MMRV vaccine

Last updated

MMRV vaccine
Combination of
Measles vaccine Vaccine
Mumps vaccine Vaccine
Rubella vaccine Vaccine
Varicella vaccine Vaccine
Clinical data
Trade names Proquad, Priorix Tetra
Other namesMeasles, Mumps, Rubella, and Varicella Virus Vaccine Live
AHFS/Drugs.com Monograph
License data
Pregnancy
category
Routes of
administration
Subcutaneous, intramuscular
ATC code
Legal status
Legal status
Identifiers
CAS Number
ChemSpider
  • none
 X mark.svgNYes check.svgY  (what is this?)    (verify)

The MMRV vaccine is a combination vaccine which combines the attenuated virus measles, mumps, rubella (German measles), and varicella (chickenpox). The MMRV vaccine has similar immunogenicity and overall safety profiles to the MMR vaccine administered with or without the varicella vaccine. The MMRV vaccine is typically given to children between one and two years of age. [8]

Contents

Several companies supply MMRV vaccines. 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 [9] [10] by GlaxoSmithKline has been approved in Germany and Australia. [11] [12] [13]

Recommendations

The MMRV vaccine, a combined MMR and varicella vaccine, simplifies administration of the vaccines. [14] 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. [15] [16]

Adverse events

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. [17]

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. [17] 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 Proquad compared to the separate administration of MMR and Varicella vaccines. [18] [19]

Proquad was approved for medical use in the United States in September 2005, [20] [21] in the European Union in April 2006, [7] in Australia in February 2007, [2] and in Canada in May 2014. [4]

Priorix Tetra was approved for medical use in Australia in November 2005, [3] and in Canada in June 2008. [5]

Related Research Articles

<span class="mw-page-title-main">Measles</span> Viral disease affecting humans

Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.

<span class="mw-page-title-main">Mumps</span> Human disease caused by paramyxovirus

Mumps is a highly contagious viral disease caused by the mumps virus. Initial symptoms of mumps are non-specific and include fever, headache, malaise, muscle pain, and loss of appetite. These symptoms are usually followed by painful swelling around the side of the face, which is the most common symptom of a mumps infection. Symptoms typically occur 16 to 18 days after exposure to the virus. About one third of people with a mumps infection do not have any symptoms (asymptomatic).

<span class="mw-page-title-main">MMR vaccine</span> Combined vaccine against measles, mumps, and rubella

The MMR vaccine is a vaccine against measles, mumps, and rubella, abbreviated as MMR. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses. After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella. The vaccine is also recommended for those who do not have evidence of immunity, those with well-controlled HIV/AIDS, and within 72 hours of exposure to measles among those who are incompletely immunized. It is given by injection.

<span class="mw-page-title-main">Rubella</span> Human viral disease

Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and last for three days. It usually starts on the face and spreads to the rest of the body. The rash is sometimes itchy and is not as bright as that of measles. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. Joint pain is common in adults. Complications may include bleeding problems, testicular swelling, encephalitis, and inflammation of nerves. Infection during early pregnancy may result in a miscarriage or a child born with congenital rubella syndrome (CRS). Symptoms of CRS manifest as problems with the eyes such as cataracts, deafness, as well as affecting the heart and brain. Problems are rare after the 20th week of pregnancy.

<span class="mw-page-title-main">DPT vaccine</span> Combination vaccine

The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis, and tetanus (lockjaw). The vaccine components include diphtheria and tetanus toxoids, and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The term toxoid refers to vaccines which use an inactivated toxin produced by the pathogen which they are targeted against to generate an immune response. In this way, the toxoid vaccine generates an immune response which is targeted against the toxin which is produced by the pathogen and causes disease, rather than a vaccine which is targeted against the pathogen itself. The whole cells or antigens will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" stands for "acellular". In comparison to alternative vaccine types, such as live attenuated vaccines, the DTP vaccine does not contain any live pathogen, but rather uses inactivated toxoid to generate an immune response; therefore, there is not a risk of use in populations that are immune compromised since there is not any known risk of causing the disease itself. As a result, the DTP vaccine is considered a safe vaccine to use in anyone and it generates a much more targeted immune response specific for the pathogen of interest.

<span class="mw-page-title-main">Vaccine hesitancy</span> Reluctance or refusal to be vaccinated or have ones children vaccinated

Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. Although adverse effects associated with vaccines are occasionally observed, the scientific consensus that vaccines are generally safe and effective is overwhelming. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. Therefore, the World Health Organization characterizes vaccine hesitancy as one of the top ten global health threats.

