Provisional Recommendations for Use of Measles, Mumps, Rubella and Varicella (MMRV) Vaccine

ACIP Provisional Recommendations for Use of Measles, Mumps, Rubella and Varicella (MMRV) Vaccine
Date of ACIP vote: June 25, 2009
Date of posting of provisional recommendations: October 20, 2009

On June 25, 2009, ACIP voted on updated recommendations for use of MMRV vaccine and approved other MMRV vaccine-related guidance. The updated provisional recommendations for use of MMRV vaccine and CDC implementation guidance are listed below.
Dose 1 at Ages 12 through 47* Months
For the first dose of measles, mumps, rubella, and varicella vaccines at ages 12 through 47 months, either MMR and varicella vaccines or MMRV vaccine can be used. Providers who are considering administering MMRV vaccine should discuss the benefits and risks of both vaccination options with the parents or caregivers. Compared with use of MMR and varicella vaccines at the same visit, use of MMRV vaccine results in one fewer injection but is associated with a higher risk for fever and febrile seizures 5 through 12 days after the first dose among children aged 12 through 23 months* (about one extra febrile seizure for every 2,300–2,600 MMRV vaccine doses). Use of MMR and varicella vaccines avoids this increased risk for fever and febrile seizures following MMRV vaccine. Providers who face barriers to clearly communicating these benefits and risks for any reason (e.g., language barriers) should administer MMR and varicella vaccines.

Dose 1 at Ages 48 Months and Older and Dose 2 at any Age
For the first dose of measles, mumps, rubella, and varicella vaccines at ages 48 months and older and for dose 2 at any age (15 months through 12 years), use of MMRV vaccine generally is preferred over separate injections of its equivalent component vaccines (i.e., MMR and varicella vaccines). Considerations should include provider assessment†, patient preference, and the potential for adverse events.
Of note, the routinely recommended ages for measles, mumps, rubella and varicella vaccination continue to be 12 through 15 months of age for dose 1 and 4 through 6 years of age for dose 2.

Other MMRV Vaccine-related Guidance
New precaution for MMRV Vaccine Use
A personal or family (i.e., sibling, parent) history of seizures is a precaution for MMRV vaccination. Studies suggest that children who have a personal or family history of febrile seizures or family history of epilepsy are at increased risk for febrile seizures compared with children who do not have such histories. Children with a personal or family history of seizures generally should be vaccinated with MMR and varicella vaccines because the risks of using MMRV vaccine in this group of children generally outweigh the benefit of MMRV vaccine.

CDC has developed materials to help with the implementation of the updated recommendations for use of MMRV vaccine:
www.cdc.gov/vaccines/vpd-vac/combo-vaccines/mmrv/vacopt.htm

* The 47 month cut-off was chosen on the basis of the epidemiology of febrile seizures: first febrile seizures are uncommon after age 4 years, approximately 94% of febrile seizures occur in children aged less than 4 years.
† Provider assessment should include the number of injections, vaccine availability, likelihood of improved coverage, likelihood of patient return, and storage and cost consideration.

This document can be found on the CDC website at: www.cdc.gov/vaccines/recs/provisional/default.htm