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Measles, mumps, and rubella immunization in adults

Patricia L Hibberd, MD, PhD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Elinor L Baron, MD, DTMH


The combination measles, mumps, and rubella (MMR) vaccine includes live virus vaccines against measles, mumps, and rubella; it is an important tool for preventing serious illness due to these infections [1,2].

Issues related to the use of combination MMR vaccine in adults will be discussed here; use of MMR immunization in infants, children, and adolescents is discussed separately. (See "Measles, mumps, and rubella immunization in infants, children, and adolescents" and "Approach to immunizations in healthy adults".)

Issues related to the epidemiology, clinical manifestations, diagnosis, and management of measles, mumps, and rubella are discussed separately. (See "Measles: Clinical manifestations, diagnosis, treatment, and prevention" and "Mumps" and "Rubella".)


The measles virus causes an acute infection characterized by fever, cough, coryza, conjunctivitis, rash (picture 1A-B), and enanthem (picture 2) that may be followed by severe complications including encephalitis. Adults with measles are at increased risk of mortality compared with older children, and measles in pregnancy is associated with premature labor and spontaneous abortion [3]. (See "Measles: Clinical manifestations, diagnosis, treatment, and prevention".)

The mumps virus causes an acute infection characterized by parotid swelling (picture 3). Mumps infection usually is self-limited but may be associated with complications including orchitis and oophoritis, aseptic meningitis, and encephalitis. The most serious complications of mumps arise more frequently in adults than in children, including neurologic complications. (See "Mumps", section on 'Clinical manifestations'.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2017.
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  1. McLean HQ, Fiebelkorn AP, Temte JL, et al. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62:1.
  2. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr 2016; 170:1209.
  3. Watson JC, Hadler SC, Dykewicz CA, et al. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1998; 47:1.
  4. Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C. Vaccines for measles, mumps and rubella in children. Cochrane Database Syst Rev 2012; :CD004407.
  5. Fowlkes A, Witte D, Beeler J, et al. Persistence of vaccine-induced measles antibody beyond age 12 months: a comparison of response to one and two doses of Edmonston-Zagreb measles vaccine among HIV-infected and uninfected children in Malawi. J Infect Dis 2011; 204 Suppl 1:S149.
  6. Watson JC, Pearson JA, Markowitz LE, et al. An evaluation of measles revaccination among school-entry-aged children. Pediatrics 1996; 97:613.
  7. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book), 12th ed, Atkinson W, Wolfe C, Hamborsky J (Eds), The Public Health Foundation, Washington, DC 2011.
  8. Fiebelkorn AP, Coleman LA, Belongia EA, et al. Measles Virus Neutralizing Antibody Response, Cell-Mediated Immunity, and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles, Mumps, and Rubella Vaccine in Young Adults. J Infect Dis 2016; 213:1115.
  9. Rice P, Young Y, Cohen B, Ramsay M. MMR immunisation after contact with measles virus. Lancet 2004; 363:569.
  10. King GE, Markowitz LE, Patriarca PA, Dales LG. Clinical efficacy of measles vaccine during the 1990 measles epidemic. Pediatr Infect Dis J 1991; 10:883.
  11. Barrabeig I, Rovira A, Rius C, et al. Effectiveness of measles vaccination for control of exposed children. Pediatr Infect Dis J 2011; 30:78.
  12. Ma SJ, Li X, Xiong YQ, et al. Combination Measles-Mumps-Rubella-Varicella Vaccine in Healthy Children: A Systematic Review and Meta-analysis of Immunogenicity and Safety. Medicine (Baltimore) 2015; 94:e1721.
  13. Jokinen S, Osterlund P, Julkunen I, Davidkin I. Cellular immunity to mumps virus in young adults 21 years after measles-mumps-rubella vaccination. J Infect Dis 2007; 196:861.
