MMRV vaccine

MMRV vaccine
Combination of
Measles vaccineVaccine
Mumps vaccineVaccine
Rubella vaccineVaccine
Varicella vaccineVaccine
Names
Trade namesProQuad, Priorix Tetra
Clinical data
Pregnancy
category
  • AU: B2[1]
  • US: X (Contraindicated)[1]
    Routes of
    use    		Subcutaneous, intramuscular
    External links
    AHFS/Drugs.comMonograph
    Legal
    License data
    Legal status
    • AU: S4 (Prescription only)
    • US: ℞-only [2]
    • EU: Rx-only [3]
    • In general: ℞ (Prescription only)
    Identifiers
    CAS Number
    • 1704519-64-1 checkY
    ChemSpider
    • none
    ATC code

    The MMRV vaccine is a vaccine against measles, mumps, rubella and chickenpox, which combines the MMR vaccine (MMR) with the varicella vaccine (V).[4] More than 95% effectiveness in preventing measles is achieved after the first dose, and 96% after the second dose.[5] When one child in a household is given the MMRV, some protection is achieved for others around them.[5] It appears to be more effective in preventing chicken pox than by giving the varicella vaccine on its own.[6] It is given as a 0.5 mL dose, by injection into muscle or under the skin to children between one and two years of age, but not after age 12 years.[7][8]

    MMRV is recommended as a way of providing protection against chicken pox in countries that have already achieved a good control of measles, mumps and rubella.[4] It simplifies administration of the vaccines.[4] Evidence does not support replacing MMR with MMRV to eliminate measles and rubella and control mumps.[4] The single varicella vaccine is often used for the first dose, with the MMRV reserved for the second dose.[6]

    Common side effects include redness and pain at the site of injection.[9] There is a risk of fever around 5 to 12 days after the vaccine, which occurs more than twice as frequently than that seen with MMR alone or MMR and varicella vaccine given in separate arms at the same time.[6] Febrile convulsions are also more frequent, particularly when used as a first dose in comparison to used as the second of a measles containing vaccine.[10] If a rash develops, it may be due to the measles or varicella component, and therefore has a risk of spreading varicella.[9] Rarely, bruising can occur due to a temporary drop in platelets.[9] Because MMRV contains live viruses, the MMRV vaccine is not recommended during pregnancy.[1]

    The development of the MMRV began in the 1980s and was licensed in 2006 after balancing the effectiveness and side effects of the varicella component.[4][11] For greater effectiveness a higher dose of the varicella component is contained in ProQuad, marketed by Merck.[6] GlaxoSmithKline's Priorix Tetra contains the same quantity of the varicella component as the single varicella vaccine.[6] Schedules vary from country to country, with Germany and parts of Italy giving the second dose MMRV after an interval of 3-months.[6] It has been introduced in India as a second measles-containing vaccine in children age one year and above.[10] As of 2018, around 30 million doses of MMRV have been distributed around the world.[7]

    Medical uses

    MMRV is a vaccine against measles, mumps, rubella and chickenpox, which combines the MMR vaccine (MMR) with the varicella vaccine (V).[4] It simplifies administration of the vaccines.[4]

    Recommendations

    The World Health Organization (WHO) recommends vaccinating against measles, mumps, rubella (German measles), and varicella (chickenpox) because the risks of these diseases far outweigh the risks of vaccinating against them. In particular, the World Health Organization recommends varicella vaccination in countries where the vaccine is affordable, the disease is a relatively important problem, and high and sustained vaccine coverage can be achieved. A few countries have widely implemented this. MMR and varicella vaccine are given at roughly the same time and a booster injection is recommended for both.

    Contraindications

    • For individuals who are moderately or severely ill, it is generally recommended that they wait until after recovery before getting ProQuad. No such precautions are recommended for minor illnesses, such as a cold.
    • It is recommended that aspirin or aspirin containing products be avoided for at least six weeks after receiving ProQuad vaccine (aspirin is not recommended in children under 16 in any case). A serious condition called Reye's syndrome has been reported in patients with chicken pox and influenza.
    • Individuals should not receive ProQuad without first consulting their doctor if there is a history of a life-threatening allergic reaction to gelatin, eggs, the antibiotic neomycin, or a previous MMR or chicken pox vaccine.

    Doctors are advised to be aware of whether or not a patient has HIV/AIDS or another disease that affects the immune system, is taking a medication that affects the immune system, has cancer, a fever or active untreated tuberculosis, is receiving cancer treatment, or has ever had a low platelet count (a blood disorder).

