Can the Measles, Mumps, Rubella, and Varicella (MMRV) vaccine and Influenza (FLU) vaccine be administered together?

Co-administration of MMRV and Influenza Vaccines

Yes, the MMRV (Measles, Mumps, Rubella, and Varicella) vaccine and influenza (flu) vaccine can be safely administered together at the same visit. Multiple vaccines can be safely administered during the same visit at different anatomical sites, with no need to delay any of these vaccinations 1.

Evidence Supporting Co-administration

The CDC guidelines support that:

• Inactivated vaccines (like influenza) can be administered simultaneously with any other inactivated or live vaccines 1
• Simultaneous administration of live (MMRV) and inactivated (flu) vaccines produces seroconversion rates and adverse reaction rates similar to those observed when vaccines are administered separately 1
• There is no evidence of diminished immune response or increased adverse events when these vaccines are given together 1

Administration Guidelines

When administering MMRV and influenza vaccines together:

• Each vaccine must be administered at a different injection site using separate syringes 1
• Do not mix vaccines in the same syringe unless specifically FDA-approved for mixing 1
• Document each vaccine administered, including manufacturer, lot number, site, and date of administration 1
• Provide vaccine information statements for each vaccine 1

Special Considerations for MMRV Vaccine

When administering MMRV vaccine, consider:

Age-specific Recommendations

1. For first dose at age 12-47 months:

   • Either MMR + separate varicella vaccine OR MMRV may be used
   • MMR + separate varicella vaccine is preferred unless parents specifically request MMRV 2, 1
   • This preference is due to increased risk of fever and febrile seizures with MMRV in this age group (approximately one extra febrile seizure for every 2,300-2,600 MMRV vaccine doses) 2

2. For first dose at age ≥48 months or second dose at any age:

   • MMRV is generally preferred over separate MMR and varicella vaccines 2, 1
   • Considerations include number of injections, vaccine availability, likelihood of improved coverage, and patient preference 2

Precautions and Contraindications

• Important precaution: A personal or family history (sibling or parent) of seizures is a precaution for MMRV vaccination 2, 1
• Children with seizure history should generally receive separate MMR and varicella vaccines instead of MMRV 2, 1

Potential Side Effects

When administering multiple vaccines simultaneously:

• Injection site reactions (pain, redness, swelling) and mild systemic symptoms (fever, fatigue) may be accentuated 1
• Monitoring for fever, local reactions, and allergic reactions is recommended 1
• MMRV vaccine may cause measles-like rash and fever during days 5-12 post-vaccination 3

Clinical Benefits of Co-administration

Co-administration of vaccines:

• Increases the probability of full immunization 1
• Reduces the number of clinic visits required 1
• Improves vaccination compliance rates 3
• Decreases the number of injections given to children 3

Documentation and Follow-up

• Clearly document each vaccine administered, including manufacturer, lot number, site, and date of administration 1
• Counsel parents about the possibility of fever after receipt of a measles-containing vaccine and educate on timing and measures to control it 2
• Report any clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) 2