  14. Hanna-Wakim R, Yasukawa LL, Sung P, et al. Immune responses to mumps vaccine in adults who were vaccinated in childhood. J Infect Dis 2008; 197:1669.
  15. Vandermeulen C, Clement F, Roelants M, et al. Evaluation of cellular immunity to mumps in vaccinated individuals with or without circulating antibodies up to 16 years after their last vaccination. J Infect Dis 2009; 199:1457.
  16. Ong G, Goh KT, Ma S, Chew SK. Comparative efficacy of Rubini, Jeryl-Lynn and Urabe mumps vaccine in an Asian population. J Infect 2005; 51:294.
  17. Albertson JP, Clegg WJ, Reid HD, et al. Mumps Outbreak at a University and Recommendation for a Third Dose of Measles-Mumps-Rubella Vaccine - Illinois, 2015-2016. MMWR Morb Mortal Wkly Rep 2016; 65:731.
  18. Ogbuanu IU, Kutty PK, Hudson JM, et al. Impact of a third dose of measles-mumps-rubella vaccine on a mumps outbreak. Pediatrics 2012; 130:e1567.
  19. American Academy of Pediatrics. Rubella. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.688.
  20. Braun C, Kampa D, Fressle R, et al. Congenital rubella syndrome despite repeated vaccination of the mother: a coincidence of vaccine failure with failure to vaccinate. Acta Paediatr 1994; 83:674.
  21. Parkman PD. Making vaccination policy: the experience with rubella. Clin Infect Dis 1999; 28 Suppl 2:S140.
  22. Best JM, Icenogle JP, Brown DWG. Rubella. In: Principles and Practices of Clinical Virology, 6th Ed, Zuckerman AJ, Banatvala JE, Schoub BD, et al (Eds), John Wiley & Sons, Ltd, West Sussex, UK 2009. p.561.
  23. Kimberlin DW, Bocchini JA. Monovalent vaccines no longer available for measles, mumps, rubella. AAP News 2009; 30:9.
  24. Centers for Disease Control and Prevention. Q & As about monovalent M-M-R vaccines. Available at: www.cdc.gov/vaccines/vac-gen/shortages/mmr-faq-12-17-08.htm (Accessed on May 05, 2015).
  25. Low N, Bavdekar A, Jeyaseelan L, et al. A randomized, controlled trial of an aerosolized vaccine against measles. N Engl J Med 2015; 372:1519.
  26. Robinson CL, Romero JR, Kempe A, et al. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2017. MMWR Morb Mortal Wkly Rep 2017; 66:134.
  27. LeBaron CW, Beeler J, Sullivan BJ, et al. Persistence of measles antibodies after 2 doses of measles vaccine in a postelimination environment. Arch Pediatr Adolesc Med 2007; 161:294.
  28. Davidkin I, Jokinen S, Broman M, et al. Persistence of measles, mumps, and rubella antibodies in an MMR-vaccinated cohort: a 20-year follow-up. J Infect Dis 2008; 197:950.
  29. Markowitz LE, Albrecht P, Orenstein WA, et al. Persistence of measles antibody after revaccination. J Infect Dis 1992; 166:205.
  30. Ward BJ, Boulianne N, Ratnam S, et al. Cellular immunity in measles vaccine failure: demonstration of measles antigen-specific lymphoproliferative responses despite limited serum antibody production after revaccination. J Infect Dis 1995; 172:1591.
  31. LeBaron CW, Forghani B, Matter L, et al. Persistence of rubella antibodies after 2 doses of measles-mumps-rubella vaccine. J Infect Dis 2009; 200:888.
  32. Hillary IB, Griffith AH. Persistence of rubella antibodies 15 years after subcutaneous administration of Wistar 27/3 strain live attenuated rubella virus vaccine. Vaccine 1984; 2:274.
  33. Christenson B, Böttiger M. Long-term follow-up study of rubella antibodies in naturally immune and vaccinated young adults. Vaccine 1994; 12:41.