    Side effects

    One 2008 study indicated a rate of febrile seizures of 9 per 10,000 vaccinations with MMRV, as opposed to 4 per 10,000 for separate MMR and varicella shots; U.S. health officials known as the ACIP therefore do not express a preference for use of MMRV vaccine over separate injections.[12]

    Rare but serious adverse events reported following ProQuad vaccination include allergic reactions, including swelling of the lips, tongue, or face; difficulty breathing or closing of the throat; hives; paleness; weakness; dizziness; a fast heart beat; deafness; long-term seizures, coma, or lowered consciousness; seizures (jerking or staring) caused by fever; or temporary low platelet count.[9]

    For children age two and younger, the MMRV vaccine is associated with significantly more adverse events compared to separate administration of MMR and varicella vaccinations on the same day.[9] There are 4.3 additional febrile seizures per 10,000 vaccinated children (95% CI 2.6–5.6), 7.5 additional mostly mild fever episodes per 100 vaccinated children (95% CI, 5.4–9.4) and 1.1 additional measles-like rash per 100 children (95% CI, 0.2–1.8). Febrile seizures caused by the MMRV vaccine occur 7 to 10 days after vaccination. In children age 4–6, there is no evidence for an increased risk in febrile seizures after the administration of Merck Proquad compared to the separate administration of MMR and Varicella vaccines.[13][14]

    Availability

    ProQuad is marketed by Merck and was approved in 2005, for use in the United States by the Food and Drug Administration (FDA) for children ages twelve months through twelve years. An MMRV vaccine called Priorix Tetra[15][16] by GlaxoSmithKline has been approved in Germany and Australia.[17][18][19]

    Merck ProQuad was approved for medical use in the United States in September 2005,[20][21] in the European Union in April 2006,[3] and in Australia in February 2007.[22]

    GSK Priorix Tetra was approved for medical use in Australia in November 2005.[23]

