MMRV Vaccine (ProQuad) is a live attenuated vaccine that provides active immunity against diseases caused by measles virus, mumps virus, rubella, and varicella viruses. Thus, it prevents measles, mumps, rubella, and chickenpox. These are the most common viral borne diseases that primarily involve the respiratory tract and skin.

Uses:

• Measles, mumps, rubella, and varicella vaccination:

  • The first dose is administered between 12 and 15 months, while the second dose is administered between 4 and 6 years of age.
  • Children between the ages of 12 and 47 months can receive their first dose of the MMRV combination vaccine or separate doses of the MMR and varicella vaccinations.
  • For active vaccination against measles, mumps, rubella, and varicella in children between the ages of 12 months and 12 years.
  • The Advisory Committee on Immunization Practices recommends that healthy children receive routine measles, mumps, rubella, and varicella vaccinations (ACIP).The first dose is administered between 12 and 15 months, while the second dose is administered between 4 and 6 years of age.
  • Children between the ages of 12 and 47 months can receive their first dose of the MMRV combination vaccine or separate doses of the MMR and varicella vaccinations.
  • For active vaccination against measles, mumps, rubella, and varicella in children between the ages of 12 months and 12 years.
  • The Advisory Committee on Immunization Practices recommends that healthy children receive routine measles, mumps, rubella, and varicella vaccinations (ACIP).
  • The ACIP advises immunisation with individual MMR and varicella vaccinations rather than the MMRV combination vaccine in cases of personal or family history of seizures.
  • The ACIP advises administering the MMR and varicella vaccines separately as the first dose in this age range unless the parent or caregiver expressly wants the MMRV combination vaccination. For children receiving their first dose at or after the age of 48 months or their second dose at any age, MMRV is preferred.The ACIP advises administering the MMR and varicella vaccines separately as the first dose in this age range unless the parent or caregiver expressly wants the MMRV combination vaccination. For children receiving their first dose at or after the age of 48 months or their second dose at any age, MMRV is preferred.
  • Canadian labeling (not in US labeling):
    • The MMRV combination vaccine is authorised for use in healthy children and consists of either the live-attenuated MMR vaccine or the live-attenuated varicella [OKA-strain] vaccine (Priorix-Tetra: 9 months to 6 years; ProQuad: 12 months to 6 years). Based on prior experience with such vaccines, it may also be used in healthy children under the age of 12.The MMRV combination vaccine is authorised for use in healthy children and consists of either the live-attenuated MMR vaccine or the live-attenuated varicella [OKA-strain] vaccine (Priorix-Tetra: 9 months to 6 years; ProQuad: 12 months to 6 years). Based on prior experience with such vaccines, it may also be used in healthy children under the age of 12.

Use in Adults:

Not indicated.

Dose in Children:

Note:

• The ACIP recognises that dosages given four days prior to the minimum interval or age are acceptable; however, local or state laws may supersede this time frame.
• Consult the National Advisory Committee on Immunization (NACI) recommendations or the CDC/ACIP annual immunisation schedules for more details, including precise, thorough recommendations for catch-up scenarios and/or the management of patients with high-risk conditions (Canada).

Dose for Primary immunization:

• Children 12 months to 12 years:

  • ProQuad:
    • SubQ: Each dosage is 0.5 mL.
    • The first dose is often administered between the ages of 12 and 15 months.
    • If necessary, the second dose may be administered earlier than 4 years old as long as three months have passed since the first dose. The second dosage is given between the ages of 4 and 6 years old.
    • Measles, mumps, rubella, and varicella require two doses of each of their individual vaccinations, given either together (MMRV-ProQuad) or separately (MMR and varicella).

• CDC (ACIP) recommendations:

  • For children receiving their first dose at or after the age of 48 months or their second dose at any age, MMRV is preferred.
  • Children receiving their first dose between the ages of 12 and 47 months can receive the MMRV combination vaccine or separate
  • MMR and varicella vaccines, but the ACIP prefers the use of separate MMR and varicella vaccines as the first dose in this age group unless the parent or caregiver requests the MMRV combination.
  • Before administering ProQuad, at least one month must elapse after receiving a dose of a vaccine that contains measles, such as M-M-R II.
  • When giving ProQuad after receiving a varicella-containing vaccination (such as Varivax), at least 3 months should pass.
  • The ACIP advises giving the MMR and varicella vaccinations separately to children who have a personal or family history of seizures.

• Canadian labeling:

  • ProQuad: Children 12 months to 6 years:

    • SubQ: 0.5 mL each dosage; two doses given at least four weeks apart; suitable for use in kids up to the age of twelve.

  • Priorix-Tetra: Infants ≥9 months and Children ≤6 years:

    • 2 doses must be spaced at least four to six weeks apart.
    • 0.5 mL each dosage, subQ or IM
    • The shortest time between dosages is four weeks.

