Document text
MMRV
MMRV = One combined shot for Measles, Mumps,
Rubella and Varicella
alternative to
MMR+V = Two shots, one for Measles, Mumps and
Rubella and another for Varicella
No known difference in efficacy
MMRV Timeline
2005: FDA licensed the combined MMRV
vaccine for use in children 12 months to 12
years of age.
2006: The CDC Advisory Committee on
Immunization Practices recommended use of
MMRV, with preference over separate MMR
and Varicella vaccines.
Weekly Safety Surveillance
CDC’s Vaccine Safety Datalink Rapid Cycle
Analysis
Weekly Data from Electronic Health Records
First MMRV dose, at age 12 -23 months
2007: Signal for an excess number of febrile
seizures after ~26,000 doses
Seizure Signal
For 12 -23 month olds,
seizure signal on February
11, 2007.
Cumulative doses at that
time: 25,779
Observed Expected Relative
RiskLLR (critical
value)
Number
Seizures 59 38 1.57 5.17 (4.12)
Note: No seizure risk after second dose at age 4 -6 years old
Postvaccination seizures among 12 - to 23 -month -olds according
to vaccine received: VSD study population, 2000 –2008.
Risk for Febrile Seizures after
MMRV Compared to MMR+V
Also excess in post -vaccination fever
MMRV Working Group Vote
Four Options for the Vote, ages 12 -47 months:
1.Both recommended, Preference for MMRV
2.Both recommended, Equal preference
3.Both recommended, Preference for MMR+V
4.Only recommend MMR+V1. Zero votes
2. Minority
3. Majority
4. One vote
2009
ACIP Vote
Four Options for the Vote, ages 12 -47 months:
1.Both recommended, Preference for MMRV
2.Both recommended, Equal preference
3.Recommend both, Preference for MMR+V
4.Only recommend MMR+V1. Zero votes
2. Majority
3. Minority
4. Zero votesJune 2009
CDC 2009 Recommendation
ACIP is only advisory. CDC decided:
-Either MMRV or MMR+V may be
administered
-For dose 1 in children age 12 -47 months,
preference for MMR+V
Summary
-No known difference in efficacy between
MMRV and MMR+V
-After first dose for children at ages 12 -23
months, more febrile seizures after MMRV
than MMR+V, ~ 1 per 2,300 doses
-After second dose at ages 4 -6 years, no
excess risk for febrile seizures
Proposed Recommendation
As there exist a safer equally effective
alternative, the MMRV vaccine should
not be administered to children under
the age of 47 months.