  34. LeBaron CW, Forghani B, Beck C, et al. Persistence of mumps antibodies after 2 doses of measles-mumps-rubella vaccine. J Infect Dis 2009; 199:552.
  35. Gothefors L, Bergström E, Backman M. Immunogenicity and reactogenicity of a new measles, mumps and rubella vaccine when administered as a second dose at 12 y of age. Scand J Infect Dis 2001; 33:545.
  36. Broliden K, Abreu ER, Arneborn M, Böttiger M. Immunity to mumps before and after MMR vaccination at 12 years of age in the first generation offered the two-dose immunization programme. Vaccine 1998; 16:323.
  37. American College Physicians Task Force on Adult Immunization and Infectious Diseases Society of America. Guide for adult immunization. Philadelphia. American College of Physicians, 1994.
  38. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009; 15:1143.
  39. American Academy of Pediatrics. Measles. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.535.
  40. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1997; 46:1.
  41. ACIP Provisional Recommendations for Measles-Mumps-Rubella (MMR) 'Evidence of Immunity' Requirements for Healthcare Personnel http://www.cdc.gov/vaccines/recs/provisional/downloads/mmr-evidence-immunity-Aug2009-508.pdf (Accessed on November 15, 2011).
  42. Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC). Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60:1.
  43. Bolyard EA, Tablan OC, Williams WW, et al. Hospital Infection Control Advisory Committee. Guidelines for infection control in health-care personnel. Am J Infect Control 1998; 26:289.
  44. Centers for Disease Control and Prevention. Mumps. In: Manual for the Surveillance of Vaccine-Preventable Diseases. Atlanta, GA, October 2012. Available at: www.cdc.gov/vaccines/pubs/surv-manual/chpt09-mumps.html (Accessed on May 05, 2015).
  45. Arciuolo RJ, Jablonski RR, Zucker JR, Rosen JB. Effectiveness of Measles Vaccination and Immune Globulin Post-Exposure Prophylaxis in an Outbreak Setting-New York City, 2013. Clin Infect Dis 2017; 65:1843.
  46. Sheppeard V, Forssman B, Ferson MJ, et al. The effectiveness of prophylaxis for measles contacts in NSW. N S W Public Health Bull 2009; 20:81.
  47. Measles: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook - 12th Edition (April 2011) http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html (Accessed on November 15, 2011).
  48. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014; 58:e44.
  49. Poon TP, Tchertkoff V, Win H. Subacute measles encephalitis with AIDS diagnosed by fine needle aspiration biopsy. A case report. Acta Cytol 1998; 42:729.
  50. Bitnun A, Shannon P, Durward A, et al. Measles inclusion-body encephalitis caused by the vaccine strain of measles virus. Clin Infect Dis 1999; 29:855.
  51. Baram TZ, Gonzalez-Gomez I, Xie ZD, et al. Subacute sclerosing panencephalitis in an infant: diagnostic role of viral genome analysis. Ann Neurol 1994; 36:103.
  52. Centers for Disease Control and Prevention (CDC). Measles pneumonitis following measles-mumps-rubella vaccination of a patient with HIV infection, 1993. MMWR Morb Mortal Wkly Rep 1996; 45:603.
  53. Derryck A, LaRussa P, Steinberg S, et al. Varicella and zoster in children with human immunodeficiency virus infection. Pediatr Infect Dis J 1998; 17:931.
  54. Kroger AT, Duchin J, Vázquez M. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Available at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html (Accessed on April 27, 2017).
  55. Kamboj M, Sepkowitz KA. Risk of transmission associated with live attenuated vaccines given to healthy persons caring for or residing with an immunocompromised patient. Infect Control Hosp Epidemiol 2007; 28:702.
  56. LeBaron CW, Bi D, Sullivan BJ, et al. Evaluation of potentially common adverse events associated with the first and second doses of measles-mumps-rubella vaccine. Pediatrics 2006; 118:1422.
