No, a baby does not need separate Varivax if receiving ProQuad
ProQuad (MMRV) already contains the varicella vaccine component, so administering separate Varivax would be redundant and unnecessary. 1, 2
Understanding ProQuad Composition
ProQuad is a combination vaccine that includes:
- Measles virus
- Mumps virus
- Rubella virus
- Varicella-zoster virus (the same component as in Varivax, but at a higher titer) 2, 3
The varicella component in ProQuad provides equivalent immunogenicity and protection compared to standalone Varivax, with seroconversion rates and antibody responses that are similar to those achieved with separate administration of MMR and Varivax vaccines. 2, 4
Age-Specific Recommendations
For First Dose (12-47 months):
- Either MMR + Varivax separately OR ProQuad may be used 1
- The CDC recommends MMR + Varivax separately for ages 12-23 months unless parents prefer ProQuad after discussing the small increased febrile seizure risk (1 additional seizure per 2,300-2,600 children) 1
- For ages 24-47 months, either option is acceptable 1
For First Dose (≥48 months) or Any Second Dose:
- ProQuad is generally preferred over separate injections 1, 5
- No increased febrile seizure risk exists in children ≥4 years receiving ProQuad 1
Complete Vaccination Schedule
Regardless of whether ProQuad or separate vaccines are used:
- Two doses of varicella-containing vaccine are required for complete protection 6, 7
- Minimum interval between doses: 3 months for children 12 months-12 years 5, 6
- The two-dose schedule provides 98% efficacy against any varicella disease versus 94% with one dose 7
Important Contraindication
Personal or family history (sibling or parent) of seizures is a precaution for ProQuad - in these cases, separate MMR and Varivax should be given instead. 1, 5
Clinical Bottom Line
If a child receives ProQuad, they have received varicella vaccination. The only consideration is ensuring they complete the two-dose series with either a second dose of ProQuad or separate MMR + Varivax at the appropriate interval. 8, 4