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From the Department of State Health Services Immunization Branch
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July 18, 2008
Updated Recommendations on Use of the Combination Measles, Mumps, Rubella, and Varicella (MMRV) Vaccine
The goal of the Vaccine Advisory is to disseminate, in a timely manner, practical information related to vaccines, vaccine-preventable diseases, and the vaccine programs managed by the Immunization Branch. The Immunization Branch welcomes readers’ input to improve the contents of this document.
This advisory presents updated recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding the administration of combination MMRV vaccine. These updated recommendations remove the ACIP’S previous preference for administering MMRV vaccine over two separate injections (MMR and varicella vaccines).
This advisory contains:
- Background information
- Summary of ACIP‘s new recommendations for MMRV vaccine
- Clinical guidance for using the MMRV vaccine
- Texas Vaccines for Children program information on MMRV availability for eligible participants
- Texas school and child-care facilities requirements for MMRV vaccine
- Reporting vaccine adverse events
- Additional resources
The combination MMRV vaccine was licensed by the Food and Drug Administration (FDA) on September 6, 2005, for use in children aged 12 months - 12 years. MMRV vaccine has not been widely distributed in the United States since June 2007 and is not expected to be available again until 2009.
On February 27, 2008, new information was presented to the ACIP regarding the risk for febrile seizures among children aged 12 - 23 months after administration of the combination measles, mumps, rubella, and varicella (MMRV) vaccine ProQuad®, (Merck & Co., Inc., Whitehouse Station, New Jersey). Taking into consideration MMRV vaccine supply and safety, the ACIP decided to no longer express preference for MMRV vaccine over separate administration of MMR and varicella vaccines.
2) Summary of ACIP Recommendations
Changes to recommendations on the use of MMRV vaccine include new wording on the use of this vaccine. Highlights follow:
- ACIP voted to change the preference language for MMRV vaccine to read as follows: “Combination MMRV vaccine is approved for use among healthy children aged 12 months - 12 years. MMRV vaccine is indicated for simultaneous vaccination against measles, mumps, rubella, and varicella. ACIP does not express a preference for use of MMRV vaccine over separate injections of equivalent component vaccine (i.e., MMR vaccine and varicella vaccine).”
- Stocks of ProQuad®, (MMR-V), have been depleted as of June 15, 2007. Merck, the manufacturer of ProQuad has suspended the production of this vaccine and is prioritizing production of varicella and zoster vaccines over production of ProQuad. As a result, ProQuad is not expected to be available until 2009. Merck expects to have enough supply to fully implement the recommended immunization schedule for varicella vaccine for all age groups and for the recommended use of zoster vaccine. Updates will be provided when available.
The ACIP's final recommendations.
3) Clinical guidance for using the MMRV vaccine
- MMRV vaccine is currently in very limited distribution in the United States, due to manufacturing issues unrelated to vaccine safety or efficacy. However, some clinics may have MMRV vaccine in stock.
- ACIP continues to recommend two doses of vaccines to protect against measles, mumps, rubella, and varicella. The first dose is recommended at 12-15 months, and the second dose is recommended at ages 4-6 years.
- Providers can choose whether to administer combination MMRV vaccine or MMR and varicella vaccines separately for prevention of measles, mumps, rubella, and varicella.
- Health care providers can remind parents that most children who receive an MMRV vaccine do not have any problems, and being vaccinated with MMRV or MMR and varicella vaccines is safer than getting measles, mumps, rubella, or chickenpox.
- ACIP recommends that a personal or family history of seizures is not a contraindication or precaution for administration of MMRV, MMR, or varicella vaccines.
4) Texas Vaccines for Children (TVFC) program
Merck, the manufacturer of ProQuad®, the Measles/Mumps/Rubella/Varicella (MMRV) vaccine, has suspended the production of this vaccine in order to continue to adequately supply the varicella and zoster vaccines. The Texas Vaccines for Children (TVFC) program no longer has ProQuad® available. Merck plans to make MMRV vaccine available again sometime in 2009, and when that happens, providers will be notified by the TVFC via official memorandum. Until that time, TVFC providers will need to continue using the individual varicella and MMR products to meet the needs of their patient populations.
For other questions or information, please contact your health service region or TVFC consultant.
ImmTrac users can report the MMRV (measles, mumps, rubella and varicella) vaccine, ProQuad®, using the ImmTrac code “MMRV”. At this time, the ImmTrac immunization scheduler does not generate recommendations for routine two-dose varicella vaccination for children under 13 years of age. This functionality is scheduled for implementation by August 1, 2008. For more information about ImmTrac, please refer to: www.ImmTrac.com.
6) Texas school and child-care facilities requirements for MMRV vaccine
The current MMR and varicella requirement consists of the following:
- Measles, mumps, rubella (MMR) – Two doses of a measles-containing vaccine given on or after the first birthday and the second dose upon entry into kindergarten.
- Varicella – One dose given on or after the first birthday. Two doses if the vaccine was given at 13 years of age or older.
Blood tests showing immunity to measles, mumps, rubella, and varicella or evidence of the infection is acceptable in place of the vaccine. Please visit the Texas School and Child-care Facility Requirements web page for more information about immunization requirements.
7) Reporting vaccine adverse events
Clinically significant adverse events following vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS).
Adverse events from privately purchased vaccine may be reported directly to VAERS. Secure web-based reporting is available on the VAERS website. Contact 800-VAC-RXNS for forms and information.
In Texas, reports of events following vaccination at public health clinics or with vaccine provided through public funding such as the Texas Vaccines for Children (TVFC) program should be reported through the Texas Department of State Health Services, Immunization Branch (MC 1946), P.O. Box 149347, Austin, TX 78714-9347. The pre-addressed and postage-paid VAERS form with this address can be obtained by calling the Immunization Branch. A copy of the form is also available in the TVFC toolkit. To request a VAERS form or additional information, call the VAERS contact in your area:
- In Texas: 800.252.9152
- For Bexar County: 210.207.2087
- For City of Houston: 713.558.3518
8) Additional Resources
We hope you generously forward this advisory to others who may benefit from this information.
Texas Department of State Health Services Immunization Branch
P.O. Box 149347, Austin, Texas, 78714-9347. 1-800-252-9152
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