My patient has had two documented doses of MMR. Her rubella titer was nonreactive at a prenatal visit. What should I do?
It is possible that she failed to respond to both doses. It is also possible that she did respond but has a low level of antibody. Failure to respond to two properly timed doses of MMR vaccine would be expected to occur in one or two persons per thousand vaccinees, at most. A small number of people appear to develop a relatively small amount of antibody following vaccination with rubella and other vaccines. This level of antibody may not be detectable on relatively insensitive commercial screening tests. Controlled trials with sensitive tests indicate a response rate of >99% following two doses of rubella-containing vaccine. I would suggest you make a note of her documented vaccination and stop testing. Another approach would be to administer one additional dose of MMR. However, there are no data on the administration of additional doses of rubella-containing vaccine in this situation.
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- If an adult healthcare worker has a negative measles titer, should she receive one or two doses of MMR and what is the interval between the two doses?
- My patient has had two documented doses of MMR. Her rubella titer was nonreactive at a prenatal visit. What should I do?
