At what age are varicella (chickenpox) and MMR (Measles, Mumps, Rubella) vaccines typically administered?

MMR and Varicella Vaccine Administration Schedule

Both MMR and varicella vaccines are routinely administered at 12-15 months of age for the first dose, with a second dose recommended at 4-6 years of age before kindergarten entry. 1

First Dose Schedule

• Minimum age for both vaccines: 12 months 1
• Recommended timing: 12-15 months of age 1
• Administration options:
  • Separate MMR and varicella vaccines
  • Combined MMRV (ProQuad) vaccine (approved for children 12 months through 12 years) 1

Second Dose Schedule

• Recommended timing: 4-6 years of age (before entering kindergarten or first grade) 1
• Minimum intervals:
  • For children 12 months-12 years: At least 3 months between varicella doses 1
  • For persons ≥13 years: At least 4 weeks between varicella doses 1
  • For MMR: At least 4 weeks between doses 1
• Important note: If the second varicella dose is administered ≥28 days after the first dose, it is considered valid and does not need to be repeated 1

Special Considerations

For Children Who Missed the Routine Schedule

• Children who did not receive the vaccines at the recommended ages should receive catch-up vaccination 1
• For varicella: Two doses are required for all children, adolescents, and adults without evidence of immunity 1
• For MMR: Two doses are required, with at least 4 weeks between doses 1

Age-Specific Recommendations

• Children 12 months-12 years: Two doses of varicella vaccine administered subcutaneously, separated by at least 3 months 1
• Persons ≥13 years: Two doses of varicella vaccine administered subcutaneously, separated by at least 4 weeks 1
• Only single-antigen varicella vaccine (not MMRV) may be used for persons ≥13 years 1

MMRV vs. Separate MMR and Varicella Vaccines

• MMRV vaccine is approved only for children 12 months through 12 years of age 1
• For children receiving their first dose at 12-47 months, separate MMR and varicella vaccines are generally preferred due to an increased risk of fever and febrile seizures with MMRV 2
• For children receiving their first dose at ≥48 months or second dose at any age, MMRV is generally preferred 2
• A personal or family history of seizures is a precaution for MMRV vaccine use 2

Implementation and Coverage

The implementation of the two-dose varicella vaccination program has shown substantial progress since its recommendation in 2007. Two-dose varicella vaccination coverage levels among children aged 7 years increased from 3.6%-8.9% in 2006 to 79.9%-92.0% in 2012, approaching the levels of 2-dose MMR coverage 3.

Vaccine Effectiveness

The estimated vaccine efficacy over a 10-year observation period for 2 doses of varicella vaccine for prevention of any varicella disease is 98% (compared with 94% for 1 dose), with 100% efficacy for prevention of severe disease 1. Recipients of 2 doses are 3.3-fold less likely to have breakthrough varicella compared to those who receive only 1 dose 1.

Safety Considerations

A second dose of varicella vaccine is well tolerated in children who have been previously vaccinated, with primarily mild injection site reactions and occasional mild systemic reactions such as fever or rash 4.

Remember that there is no need to restart a vaccine series regardless of the time that has elapsed between doses 1.