine does a 54-year-old man with no documented vaccination history require?

MMR Vaccination for a 54-Year-Old Male Without Documentation

A 54-year-old man born in 1970 (after 1957) with no vaccination records should receive one dose of MMR vaccine, unless he works in healthcare, attends a post-secondary educational institution, or plans international travel—in which case he requires two doses separated by at least 28 days. 1, 2

Birth Year Determines Baseline Requirements

• Adults born before 1957 are generally presumed immune to measles, mumps, and rubella and do not require MMR vaccination. 3, 1
• However, this patient was born in 1970 (after 1957), so he cannot be presumed immune based on birth year alone. 3, 1
• All adults born in 1957 or later without documented immunity should receive at least one dose of MMR vaccine. 3, 1, 4

Risk Category Determines Whether a Second Dose Is Needed

One Dose Is Sufficient For:

• General adult population born in 1957 or later without specific high-risk exposures. 3, 1

Two Doses Are Required For:

• Healthcare personnel born in 1957 or later—two doses separated by at least 28 days. 3, 1, 2
• Students in post-secondary educational institutions (colleges, universities, vocational schools)—two doses separated by at least 28 days. 1, 2
• International travelers—two doses separated by at least 28 days before travel. 1, 2, 5
• Adults in outbreak settings or recently exposed to measles or mumps—two doses. 1, 2
• Adults who received killed measles vaccine (1963-1967) or vaccine of unknown type—two doses. 1, 2

Critical Dosing Interval

• If a second dose is indicated, the minimum interval between doses is 28 days (4 weeks). 1, 2, 5
• If inadvertently administered before 28 days, the dose must be repeated after the appropriate interval. 2

Common Pitfalls to Avoid

• Do not assume immunity based on birth year for anyone born in 1957 or later—vaccination or serologic testing is required. 3, 1
• Physician-diagnosed disease is no longer acceptable as evidence of immunity for measles or mumps (this was removed from ACIP criteria in 2012). 4
• Laboratory confirmation of disease is now the only acceptable disease-based evidence of immunity. 4
• For healthcare workers specifically, even those born before 1957 should be considered for vaccination if they lack laboratory evidence of immunity, given documented measles transmission in healthcare settings. 3, 2

Safety Considerations

• MMR is well-tolerated in adults, with serious adverse events occurring at rates ≤6 per 100,000 doses. 6
• Common non-serious reactions include arthropathy (263 per 100,000 doses), injection site reactions (157 per 100,000), and rash (113 per 100,000). 6
• These non-serious events typically occur approximately one week after vaccination. 7, 6