Rubella Vaccine Recommendations

Introduction

Single-antigen rubella vaccine is not available. Rubella vaccine is included in these combination vaccines:

• Measles, mumps, and rubella (MMR) vaccine
• Measles, mumps, rubella, and varicella (MMRV) vaccine

This page summarizes CDC's current MMR and MMRV vaccine recommendations by age and risk. Access the official, full text below:

Presumptive evidence of immunity

ACIP recommends that people who don't have presumptive evidence of immunity to measles, mumps, and rubella should get vaccinated against these diseases.

Presumptive evidence of immunity can be established in any of the following ways:

• Written documentation of adequate vaccines for measles, mumps, and rubella
• Laboratory evidence of immunity
• Laboratory confirmation of disease
• Birth before 1957 (except people of childbearing age who could become pregnant)

Although birth before 1957 is considered acceptable evidence of immunity for healthcare personnel in routine circumstances, healthcare facilities should consider vaccinating healthcare personnel born before 1957 who lack laboratory evidence of immunity or laboratory confirmation of disease.

Healthcare providers should not accept verbal reports of vaccination without written documentation as presumptive evidence of immunity.

Routine recommendations

Children

CDC recommends children should routinely get 2 doses of MMR vaccine:

• First dose at age 12 through 15 months
• Second dose at age 4 through 6 years (before school entry)

This can be administered as MMR or MMRV vaccine. Children can receive the second dose of MMR vaccine earlier than 4 through 6 years (as long as it is at least 28 days after the first dose). A second dose of MMRV vaccine can be given 3 months after the first dose up to 12 years of age.

CDC recommends that separate MMR and varicella vaccines be given for the first dose in children aged 12–47 months; however, MMRV may be used if parents or caregivers express a preference.

Adults

Adults and teens should also be up to date on MMR vaccinations with either 1 or 2 doses (depending on risk factors); unless they have other presumptive evidence of immunity to measles, mumps, and rubella. MMR vaccination is especially important for healthcare professionals, international travelers, and other specific groups.

One dose of MMR vaccine, or other presumptive evidence of immunity, is sufficient for most adults. Providers generally do not need to actively screen adult patients for measles immunity in non-outbreak areas in the United States. After vaccination, it is also not necessary to test patients for antibodies to confirm immunity. There is no recommendation for a catch-up program among adults for a second dose of MMR (e.g., people born before 1989 or otherwise).

Considerations for people of childbearing age

All patients of childbearing age, especially those who grew up outside the United States in areas where routine rubella vaccination might not occur, should be vaccinated with one dose of MMR vaccine or have other acceptable presumptive evidence of rubella immunity. Only a positive serologic test for rubella antibody or documentation of appropriate vaccination should be accepted as presumptive evidence of immunity for people who may become pregnant.

Vaccinated people of childbearing age who have received 1 or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should be administered 1 additional dose of MMR vaccine (maximum of 3 doses) and do not need to be retested for serologic evidence of rubella immunity.

Patients known to be pregnant or attempting to become pregnant should not receive a live virus vaccine, including MMR vaccine. Although there is no evidence that rubella vaccine virus is harmful to the fetus during pregnancy, as a precaution, women should not get pregnant for 4 weeks (28 days) after MMR vaccination.

Post-exposure prophylaxis for rubella

Unlike with measles, MMR vaccine is not effective at helping protect people who have recently been infected with rubella (post-exposure prophylaxis, or PEP). However, vaccination after exposure is not harmful and may possibly prevent later disease if re-exposed.

For more information on mumps outbreak control and post-exposure prophylaxis, healthcare providers should:

• Consult their health department.
• Refer to the rubella chapter of the Surveillance of Vaccine-Preventable Diseases Manual.

MMR & MMRV contraindications and precautions

Contraindications and precautions to vaccination generally dictate circumstances when vaccines will not be given. Most contraindications and precautions are temporary, and the vaccine can be given at a later time.

Resources

• Vaccine Safety (MMR | MMRV)
• Vaccine Information Statements (MMR | MMRV)
• Immunization schedules (Child and adolescent | Adult)
• Vaccines For Children Program Information for Providers
• Ask the Experts: MMR | Immunize.org

Clinical information

• Surveillance Manuals (Measles | Mumps | Rubella)
• Pink Book (Measles | Mumps | Rubella)
• Clinical overview (Measles | Mumps | Rubella)