Measles, Mumps & Rubella

Why proof of measles, mumps and rubella (MMR) immunity is required for placement, how the vaccine protects you and your patients, and the record you need to submit.

Status: Required for all students

Valid for: Does not expire once you have two documented doses or laboratory evidence of immunity.

This page explains why proof of measles, mumps and rubella immunity is required and how the vaccine works, using guidance from Health Canada and the Public Health Agency of Canada. It is educational and does not replace advice from your own health care provider or the specific rules of your program and placement site. See the Source & references at the bottom.

Why this is required

Placement sites require proof that you are immune to the vaccine-preventable diseases you could encounter — or pass on — during patient care. A single MMR vaccine covers three of them: measles, mumps and rubella.

Protects you. Measles is one of the most contagious diseases known, and clinical settings are exactly where exposure can happen — two doses give you near-complete protection.
Protects your patients. Rubella can cause severe birth defects if passed to a pregnant patient, and measles is dangerous to infants and immunocompromised patients. Documented immunity lowers the risk that you become a link in an outbreak.
It is usually already done. MMR is part of routine childhood immunization in Canada, so most students only need to locate records of their two doses.

Health Canada is explicit here: health care workers, regardless of year of birth, should have two doses of measles-containing vaccine or laboratory evidence of immunity. This is why many programs ask for an MMR titre (blood test) as well as, or instead of, your vaccination record.

About the three diseases

Measles (rubeola) is caused by the measles virus and is one of the most highly communicable diseases known, with secondary attack rates over 90% among susceptible people. It spreads by the airborne route and respiratory droplets. About 10% of cases develop complications such as ear infections or pneumonia, encephalitis occurs in roughly 1 in 1,000 cases and can cause permanent brain damage, and rare cases lead to the fatal late complication SSPE.
Mumps spreads by respiratory droplets and saliva. About 40% of infections cause the classic swollen salivary glands (parotitis); complications include orchitis (testicular inflammation) in 20–30% of post-pubertal males, meningitis, and rarely permanent deafness.
Rubella (German measles) is highly communicable and usually mild — but infection in pregnancy can cause congenital rubella syndrome, leading to miscarriage, stillbirth or birth defects such as heart disease, cataracts, deafness and intellectual disability. The risk is highest in the first trimester (about 85%).

How the vaccine works

MMR is a live attenuated vaccine — it uses weakened measles, mumps and rubella viruses that teach your immune system to recognise them without causing the diseases. In Canada, measles vaccine is only available in combination, as MMR or MMRV (with varicella), so a single shot protects against several diseases at once. Because it is a live vaccine, MMR is not given during pregnancy.

How well it works

A single dose of measles vaccine is 85% to 95% effective, and with a second dose efficacy approaches 100% — which is why two doses are the standard requirement.
Over 97% of people develop immunity to rubella after one dose.
Mumps protection is estimated at 62–91% after one dose and 76–95% after two doses.

Safety and side effects

Reactions are usually mild and transient:

Pain and redness at the injection site
A mild fever (under 39°C) and sometimes a rash
Reactions are less frequent after the second dose

Serious adverse events are rare following MMR immunization.

Staying protected

Two documented doses (or laboratory evidence of immunity) give long-lasting protection that does not need routine boosters. If a titre shows you are not immune to one of the three, your program may ask for one or two additional MMR doses. Because MMR is a live vaccine, it should not be given during pregnancy, and pregnancy should be avoided for a short period after vaccination — confirm timing with a health care provider.

What to submit

A record showing two doses of a measles-containing vaccine (MMR/MMRV), or
A lab report (titre) showing immunity to measles, mumps and rubella
Your full legal name and date of birth on every document

Accepted proof

Childhood immunization record (e.g. the yellow immunization card)
Provincial or public health immunization record
Lab report of an MMR serology/titre with the results clearly stated
International immunization card with an English translation

Good to know

Two doses given at least 4 weeks apart, on or after your first birthday, are what counts as documented immunity.
Many programs prefer or require a titre — a blood test proving immunity — so check whether your site accepts vaccination records alone.
If a titre comes back non-immune, you may need a booster dose; leave time for this before your placement start date.

Validity

Does not expire once you have two documented doses or laboratory evidence of immunity.

Source & references

The medical information on this page is adapted from Health Canada and the Public Health Agency of Canada:

Measles, Mumps & Rubella

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