<span class="mw-page-title-main">Vaccination schedule</span> Series of vaccinations

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen. Vaccines go through multiple phases of trials to ensure safety and effectiveness.

<span class="mw-page-title-main">Childhood immunizations in the United States</span>

The schedule for childhood immunizations in the United States is published by the Centers for Disease Control and Prevention (CDC). The vaccination schedule is broken down by age: birth to six years of age, seven to eighteen, and adults nineteen and older. Childhood immunizations are key in preventing diseases with epidemic potential.

<span class="mw-page-title-main">Mumps vaccine</span> Vaccine which prevents mumps

Mumps vaccines are vaccines which prevent mumps. When given to a majority of the population they decrease complications at the population level. Effectiveness when 90% of a population is vaccinated is estimated at 85%. Two doses are required for long term prevention. The initial dose is recommended between 12 and 18 months of age. The second dose is then typically given between two years and six years of age. Usage after exposure in those not already immune may be useful.

A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen. Breakthrough infections have been identified in individuals immunized against a variety of diseases including mumps, varicella (Chickenpox), influenza, and COVID-19. The characteristics of the breakthrough infection are dependent on the virus itself. Often, infection of the vaccinated individual results in milder symptoms and shorter duration than if the infection were contracted naturally.

<span class="mw-page-title-main">Varicella vaccine</span> Vaccine to prevent chickenpox

Varicella vaccine, also known as chickenpox vaccine, is a vaccine that protects against chickenpox. One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of disease. Vaccinating a large portion of the population also protects those who are not vaccinated. It is given by injection just under the skin. Another vaccine, known as zoster vaccine, is used to prevent diseases caused by the same virus – the varicella zoster virus.

Immunization during pregnancy is the administration of a vaccine to a pregnant individual. This may be done either to protect the individual from disease or to induce an antibody response, such that the antibodies cross the placenta and provide passive immunity to the infant after birth. In many countries, including the US, Canada, UK, Australia and New Zealand, vaccination against influenza, COVID-19 and whooping cough is routinely offered during pregnancy.

An attenuated vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable. Attenuation takes an infectious agent and alters it so that it becomes harmless or less virulent. These vaccines contrast to those produced by "killing" the pathogen.

Claims of a link between the MMR vaccine and autism have been extensively investigated and found to be false. The link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 Lancet MMR autism fraud, characterised as "perhaps the most damaging medical hoax of the last 100 years". The fraudulent research paper, authored by discredited former doctor Andrew Wakefield and published in The Lancet, falsely claimed the vaccine was linked to colitis and autism spectrum disorders. The paper was retracted in 2010 but is still cited by anti-vaccine activists.

<span class="mw-page-title-main">Chickenpox</span> Human viral disease

Chickenpox, also known as varicella, is a highly contagious, vaccine-preventable disease caused by the initial infection with varicella zoster virus (VZV), a member of the herpesvirus family. The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over. It usually starts on the chest, back, and face. It then spreads to the rest of the body. The rash and other symptoms, such as fever, tiredness, and headaches, usually last five to seven days. Complications may occasionally include pneumonia, inflammation of the brain, and bacterial skin infections. The disease is usually more severe in adults than in children.

<span class="mw-page-title-main">Measles vaccine</span> Vaccine used to prevent measles

Measles vaccine protects against becoming infected with measles. Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When the rate of vaccination within a population is greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if the rate of vaccination decreases. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to measles.

<span class="mw-page-title-main">Rubella vaccine</span> Vaccine used to prevent rubella

Rubella vaccine is a vaccine used to prevent rubella. Effectiveness begins about two weeks after a single dose and around 95% of people become immune. Countries with high rates of immunization no longer see cases of rubella or congenital rubella syndrome. When there is a low level of childhood immunization in a population it is possible for rates of congenital rubella to increase as more women make it to child-bearing age without either vaccination or exposure to the disease. Therefore, it is important for more than 80% of people to be vaccinated. By introducing rubella containing vaccines, rubella has been eradicated in 81 nations, as of mid-2020.

