Vaccines and Preventable Diseases:
MMR & Varicella Vaccines or MMRV Vaccine: Discussing Options with Parents
On this page:
- Two Options for Protection
- MMRV Vaccine as the First Dose at Ages 12 through 47 Months - The Necessary Conversation
- Summary of Risks and Benefits
- The Risk of Febrile Seizures
- Barriers to Understanding
- MMRV Vaccine as a First Dose at Ages 48 Months and Older or as a Second Dose at Any Age
- Successful Communication about the Vaccination Options
Two Options for Protection
There are two options for protecting children who are 12 months through 12 years old against measles, mumps, rubella, and varicella: using the varicella vaccine and the trivalent measles, mumps, and rubella (MMR) vaccine or using the quadrivalent measles, mumps, rubella, and varicella (MMRV) vaccine. This means that parents and caregivers have a decision to make, and they will rely on you as their children's healthcare provider for help in making that decision.
Using the MMRV vaccine does result in one fewer injection, which may appeal to many parents. However, when used as a first dose at ages 12 through 23 months, studies have shown that this benefit comes with a tradeoff: at this age, MMRV vaccine is associated with higher risks of fever within the 42 days after vaccination and febrile seizures during the 5 to 12 days after vaccination when compared with administration of MMR and varicella vaccines at the same visit. Data are limited to this age group, but experts agree that this increased risk of fever and febrile seizures during the 5 to 12 days after MMRV vaccination likely also occurs in children aged 24 through 47 months.
MMRV Vaccine as the First Dose at Ages 12 through 47 Months - The Necessary Conversation
For the first dose of measles, mumps, rubella, and varicella vaccines given at ages 12 through 47 months, either MMR and varicella vaccines or MMRV vaccine can be used. However, if you are considering using the MMRV vaccine for a child in this age group, it is important to take the time to talk with parents or caregivers about the benefits and risks of that decision. As you know, questions or concerns about vaccines can be a source of stress for some parents during a well-child visit. As their child's healthcare provider, you remain parents' most trusted source of information about vaccines.
Summary of Risks and Benefits
Discussing whether to use the MMRV vaccine or MMR and varicella vaccines for a 12- through 47-month-old’s first vaccination centers on helping parents understand the risk/benefit tradeoff.
MMR and Varicella Vaccines (Administered at the same doctor visit) |
MMRV Vaccine |
|
|---|---|---|
| Protection against measles, mumps, rubella and varicella | Provides the same protection against the four diseases as the MMRV vaccine | Provides the same protection against the four diseases as the MMR and varicella vaccines |
| Number of shots | Two shots needed at the same doctor visit to provide protection against measles, mumps, rubella, and varicella | One shot needed to provide protection against measles, mumps, rubella, and varicella |
| Fever | Fewer children have fevers of 102⁰F or higher within 42 days of being vaccinated (about 15 out of every 100 children vaccinated) | More children have fevers of 102⁰F or higher within 42 days of being vaccinated (about 22 out of every 100 children vaccinated) |
| Febrile seizures (Seizures caused by fever) | Fewer children have febrile seizures during the 5 to12 days after vaccination (about 4 out of every 10,000 children vaccinated) | More children have febrile seizures during the 5 to12 days after vaccination (about 8 out of every 10,000 children vaccinated) |
The Risk of Febrile Seizures
About 2-5 percent of young children (i.e., between 200 and 500 per 10,000 children) will have at least one febrile seizure. Febrile seizures usually occur in children aged 6 through 60 months. The peak age for febrile seizures is 14 through 18 months, which overlaps with the ages when the first doses of measles, mumps, rubella and varicella vaccines are recommended.
Although febrile seizures generally have an excellent prognosis, witnessing this type of event can be very distressing for parents and caregivers and often results in a trip to the emergency room for the child. With this in mind, it is especially important to discuss febrile seizure risk with parents when considering using MMRV vaccine for the first dose in a child aged 12 through 47 months. A personal history of febrile seizures or a family history of either febrile seizures or epilepsy increases a child’s risk of having a febrile seizure. Children who have a personal or family (sibling or parent) history of seizures should generally be vaccinated with MMR and varicella vaccines instead of MMRV vaccine.
Barriers to Understanding
Parents and caregivers need to understand the risks and benefits of both vaccination options before the MMRV vaccine is administered for their child’s first dose of protection against measles, mumps, rubella, and varicella. If you face any barriers to clearly communicating these risks and benefits for any reason (e.g., language barriers), you should administer MMR and varicella vaccines.
MMRV Vaccine as a First Dose at Ages 48 Months and Older or as a Second Dose at Any Age
The available data from postlicensure studies do not suggest that children aged 4 through 6 years who receive MMRV vaccine have an increased risk for febrile seizures after vaccination compared with same-age children who receive MMR and varicella vaccines at the same visit. In addition, the second dose of MMRV vaccine is less likely to cause fever than the first dose.
When the first dose of measles, mumps, rubella, and varicella vaccines is administered 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 MMR and varicella vaccines. Considerations should include provider assessment (including the number of injections, vaccine availability, likelihood of improved coverage, likelihood of patient return, storage and cost), patient preference, and the potential for adverse events.
Successful Communication about the Vaccination Options
A successful discussion about vaccines involves a two-way conversation between the healthcare provider and the parent or caregiver, with both parties sharing information and asking questions. Discussing whether to use the MMR and varicella vaccines or the MMRV vaccine is a new type of conversation about comparing options. Parents may have questions and it may take time to address those questions. But your willingness to listen and answer questions will likely play a major role in helping parents to make an informed decision, and certainly, to choose one of the vaccination options over electing not to protect their child from these four diseases.
Content last reviewed on October 20, 2009
Content Source: National Center for Immunization and Respiratory Diseases