    References

    1. 1 2 3 "Measles virus vaccine / mumps virus vaccine / rubella virus vaccine / varicella virus vaccine (ProQuad) Use During Pregnancy". Drugs.com. 16 October 2019. Archived from the original on 19 October 2019. Retrieved 26 January 2020.
    2. ↑ "DailyMed - PROQUAD- measles, mumps, rubella and varicella virus vaccine live injection, powder, lyophilized, for suspension". Archived from the original on 6 April 2020. Retrieved 26 December 2021.
    3. 1 2 "ProQuad EPAR". European Medicines Agency (EMA). Archived from the original on 21 October 2020. Retrieved 8 October 2020.
    4. 1 2 3 4 5 6 7 Vesikari, Timo; Usonis, Vytautas (2021). "9. Measles-Mumps-Rubella vaccine". In Vesikari, Timo; Damme, Pierre Van (eds.). Pediatric Vaccines and Vaccinations: A European Textbook (Second ed.). Switzerland: Springer. pp. 86–87. ISBN 978-3-030-77172-0. Archived from the original on 29 January 2022. Retrieved 28 January 2022.
    5. 1 2 Di Pietrantonj, C; Rivetti, A; Marchione, P; Debalini, MG; Demicheli, V (April 2020). "Vaccines for measles, mumps, rubella, and varicella in children". Cochrane Database of Systematic Reviews. 4: CD004407. doi:10.1002/14651858.CD004407.pub4. PMC 7169657. PMID 32309885.
    6. 1 2 3 4 5 6 Spoulou, Vana; Liese, Johannes; Vesikari, Timo (2021). "10. Varicella vaccine". In Vesikari, Timo; Damme, Pierre Van (eds.). Pediatric Vaccines and Vaccinations: A European Textbook (Second ed.). Switzerland: Springer. pp. 95–96. ISBN 978-3-030-77172-0. Archived from the original on 29 January 2022. Retrieved 28 January 2022.
    7. 1 2 Haas, Hervé; Richard, Patrick; Eymin, Cécile; Fiquet, Anne; Kuter, Barbara; Soubeyrand, Benoit (8 January 2019). "Immunogenicity and safety of intramuscular versus subcutaneous administration of a combined measles, mumps, rubella, and varicella vaccine to children 12 to 18 months of age". Human Vaccines & Immunotherapeutics. 15 (4): 778–785. doi:10.1080/21645515.2018.1549452. ISSN 2164-5515. PMID 30481110. Archived from the original on 26 January 2021. Retrieved 28 January 2022.
    8. ↑ "Administering MMR Vaccine | CDC". www.cdc.gov. 26 January 2021. Archived from the original on 28 December 2021. Retrieved 29 January 2022.
    9. 1 2 3 4 5 "Measles-Mumps-Rubella-Varicella (MMRV) Vaccine Information Statement | CDC". www.cdc.gov. 10 August 2021. Archived from the original on 26 December 2019. Retrieved 28 January 2022.
    10. 1 2 Shah, Nitin; Parikh, Raunak; Casabona, Giacomo; Kolhapure, Shafi (15 December 2017). "A New Combined Vaccine Against Measles, Mumps, Rubella and Varicella in India". Indian Pediatrics. 54 (12): 1041–1046. doi:10.1007/s13312-017-1209-9. ISSN 0974-7559. PMID 29317560. Archived from the original on 30 January 2022. Retrieved 30 January 2022.
    11. ↑ Gillet, Yves; Habermehl, Pirmin; Thomas, Stéphane; Eymin, Cécile; Fiquet, Anne (14 April 2009). "Immunogenicity and safety of concomitant administration of a measles, mumps and rubella vaccine (M-M-RvaxPro®) and a varicella vaccine (VARIVAX®) by intramuscular or subcutaneous routes at separate injection sites: a randomised clinical trial". BMC Medicine. 7 (1): 16. doi:10.1186/1741-7015-7-16. ISSN 1741-7015. PMID 19366435. Archived from the original on 20 December 2021. Retrieved 28 January 2022.
    12. ↑ Klein NP, Yih WK, Marin M, et al. (March 2008). "Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine" (PDF). MMWR Morb. Mortal. Wkly. Rep. 57 (10): 258–60. PMID 18340332. Archived (PDF) from the original on 19 October 2020. Retrieved 26 December 2021.
    13. ↑ Klein NP, Fireman B, Yih WK, et al. (July 2010). "Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures". Pediatrics. 126 (1): e1–8. doi:10.1542/peds.2010-0665. PMID 20587679.
    14. ↑ "CBER clinical review of studies submitted in support of licensure of ProQuad" (PDF). US Food and Drug Administration. August 2005. Archived (PDF) from the original on 6 May 2017. Retrieved 26 December 2021.
    15. ↑ Wellington K, Goa KL (2003). "Measles, mumps, rubella vaccine (Priorix; GSK-MMR): a review of its use in the prevention of measles, mumps and rubella". Drugs. 63 (19): 2107–26. doi:10.2165/00003495-200363190-00012. PMID 12962524. S2CID 46973762.
    16. ↑ "GlaxoSmithKline Clinical Trial Register". GlaxoSmithKline. Archived from the original on 30 November 2007. Retrieved 19 October 2019.
    17. ↑ "Priorix-tetra". The Australian Immunisation Handbook. 4 June 2018. Archived from the original on 19 October 2019. Retrieved 18 October 2019.
    18. ↑ Bauchau V, Van Holle L, Cohen C (November 2015). "Modelling Hospitalisation Ratios for Febrile Convulsions and Severe Varicella Under Combined Measles, Mumps, Rubella, and Varicella (MMRV-Priorix-Tetra) Compared to Separate MMR + V Vaccination". Drug Saf. 38 (11): 1095–102. doi:10.1007/s40264-015-0326-4. PMC 4608986. PMID 26251259.
    19. ↑ "PEI Table of vaccines for measles with a valid marketing authorisation". PEI , Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel (in Deutsch). 19 October 2019. Archived from the original on 19 October 2019. Retrieved 18 October 2019.
    20. ↑ "ProQuad". U.S. Food and Drug Administration (FDA). Archived from the original on 23 July 2017. Retrieved 8 October 2020.
    21. ↑ "ProQuad". U.S. Food and Drug Administration (FDA). STN: 125108. Archived from the original on 11 November 2020. Retrieved 8 October 2020.
    22. ↑ "ProQuad measles, mumps, rubella, varicella live virus vaccine injection vial" (PDF). Therapeutic Goods Administration (TGA). Retrieved 8 October 2020.{{cite web}}: CS1 maint: url-status (link)
    23. ↑ "Priorix Tetra Vaccine 0.5mL powder for injection vial" (PDF). Therapeutic Goods Administration (TGA). Retrieved 8 October 2020.{{cite web}}: CS1 maint: url-status (link)

    Further reading

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