What is the recommended spacing for administering Tdap, meningococcal, and MMRV vaccines to a 13-year-old with no prior vaccinations or medical history?

Vaccine Administration for a 13-Year-Old with No Prior Vaccinations

All three vaccines—Tdap, meningococcal conjugate (MCV4), and MMRV—can be administered simultaneously at the same visit with no required spacing between them. 1

Simultaneous Administration is Preferred

The most efficient and evidence-based approach is to administer all three vaccines during the same clinical encounter. 1

• Tdap, meningococcal conjugate vaccine, and MMR/varicella vaccines are all recommended for adolescents aged 13-18 years who have not been previously vaccinated. 1

• There is no immunologic interference when these vaccines are given together, and simultaneous administration maximizes protection while reducing missed opportunities. 1, 2

• For this 13-year-old, administer one dose of Tdap, one dose of MCV4, and two doses of MMR and varicella vaccines (either as separate vaccines or as MMRV if age-appropriate). 1

Specific Vaccine Dosing for This Patient

Tdap Vaccine

• Administer a single 0.5 mL dose of Tdap intramuscularly at this visit. 1
• This adolescent aged 13 years who has never received any tetanus-containing vaccines should receive a complete primary series: one dose of Tdap followed by Td at least 4 weeks later, then a second Td dose 6-12 months after the first Td. 3

Meningococcal Conjugate Vaccine (MCV4)

• Administer a single 0.5 mL dose of MCV4 intramuscularly at this visit. 1, 4
• For individuals 2 years of age and older with no prior vaccination, only a single dose is required for primary vaccination. 4

MMR and Varicella Vaccines

• For a 13-year-old, administer two separate 0.5 mL doses of MMR vaccine and two separate 0.5 mL doses of varicella vaccine. 1, 5
• The first doses of both MMR and varicella can be given at today's visit simultaneously with Tdap and MCV4. 2
• The second doses of MMR and varicella should be administered at least 4 weeks (28 days) after the first doses, as this is the minimum interval for persons aged ≥13 years. 1, 5
• MMRV combination vaccine (ProQuad) is NOT approved for use in patients ≥13 years of age; only single-antigen vaccines should be used. 5

Critical Spacing Rules

Live Virus Vaccine Spacing

• MMR and varicella vaccines are both live virus vaccines and must either be given on the same day OR separated by at least 28 days. 2
• If not administered simultaneously, waiting less than 28 days between these live virus vaccines may result in impaired immune response. 2

No Spacing Required Between Tdap, MCV4, and Live Vaccines

• Tdap and MCV4 are inactivated vaccines and can be given at any interval before, with, or after live virus vaccines without interference. 1, 6, 7
• There is no minimum interval required between tetanus toxoid-containing vaccines (Tdap) and other vaccines when otherwise indicated. 3

Recommended Vaccination Schedule for This Patient

Visit 1 (Today):

• Tdap (0.5 mL IM)
• MCV4 (0.5 mL IM)
• MMR #1 (0.5 mL SC)
• Varicella #1 (0.5 mL SC)

Visit 2 (At least 28 days after Visit 1):

• MMR #2 (0.5 mL SC)
• Varicella #2 (0.5 mL SC)

Visit 3 (At least 4 weeks after Visit 1):

• Td (0.5 mL IM) - to continue the primary tetanus/diphtheria series 3

Visit 4 (6-12 months after Visit 3):

• Td (0.5 mL IM) - to complete the primary tetanus/diphtheria series 3

Common Pitfalls to Avoid

• Do not delay any vaccine unnecessarily—simultaneous administration is safe and recommended. 1, 2
• Do not administer MMR and varicella vaccines 1-27 days apart; this creates suboptimal immune response. 2
• Do not use MMRV combination vaccine in patients ≥13 years old; it is only licensed for ages 12 months through 12 years. 5
• Do not forget to complete the full primary tetanus/diphtheria series with two additional Td doses after the initial Tdap. 3
• Do not assume one dose of Tdap provides complete tetanus/diphtheria protection in a never-vaccinated adolescent—a three-dose primary series is required. 3

Safety Considerations

• All four vaccines can be safely administered at different anatomic sites during the same visit. 1
• Research has demonstrated no increased adverse events or immune interference when Tdap, MCV4, and MMR/varicella vaccines are given concomitantly. 6, 7, 8
• The most common adverse events are local pain at injection sites and fever, which are generally mild and self-limited. 8