Ask the Experts: MMR (Measles, Mumps, and Rubella): Vaccine Recommendations

Results (25)

The most recent comprehensive ACIP recommendations for the use of MMR vaccine were published in 2013 and are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. CDC published the ACIP recommendations for the use of Priorix (GSK) brand of MMR vaccine on November 18, 2022, and they are available here: www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7146a1-H.pdf.

There is no difference in recommendations between Priorix and MMRII (Merck) brands of MMR vaccine. Priorix may be used in any situation where MMR vaccination is recommended. Despite minor differences in manufacturing (MMRII contains gelatin, Priorix does not) and approved route of administration (MMRII is approved for subcutaneous or intramuscular injection, Priorix is approved for subcutaneous injection only), the two vaccines may be considered functionally identical and interchangeable.

MMR vaccine is recommended routinely for all children at age 12 through 15 months, with a second dose at age 4 through 6 years. The second dose of MMR can be given as early as 4 weeks (28 days) after the first dose and be counted as a valid dose if both doses were given after the child’s first birthday. The second dose is not a booster, but rather is intended to produce immunity in the small number of people who fail to respond to the first dose.

Adults with no evidence of immunity should get 1 dose of MMR vaccine (evidence of immunity is defined as documented receipt of 1 dose of live measles virus-containing vaccine [or 2 doses, if high risk], laboratory evidence of immunity or laboratory confirmation of disease, or birth before 1957), unless the adult is in a high-risk group. Susceptible high-risk people need 2 doses of vaccine, given 4 weeks apart. High risk people include school-age children, healthcare personnel, international travelers, and students attending post-high school educational institutions.

Live-attenuated measles vaccine became available in the U.S. in 1963. An ineffective, inactivated measles vaccine was also available in the U.S. in 1963–1967. Combined MMR vaccine (MMRII, Merck) was licensed in 1971; Priorix (GSK) MMR vaccine was licensed and recommended in 2022. For people who previously received a dose of measles vaccine in 1963–1967 and are unsure which type of vaccine it was, or are sure it was inactivated measles vaccine, that dose should be considered invalid and the patient revaccinated as age- and risk-appropriate with MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered completely vaccinated for their age or risk status.

Last reviewed: June 19, 2023

Acceptable presumptive evidence of immunity against measles includes at least one of the following:

  • written documentation of adequate vaccination:
    • one or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk
    • two doses of measles-containing vaccine for school-age children, adolescents, and adults at high risk, including college students, healthcare personnel, and international travelers
  • laboratory evidence of immunity
  • laboratory confirmation of measles (verbal history of measles does not count)
  • birth before 1957

Although birth before 1957 is considered acceptable evidence of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do not have other evidence of immunity with 2 doses of MMR vaccine (minimum interval 28 days).

During an outbreak of measles, healthcare facilities should recommend 2 doses of MMR vaccine at the appropriate interval for unvaccinated healthcare personnel regardless of birth year if they lack laboratory evidence of measles immunity.

Last reviewed: June 19, 2023

Zero, one, or two doses of MMR vaccine are needed for the adults described below.

Zero doses:

  • adults born before 1957 except healthcare personnel*
  • adults born 1957 or later who are at low risk (i.e., not an international traveler or healthcare worker, or person attending college or other post-high school educational institution) and who have already received one or more documented doses of live measles vaccine
  • adults with laboratory evidence of immunity or laboratory confirmation of measles

One dose of MMR vaccine:

  • adults born in 1957 or later who are at low risk (i.e., not an international traveler, healthcare worker, or person attending college or other post-high school educational institution) and have no documented vaccination with live measles vaccine and no laboratory evidence of immunity or prior measles infection

Two doses of MMR vaccine:

  • high-risk adults without any prior documented live measles vaccination and no laboratory evidence of immunity or prior measles infection, including:
    • healthcare personnel*
    • international travelers born in 1957 or later
    • people attending colleges and other post-high school educational institutions

People who previously received a dose of measles vaccine in 1963–1967 and are unsure which type of vaccine it was, or are sure it was inactivated measles vaccine, should be revaccinated with either one (if low-risk) or two (if high-risk) doses of MMR vaccine.

* Healthcare personnel born before 1957 should be considered for MMR vaccination in the absence of an outbreak, but are recommended for MMR vaccination during outbreaks.

Last reviewed: June 19, 2023

Although birth before 1957 is considered acceptable evidence of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) born before 1957 who do not have laboratory evidence of measles immunity, laboratory confirmation of disease, or vaccination with 2 appropriately spaced doses of MMR vaccine.

