From the Guidelines
Management of suspected MMR and varicella vaccine reactions primarily involves supportive care, with the benefits of these vaccines in preventing serious diseases far outweighing the risks of reactions. For mild reactions like fever, pain, or redness at the injection site, acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) or ibuprofen (10 mg/kg every 6-8 hours with food) can provide relief, as noted in general medical practice 1. Apply cool compresses to the injection site for localized reactions. For fever, ensure adequate hydration and rest. More severe reactions like high fever (>103°F), extensive rash, or signs of anaphylaxis require immediate medical attention. Anaphylaxis necessitates epinephrine administration (0.01 mg/kg of 1:1000 solution, maximum 0.3 mg for children and 0.5 mg for adults) and emergency care.
The safety of administering MMR and MMRV vaccines to children with egg allergy, even those with a history of severe reactions, has been recognized by various organizations, including the ACIP and AAP, as stated in 1 and 1. The quality of evidence supporting the safety of these vaccines for children with egg allergy is moderate, with significant contribution from expert opinion. According to 1, the use of combination measles, mumps, rubella, and varicella vaccine is recommended, with considerations for provider assessment, patient preference, and potential adverse events.
Key points to consider in managing suspected MMR and varicella vaccine reactions include:
- The vaccines are safe for children with egg allergy, even those with a history of severe reactions 1
- Supportive care is the primary management approach for mild reactions
- Severe reactions require immediate medical attention
- The benefits of these vaccines in preventing serious diseases outweigh the risks of reactions
- Considerations for vaccine administration should include provider assessment, patient preference, and potential adverse events, as outlined in 1.
From the Research
Management and Treatment Options for MMR and Varicella Reaction
- The management and treatment options for a suspected Measles, Mumps, and Rubella (MMR) and Varicella reaction involve monitoring for adverse events and providing supportive care as needed 2, 3, 4, 5, 6.
- Studies have shown that concomitant administration of MMR and Varicella vaccines is generally well-tolerated and immunogenic in healthy children 2, 4.
- The most frequently reported injection-site reactions for both vaccines are erythema and swelling, which are usually mild and self-limiting 2.
- Systemic adverse events, such as fever and varicella-like rashes, can occur but are typically comparable in incidence and nature to those seen with separate administration of the vaccines 2, 5.
Immunogenicity and Safety
- The immunogenicity of MMR and Varicella vaccines administered concomitantly is comparable to that of separate administration, with high seroconversion rates and antibody titers achieved for all four antigens 2, 4, 5.
- The safety profile of the combination vaccine is similar to that of the component vaccines, with a higher incidence of low-grade fever noted after the first dose but no difference after the second dose 6.
Vaccine Administration and Recommendations
- The MMRV vaccine can be administered in two doses to children aged 11-14 months and 15-23 months, offering a convenient way to implement varicella vaccination and achieve high vaccine coverage rates 6.
- The vaccine is recommended for use in countries considering introducing MMRV vaccines, as it provides protection against four diseases in a single vaccine and offers advantages for children, parents, and healthcare providers 6.