<span class="mw-page-title-main">Vaccines for Children Program</span>

The Vaccines for Children Program (VFC) is a federally funded program in the United States providing no-cost vaccines to children who lack health insurance or who otherwise cannot afford the cost of the vaccination. The VFC program was created by the Omnibus Budget Reconciliation Act of 1993 and is required to be a new entitlement of each state's Medicaid plan under section 1928 of the Social Security Act. The program was officially implemented in October 1994 and serves eligible children in all U.S. states, as well as the Commonwealth of Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands.

<span class="mw-page-title-main">Tetanus vaccine</span> Vaccines used to prevent tetanus

Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. During childhood, five doses are recommended, with a sixth given during adolescence.

In early months of 2019, a measles outbreak occurred in the Portland metropolitan area, including the Clark County, Washington suburbs, in the United States. At the time, the outbreak was the largest outbreak in more than two decades; outbreaks in 2019 in areas including Brooklyn and Rockland County, New York have since seen far greater numbers of cases.

References

  1. "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. 1 2 "Proquad measles mumps rubella varicella live virus vaccine injection vial with prefilled diluent syringe (126157)". Therapeutic Goods Administration (TGA). 26 May 2022. Archived from the original on 10 June 2024. Retrieved 10 June 2024.
  3. 1 2 "Priorix-Tetra vaccine 0.5mL powder for injection vial with diluent syringe (107286)". Therapeutic Goods Administration (TGA). 26 May 2022. Archived from the original on 31 January 2023. Retrieved 10 June 2024.
  4. 1 2 "Proquad Product information". Health Canada . 9 May 2014. Archived from the original on 10 June 2024. Retrieved 10 June 2024.
  5. 1 2 "Priorix Tetra Product information". Health Canada . 4 June 2008. Archived from the original on 10 June 2024. Retrieved 10 June 2024.
  6. "DailyMed - Proquad- measles, mumps, rubella and varicella virus vaccine live injection, powder, lyophilized, for suspension". Archived from the original on 6 April 2020. Retrieved 9 October 2020.
  7. 1 2 "Proquad EPAR". European Medicines Agency (EMA). 6 April 2006. Archived from the original on 21 October 2020. Retrieved 8 October 2020.
  8. Kowalzik F, Faber J, Knuf M (August 2018). "MMR and MMRV vaccines". Vaccine. Progress in Vaccines. 36 (36): 5402–5407. doi:10.1016/j.vaccine.2017.07.051. PMID   28757060.
  9. 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): 2107–2126. doi:10.2165/00003495-200363190-00012. PMID   12962524. S2CID   46973762.
  10. "GlaxoSmithKline Clinical Trial Register". GlaxoSmithKline. Archived from the original on 30 November 2007. Retrieved 19 October 2019.
  11. "Priorix-tetra". The Australian Immunisation Handbook. 4 June 2018. Archived from the original on 19 October 2019. Retrieved 18 October 2019.
  12. 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 Safety. 38 (11): 1095–1102. doi:10.1007/s40264-015-0326-4. PMC   4608986 . PMID   26251259.
  13. "PEI Table of vaccines for measles with a valid marketing authorisation". PEI , Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel (in German). 19 October 2019. Archived from the original on 19 October 2019. Retrieved 18 October 2019.
  14. Vesikari T, Sadzot-Delvaux C, Rentier B, Gershon A (July 2007). "Increasing coverage and efficiency of measles, mumps, and rubella vaccine and introducing universal varicella vaccination in Europe: a role for the combined vaccine". The Pediatric Infectious Disease Journal. 26 (7): 632–638. doi:10.1097/INF.0b013e3180616c8f. PMID   17596807. S2CID   41981427.
  15. Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP) (March 2008). "Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine" (PDF). MMWR. Morbidity and Mortality Weekly Report. 57 (10): 258–260. PMID   18340332. Archived (PDF) from the original on 19 October 2020. Retrieved 19 January 2021.
  16. Marin M, Broder KR, Temte JL, Snider DE, Seward JF (May 2010). "Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP)" (PDF). MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports. 59 (RR-3): 1–12. PMID   20448530. Archived (PDF) from the original on 16 March 2023. Retrieved 10 June 2024.
  17. 1 2 "MMRV (Measles, Mumps, Rubella & Varicella) VIS". CDC. 21 May 2010. Archived from the original on 20 January 2015.
  18. Klein NP, Fireman B, Yih WK, Lewis E, Kulldorff M, Ray P, et al. (July 2010). "Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures". Pediatrics. 126 (1): e1–e8. doi: 10.1542/peds.2010-0665 . PMID   20587679.
  19. "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 16 December 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.

Further reading