Is the MMR (Measles, Mumps, Rubella) and varicella combination vaccine available?

MMRV Combination Vaccine Availability and Use

Yes, the MMR and varicella combination vaccine (MMRV, brand name ProQuad) is available in the United States for children aged 12 months through 12 years. 1

Licensing and Availability

• The FDA licensed MMRV vaccine (ProQuad, Merck & Co., Inc.) in September 2005 for use in children aged 12 months–12 years 1
• After a temporary manufacturing shortage from July 2007, the vaccine became available again in May 2010 1
• MMRV provides protection against all four diseases (measles, mumps, rubella, and varicella) in a single injection 1

Age-Specific Recommendations for Use

First Dose (Ages 12-47 Months): Use Separate MMR + Varicella

For children receiving their first dose at age 12-47 months, CDC recommends administering separate MMR and varicella vaccines unless parents specifically request MMRV. 1, 2

• This recommendation is based on postlicensure data showing MMRV causes one additional febrile seizure per 2,300-2,600 children vaccinated compared to separate injections 1, 2
• The increased risk occurs 5-12 days after the first dose in children aged 12-23 months 1
• Providers must discuss both options with parents/caregivers, explaining the benefits (one injection vs. two) and risks (higher fever and febrile seizure risk) 1, 2

Second Dose (Any Age) and First Dose (≥48 Months): MMRV Preferred

For the second dose at any age (15 months–12 years) or for the first dose at age ≥48 months, MMRV vaccine is generally preferred over separate injections. 1, 2

• The 47-month cutoff was selected because approximately 97% of febrile seizures occur in children aged ≤47 months 1
• No increased risk of febrile seizures has been demonstrated in children aged 4-6 years receiving MMRV as a second dose 1
• MMRV preference aligns with ACIP's general recommendations favoring combination vaccines when appropriate 1

Key Precautions and Contraindications

New Precaution: Personal or Family History of Seizures

Children with a personal or family history (sibling or parent) of seizures of any etiology should receive separate MMR and varicella vaccines rather than MMRV. 1, 2, 3

• Children with such histories are at increased risk for febrile seizures compared to those without 1
• The risks of MMRV in this population outweigh the benefits 1

Standard Contraindications

MMRV vaccine is contraindicated in children with: 1

• History of anaphylactic reaction to neomycin
• Allergic reaction to gelatin or other vaccine components
• Altered immunity (blood dyscrasias, leukemia, lymphomas, malignancies affecting bone marrow/lymphatic system)
• Primary or acquired immunodeficiency (HIV/AIDS, cellular immune deficiencies, hypogammaglobulinemia)
• Family history of congenital/hereditary immunodeficiencies (unless immune competence demonstrated)
• Systemic immunosuppressive therapy (≥2 mg/kg or ≥20 mg/day prednisone equivalent for ≥2 weeks)
• Pregnancy

Immunogenicity and Safety Profile

• Both MMRV and separate MMR + varicella vaccines provide equivalent protection against all four diseases 1
• Seroconversion rates exceed 99% for all antigens after the second dose 4, 5, 6
• The second dose of varicella-containing vaccine produces substantial antibody increases (14-27 fold rise in titers) 4, 5
• MMRV causes more frequent low-grade fever after the first dose (27.7% vs. 18.7%) and measles-like rash (5.9% vs. 1.9%) compared to separate injections 7

Practical Considerations

• The minimum interval between first and second doses is 3 months, though the routine recommendation is to give the second dose at age 4-6 years 1, 3
• If MMR and varicella vaccines are not given simultaneously, they must be separated by at least 28 days 2, 3
• Antipyretics (acetaminophen, ibuprofen) do not prevent febrile seizures and should not be routinely given prophylactically 1
• Parents should be counseled that most fevers and febrile seizures occur 5-12 days after vaccination with measles-containing vaccines 1