Titer Testing for Adults Working in Daycare Settings

When to Order Titers vs. Direct Vaccination

The Centers for Disease Control and Prevention recommends ordering serologic testing for measles IgG, mumps IgG, rubella IgG, and varicella IgG if vaccination documentation is unavailable or uncertain for adults working in daycare settings 1, 2
Prevaccination serologic screening is not necessary if it is more cost-effective to simply vaccinate, as the vaccines are safe even in immune individuals 1

Adults can demonstrate immunity to MMR without serologic testing if they have documentation of 2 doses of MMR vaccine given at least 28 days apart after the first birthday, as recommended by the Centers for Disease Control and Prevention 1, 6
The Centers for Disease Control and Prevention considers adults born before 1957 to be generally immune to measles, mumps, and rubella, but not for women of childbearing age regarding rubella 3, 4

The Centers for Disease Control and Prevention recommends ordering measles IgG antibody, mumps IgG antibody, and rubella IgG antibody tests for adults working in daycare settings 3, 5
Enzyme immunoassay (EIA) or ELISA are preferred over older hemagglutination-inhibition (HI) tests for measles, mumps, and rubella antibody testing, as recommended by the Centers for Disease Control and Prevention 3, 5
Any detectable antibody indicates immunity to measles, mumps, and rubella, according to the Centers for Disease Control and Prevention 3, 5

The Centers for Disease Control and Prevention recommends ordering varicella-zoster virus (VZV) IgG antibody tests for adults working in daycare settings 7, 2
Approximately 90% of US-born adults are already immune to varicella, as reported by the Infectious Diseases Society of America 7

Daycare employees are specifically highlighted as high-priority for varicella vaccination due to their work environment where transmission is likely, as recommended by the Infectious Diseases Society of America 7, 2
The Centers for Disease Control and Prevention recommends that daycare workers receive special emphasis for ensuring immunity to all four diseases 7, 2

Equivocal titer results should be treated as susceptible unless other evidence of immunity exists, as recommended by the Centers for Disease Control and Prevention 3, 4, 5
Documented vaccination supersedes serologic results, and additional vaccine doses should not be given if someone with documented 2-dose MMR vaccination tests negative or equivocal, according to the Centers for Disease Control and Prevention 1

Physician-diagnosed disease is NOT acceptable evidence of immunity for rubella, unlike measles and mumps, as stated by the Centers for Disease Control and Prevention 3, 4, 6
Women of childbearing age cannot rely on birth before 1957 as evidence of rubella immunity and require either vaccination documentation or positive serology, as recommended by the Centers for Disease Control and Prevention 3, 4
Clinical diagnosis of rubella is unreliable and should never be used to assess immune status, according to the Centers for Disease Control and Prevention 3, 5

If titers are negative or equivocal, the Centers for Disease Control and Prevention recommends administering 1-2 doses of MMR vaccine depending on risk, with daycare workers receiving 2 doses, 28 days apart 1, 6, 8
The Centers for Disease Control and Prevention recommends administering 2 doses of varicella vaccine, 4-8 weeks apart, for adults with negative or equivocal varicella titers 2
Women should avoid pregnancy for 4 weeks after MMR or varicella vaccination, as recommended by the Centers for Disease Control and Prevention 2, 6, 8