However, during a local outbreak of measles, all healthcare personnel, including those born before 1957, are recommended to have 2 doses of MMR vaccine at the appropriate interval if they lack laboratory evidence of measles.

Healthcare facilities should check with their state or local health department’s immunization program for guidance. Access contact information here: www.immunize.org/coordinators.

Last reviewed: June 19, 2023

MMR can be given to children as young as 6 months of age who are at high risk of exposure such as during international travel or a community outbreak. However, doses given BEFORE 12 months of age cannot be counted toward the 2-dose series for MMR.

Last reviewed: June 19, 2023

People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very likely to have had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Persons born before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should be administered.

Last reviewed: June 19, 2023

Approximately 7% of people do not develop measles immunity after the first dose of vaccine. This occurs for a variety of reasons. The second dose is to provide another chance to develop measles immunity for people who did not respond to the first dose. About 97% of people develop immunity to measles after two doses of measles-containing vaccine.

Last reviewed: June 19, 2023

There are two circumstances when a third dose of MMR is recommended. ACIP recommends that women of childbearing age who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive 1 additional dose of MMR vaccine (maximum of 3 doses). Further testing for serologic evidence of rubella immunity is not recommended. MMR should not be administered to a pregnant woman.

In 2018, ACIP published guidance for MMR vaccination of people at increased risk for acquiring mumps during an outbreak. People previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine (MMR or MMRV) to improve protection against mumps disease and related complications. More information about this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

Last reviewed: June 19, 2023

MMR vaccine given within 72 hours of initial measles exposure can reduce the risk of getting sick or reduce the severity of symptoms. Another option for exposed, measles-susceptible individuals at high risk of complications who cannot be vaccinated is to give immunoglobulin (IG) within six days of exposure. Do not administer MMR vaccine and IG simultaneously, as the IG invalidates the vaccine.

Information on post-exposure prophylaxis for measles can be found in the 2013 ACIP guidance at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 24.

Last reviewed: June 19, 2023

No. Adults with evidence of immunity do not need any further vaccines. No “booster” doses of MMR vaccine are recommended for either adults or children. They are considered to have life-long immunity once they have received the recommended number of MMR vaccine doses or have other evidence of immunity.

Last reviewed: June 19, 2023

Both killed and live attenuated measles vaccines became available in 1963. Live attenuated vaccine was used more often than killed vaccine. The killed vaccine was found to be not effective and people who received it should be revaccinated with live vaccine. Without a written record, it is not possible to know what type of vaccine an individual may have received. So, people born during or after 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles disease should receive at least 1 dose of MMR. Some people at increased risk of exposure to measles (such as healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least 4 weeks.

Last reviewed: June 19, 2023

Not necessarily. People who have documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect people who may have received killed measles vaccine which was available in the United States in 1963 through 1967 and was not effective. People vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (such as people who work in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.

Last reviewed: June 19, 2023

In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of disease as evidence of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of immunity for measles and mumps. Physician diagnosis of disease had not previously been accepted as evidence of immunity for rubella. With the decrease in measles and mumps cases over the last 30 years, the validity of physician-diagnosed disease has become questionable. In addition, documenting history from physician records is not a practical option for most adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Last reviewed: June 19, 2023

Measles vaccine, given as MMR, may be effective if given within the first 3 days (72 hours) after exposure to measles. Immune globulin may be effective for as long as 6 days after exposure. Postexposure prophylaxis with MMR vaccine does not prevent or alter the clinical severity of mumps or rubella. However, if the exposed person does not have evidence of mumps or rubella immunity they should be vaccinated since not all exposures result in infection.

Last reviewed: June 19, 2023

In the 2013 revision of its MMR vaccine recommendations ACIP expanded the use of post-exposure IG prophylaxis for measles. Intramuscular IG (IGIM) should be administered to all infants younger than 12 months who have been exposed to measles. The dose of IGIM is 0.5 mL/kg of body weight; the maximum dose is 15 mL. Alternatively, MMR vaccine can be given instead of IGIM to infants age 6 through 11 months, if it can be given within 72 hours of exposure.

In addition to infants under the age of 12 months, immune globulin may be used as measles post-exposure prophylaxis for susceptible pregnant people or susceptible people who are severely immunocompromised. For details on the dosage and use of immune globulin, please refer to the measles control section in Chapter 7 of the CDC Manual for the Surveillance of Vaccine-Preventable Diseases:  www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html#control.

