A Clinician’s Handbook for Childhood & Adult Immunizations in Georgia

Measles, Mumps, Rubella Varicella

Pathophysiology

  • Measles: Virus
    Respiratory transmission
    Incubation 10-12 days
  • Mumps: Virus
    Respiratory transmission
    Incubation 14-18 days
  • Rubella: Virus
    Respiratory transmission
    Incubation 12-23 days
  • Varicella Zoster: Virus
    Respiratory transmission
    Incubation 14-16 days

Vaccine Description

Live attenuated vaccine

Dose & Route

0.5 mL reconstituted vaccine given subQ

Administration Schedule

Publication of ACIP recommendations for administering this vaccine is found ACIP MMRV Vaccine Recommendations | CDC

Dose Recommended Age

Dose 1……….12 – 15 months*
Dose 2……….4 – 6 years**
Dose 3……….≥ 12 months***

*MMRV vaccine may be administered to children 12 months through 12 years of age when all components of the vaccine are needed for completion of the vaccine series or when any single component of the vaccine series is not available at the time of immunization.

**Children who received 2 doses of MMR with dose #1 no earlier than the 1st birthday and dose #2 at least 4 weeks after dose #1 do not need an additional dose for school entry.

***Persons ≥ 12 months who previously received ≤ 2 doses of mumps-containing vaccine and are identified by public health authorities to be at increased risk during a mumps outbreak should receive a dose of mumps-virus containing vaccine.

Minimum Intervals

ProQuad® (MMRV) may be used to simultaneously administer MMR and varicella vaccine to children ages 12 mos. through 12 yrs. when both vaccines are indicated.

Spacing and timing of MMRV from individual component vaccines (MMR and varicella):

  • At least 1 month between a dose of a measles-containing vaccine and a dose of MMRV.
  • At least 3 months between a dose of varicella vaccine and a dose of MMRV.
  • However, if varicella vaccine and MMRV are inadvertently given ≥28 days or more apart, the doses may be counted as valid.

Contraindications

  • Anaphylactic reaction following a prior dose of MMR, Varicella or to any of its components (gelatin or neomycin).
  • Immunosuppression
  • Recent recipient of blood products.
  • Persons receiving large doses of corticosteroids (>2mg/kg per day or >20mg per day of prednisone) for 14 days or more.
  • Pregnancy
  • Defer vaccination in persons with moderate or severe acute illness until illness subsides.
  • TB – untreated, active
  • HIV Positive Children- MMRV should not be administered to HIV infected children. Only single antigen varicella should be considered for HIV infected children in CDC class N2, A2 or B2 with CD4+ T-lymphocyte percentages > 15%.
  • Personal or family history of seizures is a precaution for MMRV vaccination.

Special Considerations & Instructions

  • Vaccine must be stored frozen at 5°F or colder.
  • Once reconstituted, vaccine should be discarded if not used within 30 minutes.
  • Diluent may be stored at room temperature or in the refrigerator.
  • For corticosteroid recipients: administration of MMRV should be avoided for at least 1 month after cessation of high dose therapy (see Contraindications).
  • Pregnancy should be avoided for 1 month following MMRV vaccine.
  • If PPD is needed and not given the same day as MMRV, PPD testing should be delayed 4-6 weeks after MMRV vaccination.
  • May be administered simultaneously with other vaccines recommended at ages 12 mos. through 12 yrs.

MMRV and Febrile Seizures

Dose 1 at Ages 12 through 47 Months

Either MMR and varicella or MMRV vaccine can be used. Providers should discuss the benefits and risks of both vaccination options with the parents or caregivers. Use of MMRV vaccine results in one fewer injection but is associated with a higher risk for fever/febrile seizures 5 through 12 days after the first dose among children aged 12 through 23 months. CDC recommends that MMR vaccine and varicella vaccine should be administered as separate injections for the first dose in children 12– 47 months of age.

Dose 1 at Ages 48 Months and Older and Dose 2 at any

Age: Use of MMRV vaccine generally is preferred over separate injections of its equivalent component vaccines.

Download - MMRV Pdf