  57. Ting CY, Tee NW, Thoon KC. Could a fever and rash after the measles, mumps and rubella vaccination indicate wild-type measles? Acta Paediatr 2015; 104:e232.
  58. American Academy of Pediatrics. Rubella. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.688.
  59. James JM, Burks AW, Roberson PK, Sampson HA. Safe administration of the measles vaccine to children allergic to eggs. N Engl J Med 1995; 332:1262.
  60. Beck SA, Williams LW, Shirrell MA, Burks AW. Egg hypersensitivity and measles-mumps-rubella vaccine administration. Pediatrics 1991; 88:913.
  61. Ray P, Hayward J, Michelson D, et al. Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study. Pediatr Infect Dis J 2006; 25:768.
  62. Knuf M, Zepp F, Meyer CU, et al. Safety, immunogenicity and immediate pain of intramuscular versus subcutaneous administration of a measles-mumps-rubella-varicella vaccine to children aged 11-21 months. Eur J Pediatr 2010; 169:925.
  63. Cassidy WM, Jones G, Williams K, et al. Safety and immunogenicity of concomitant versus nonconcomitant administration of hepatitis B, tetanus-diphtheria, and measles-mumps-rubella vaccines in healthy eleven- to twelve-year-olds. J Adolesc Health 2005; 36:187.
  66. Verstraeten T, Jumaan AO, Mullooly JP, et al. A retrospective cohort study of the association of varicella vaccine failure with asthma, steroid use, age at vaccination, and measles-mumps-rubella vaccination. Pediatrics 2003; 112:e98.
  67. King GE, Markowitz LE, Heath J, et al. Antibody response to measles-mumps-rubella vaccine of children with mild illness at the time of vaccination. JAMA 1996; 275:704.
  68. Dennehy PH, Saracen CL, Peter G. Seroconversion rates to combined measles-mumps-rubella-varicella vaccine of children with upper respiratory tract infection. Pediatrics 1994; 94:514.
  69. Ratnam S, West R, Gadag V. Measles and rubella antibody response after measles-mumps-rubella vaccination in children with afebrile upper respiratory tract infection. J Pediatr 1995; 127:432.
  70. Siber GR, Werner BG, Halsey NA, et al. Interference of immune globulin with measles and rubella immunization. J Pediatr 1993; 122:204.
  71. American Academy of Pediatrics. Active immunization of people who recently received immune globulin and other blood products. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.38.
  72. Nieminen U, Peltola H, Syrjälä MT, et al. Acute thrombocytopenic purpura following measles, mumps and rubella vaccination. A report on 23 patients. Acta Paediatr 1993; 82:267.
  73. Beeler J, Varricchio F, Wise R. Thrombocytopenia after immunization with measles vaccines: review of the vaccine adverse events reporting system (1990 to 1994). Pediatr Infect Dis J 1996; 15:88.
  74. Drachtman RA, Murphy S, Ettinger LJ. Exacerbation of chronic idiopathic thrombocytopenic purpura following measles-mumps-rubella immunization. Arch Pediatr Adolesc Med 1994; 148:326.
  75. Vlacha V, Forman EN, Miron D, Peter G. Recurrent thrombocytopenic purpura after repeated measles-mumps-rubella vaccination. Pediatrics 1996; 97:738.
  76. Brickman HF, Beaudry PH, Marks MI. The timing of tuberculin tests in relation to immunization with live viral vaccines. Pediatrics 1975; 55:392.
  77. Vestergaard M, Hviid A, Madsen KM, et al. MMR vaccination and febrile seizures: evaluation of susceptible subgroups and long-term prognosis. JAMA 2004; 292:351.
  78. Berg AT, Shinnar S, Shapiro ED, et al. Risk factors for a first febrile seizure: a matched case-control study. Epilepsia 1995; 36:334.
  79. Chess S, Fernandez P, Korn S. Behavioral consequences of congenital rubella. J Pediatr 1978; 93:699.