IG is not indicated for people who have received 1 dose of measles-containing vaccine at age 12 months or older unless they are severely immunocompromised. IG should not be used to control measles outbreaks. IG has not been shown to prevent mumps or rubella infection after exposure and is not recommended for that purpose.

Last reviewed: June 19, 2023

Single antigen vaccine is no longer available in the U.S.; the student should get the combined MMR vaccine. If a college student or other person at increased risk of exposure cannot produce written documentation of either immunization or disease, and titers are negative, they should receive two doses of MMR.

Last reviewed: June 19, 2023

No. Self-reported doses and history of vaccination provided by a parent or other caregiver are not considered to be valid. You should only accept a written, dated record as evidence of vaccination.

Last reviewed: June 19, 2023

Adults without evidence of immunity and no contraindications to MMR vaccine can be vaccinated without testing. Only adults without evidence of immunity might be considered for testing for measles-specific IgG antibody, but testing is not needed prior to vaccination.

CDC does not recommend measles antibody testing after MMR vaccination to verify the patient’s immune response to vaccination.

Two documented doses of MMR vaccine given on or after the first birthday and separated by at least 28 days is considered proof of measles immunity, according to ACIP. Documentation of appropriate vaccination supersedes the results of serologic testing for measles, mumps, rubella, and varicella.

Last reviewed: June 19, 2023

A history of having had measles is not sufficient evidence of measles immunity. A positive serologic test for measles-specific IgG will confirm that the person is immune and is not at risk of infection regardless of the multiple myeloma. Multiple myeloma is a hematologic cancer and is considered immunosuppressive so MMR vaccine is contraindicated in this person.

Last reviewed: June 19, 2023

You have two options. You can test for immunity or you can just give 2 doses of MMR at least 4 weeks apart. There is no harm in giving MMR vaccine to a person who may already be immune to one or more of the vaccine viruses. If you or the patient opt for testing, and the tests indicate the patient is not immune to one or more of the vaccine components, give your patient 2 doses of MMR at least 4 weeks apart. If any test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination because commercial tests may not be sensitive enough to reliably detect vaccine-induced immunity.

Last reviewed: June 19, 2023

ACIP recommends 2 doses of MMR given at least 4 weeks apart for any adult born in 1957 or later who plans to travel internationally. There is no harm in giving MMR vaccine to a person who may already be immune to one or more of the vaccine viruses.

Last reviewed: June 19, 2023

No, it is not considered necessary, but he may be vaccinated. Before implementation of the national measles vaccination program in 1963, virtually every person acquired measles before adulthood. So, this patient can be considered immune based on their birth year. However, MMR vaccine also may be given to any person born before 1957 who does not have a contraindication to MMR vaccination.

Routine testing of patients born before 1957 for measles-specific antibody is not recommended by CDC.

Last reviewed: June 19, 2023

First of all, make sure all your patients are fully vaccinated according to the U.S. immunization schedule.

In certain circumstances, MMR is recommended for infants age 6 through 11 months. Give infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants as young as age 6 months as a control measure during a U.S. measles outbreak. Consult your state health department to find out if this is recommended in your situation. Do not count any dose of MMR vaccine as part of the 2-dose series if it is administered more than 4 days before a child’s first birthday. Instead, repeat the dose when the child is age 12 months.

In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.

Finally, remember that infants too young for routine vaccination and people with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. Be sure to encourage all your patients and their family members to get vaccinated if they are not immune.

Last reviewed: June 19, 2023

In recent years, mumps outbreaks have occurred primarily in populations in institutional settings with close contact (such as residential colleges) or in close-knit social groups. The current routine recommendation for 2 doses of MMR vaccine appears to be sufficient for mumps control in the general population, but insufficient for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with 2 doses of MMR vaccine is high.

In January 2018, the Advisory Committee on Immunization Practices (ACIP) published guidance for MMR vaccination of persons at increased risk for acquiring mumps during an outbreak. Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications. Either brand of MMR vaccine may be used. More information about this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

Last reviewed: June 19, 2023

You are correct that vaccinated people can still be infected with viruses or bacteria against which they are vaccinated. No vaccine is 100% effective. Vaccine effectiveness varies from greater than 95% (for diseases such as measles, rubella, and hepatitis B) to much lower (60% for influenza in years with a good match of circulating and vaccine viruses, and 70% for acellular pertussis vaccines in the 3-5 years after vaccination). More information is available for each vaccine and disease at www.cdc.gov/vaccines/vpd/vaccines-diseases.html and www.immunize.org/vaccines.

Last reviewed: June 19, 2023

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