Last reviewed: June 2018
Last updated: March  2018

US CDC recommends third dose of MMR vaccine during mumps outbreaks

In response to an increase in the number of mumps outbreaks in the US, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices now recommends that anyone aged ≥12 months who previously received one or two doses of mumps-containing vaccine and is considered to be at increased risk during a mumps outbreak should receive a third dose of MMR or MMRV vaccine to improve protection.

People are considered to be at increased risk during an outbreak if they are more likely to have prolonged or intense exposure to droplets or saliva from a person infected with mumps, for example through close contact or sharing of drinks or utensils (e.g., through living on a university campus or as part of any close-knit community). After a review of recent evidence, the CDC concluded that the routine recommendation of two doses of MMR vaccine appears to be sufficient for mumps control in the general population but insufficient for preventing mumps outbreaks in close-contact settings, even where coverage with two vaccine doses is high. In the event of a mumps outbreak, public health authorities will be responsible for defining at-risk target groups for a third vaccine dose.

See Prevention

Original source of update



History and exam

Key diagnostic factors

  • presence of risk factors
  • parotitis
  • hx of missed or no vaccination or possible vaccine failure (primary or secondary)

Other diagnostic factors

  • constitutional symptoms
  • orchitis
  • oophoritis
  • aseptic meningitis
  • mastitis
  • encephalitis
  • deafness

Risk factors

  • unvaccinated status
  • immunosuppression
  • healthcare worker
  • international traveller
  • close-contact living (college students, prisoners, military)
  • vaccine failure

Diagnostic investigations

Investigations to consider

  • FBC and differential
  • lumbar puncture
  • serum mumps IgM
  • serum mumps IgG
  • reverse transcriptase PCR
  • serum amylase
  • viral culture (CSF, saliva, or urine)
  • CT head
Full details

Treatment algorithm



Authors VIEW ALL

Consultant in Community Child Health

Great Ormond Street Hospital




DE declares that he has no competing interests.

Professor of Children's Health

UCL Institute of Child Health




HB declares that she has no competing interests.

Dr David Elliman and Professor Helen Bedford would like to gratefully acknowledge Dr Kristin Furfari, a previous contributor to this monograph. KF declares that she has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Clinical Dermatology

Columbia University

New York



RU declares that he has no competing interests.

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont College of Medicine




CDH declares that he has no competing interests.

Deputy Director

National Centre for Immunisation Research and Surveillance

Postgraduate Fellow

Department Of Microbiology and Infectious Diseases

The Children’s Hospital


New South Wales



KM declares that she has no competing interests.

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