What is the recommended age for administering the ProQuad (measles, mumps, rubella, and varicella vaccine) to a healthy pediatric patient?

ProQuad Age Recommendations

ProQuad (MMRV vaccine) is approved for use in children from 12 months through 12 years of age, with the first dose routinely recommended at 12-15 months and the second dose at 4-6 years. 1, 2

Age-Specific Dosing Guidelines

First Dose Timing

• The minimum age for ProQuad administration is 12 months 2, 3
• The routine recommended age for the first dose is 12-15 months 1, 2
• ProQuad may be administered as early as 9 months in special circumstances (outbreak situations, travel to high-prevalence measles regions, or to conform with national vaccination schedules), though this is not the routine recommendation 3, 4

Second Dose Timing

• The second dose is routinely recommended at 4-6 years of age (before entering prekindergarten, kindergarten, or first grade) 1, 2
• The second dose may be administered earlier than 4 years, provided at least 3 months have elapsed since the first dose 1, 2
• The minimum interval between doses is 3 months for children 12 months through 12 years 2

Upper Age Limit

• ProQuad is only licensed for use through 12 years of age 1, 2
• For adolescents and adults ≥13 years, only single-antigen varicella vaccine (Varivax) may be used, not the combination MMRV product 2

Critical Age-Related Safety Considerations

Febrile Seizure Risk (Ages 12-47 Months)

• For the first dose in children aged 12-47 months, CDC recommends using separate MMR and varicella vaccines rather than ProQuad unless parents express a preference for MMRV after discussing risks and benefits 1
• ProQuad carries approximately one additional febrile seizure per 2,300-2,600 doses compared to separate vaccines in children aged 12-23 months 1
• The 47-month cutoff was selected because approximately 97% of febrile seizures occur in children ≤47 months of age 1

Preferred Use at Age ≥48 Months

• For children ≥48 months (4 years), ProQuad is generally preferred over separate injections of MMR and varicella vaccines 1, 5
• Post-licensure studies demonstrated no increased febrile seizure risk in children aged 4-6 years receiving ProQuad compared to separate vaccines 5

Special Circumstances

Personal or Family History of Seizures

• A personal or family history (sibling or parent) of seizures of any etiology is a precaution for ProQuad vaccination 1, 5
• Children with seizure history should receive separate MMR and varicella vaccines instead of ProQuad 1, 5

Catch-Up Vaccination

• For previously unvaccinated children of any age within the 12 months to 12 years range, ProQuad may be used to initiate the two-dose series 1
• The same age-based recommendations apply: separate vaccines preferred for first dose at 12-47 months, ProQuad preferred at ≥48 months 1, 5