Pregnancy Risk Category: X

• Not suggested for pregnant women. Avoid becoming pregnant for three months after receiving an immunisation (per manufacturer labeling).
• For more details, consult the monographs for the vaccines against the varicella virus and the measles, mumps, and rubella viruses.

Measles, mumps, rubella, and varicella virus vaccine use during breastfeeding:

• The vaccine's rubella component may seep into breast milk.
• The presence of varicella, measles, or mumps vaccination components in breast milk is unknown.
• Immunizations are not incompatible with breastfeeding.
• The option to continue nursing after immunisation or to stop relies on the risk of baby exposure, the advantages of breastfeeding for the child, and the advantages of vaccination for the mother, claims the manufacturer.
• Infants who are being breastfed should receive their recommended schedule of vaccinations.
• Consult the monographs for the immunizations against varicella and measles, mumps, and rubella for more information.

Dose in Renal Disease:

The manufacturer does not offer dose modifications.

Dose in Hepatic disease:

The manufacturer does not offer dose modifications.

For information on other side effects associated with those medications, consult the product monographs for the Measles, Mumps, and Rubella Vaccine (M-M-R II) and the Varicella Virus Vaccine (Varivax).

Common Side Effects:

• Miscellaneous:

  • Fever

• Local:

  • Tenderness at the injection site
  • Swelling at the injection site
  • Pain at the injection site Erythema at the injection site
  • Local soreness/soreness at the injection site

Less Common Side Effects:

• Respiratory:

  • Upper Respiratory Tract Infection
  • Rhinorrhea

• Central Nervous System:

  • Irritability
  • Drowsiness

• Gastrointestinal:

  • Vomiting
  • Diarrhea

• Dermatologic:

  • Vesicular Eruption
  • Injection Site Pruritus
  • Viral Exanthem
  • Varicella-Like Rash
  • Rash At Injection Site
  • Skin Rash
  • Morbilliform Rash
  • Rubella-Like Rash

• Local:

  • Bruising At Injection Site

Contraindications:

US labeling:

• Hypersensitivity to the vaccine, shots for measles, mumps, rubella, and/or varicella, as well as any ingredients used in the vaccine's preparation, including gelatin.
• Immunosuppressive treatment patients (including high-dose systemic corticosteroids).
• untreated active tuberculosis.
• fever over 38.5°C (101.3°F) due to a present febrile illness
• pregnancy
• There is a history of adverse reactions to neomycin in blood dyscrasias, leukaemia, lymphomas, or other malignant neoplasms affecting the lymphatic or bone marrow systems.
• Immune deficiencies that can be acquired or congenital (including AIDs or symptomatic HIV; cellular immune deficiencies; hypogammaglobulinemia and dysgammaglobulinemic states).
• family members with hereditary or congenital immunodeficiency (until immune competence in the vaccine recipient is demonstrated).

Canadian labeling:

• Priorix-Tetra:
  • Pregnancy, severe humoral or cellular (primary or acquired) immunodeficiency, hypersensitivity to this immunisation, vaccines containing varicella, measles, mumps, rubella, or any of their components, including neomycin, are all contraindications.

Warnings and Precautions

• Anaphylactoid and hypersensitivity reactions:

  • For anaphylactoid and/or hypersensitivity reactions, rapid medical aid, including epinephrine 1 mg/mL, must be given throughout the vaccination process.

• CNS infection:

  • Incidences of encephalitis or meningitis brought on by the varicella virus vaccine strain have been reported in immunocompetent individuals months to years after vaccination, despite not being linked to the MMRV combination vaccine.
  • Cases frequently involve an existing or recent herpes zoster rash.

• Febrile seizures:

  • In comparison to the individual administration of MMR and varicella, the use of the combination product (MMRV) has been linked to a higher incidence of febrile seizures in children between the ages of 12 and 23 months.
  • The advantages and hazards of each choice should be explained to parents and other caregivers.The ACIP advises against administering the MMRV combination vaccination to children who have had seizures in the past or who have a personal or family history of seizures.
  • Children receiving their first dose between the ages of 12 and 47 months may receive the MMRV combination vaccine or individual doses of the MMR and varicella vaccinations. Because it is uncommon for children to develop their first febrile seizure after the age of four, the ACIP recommends utilising the combination MMRV vaccine for children receiving their first dose at 48 months or their second dose at any age.
  • In this age group, the ACIP recommends to provide the MMR and varicella vaccines separately as the first dose unless the parent or caregiver specifically requests the MMRV combination.

• Syncope:

  • A significant secondary injury (such as a skull fracture or cerebral haemorrhage) has been linked to the administration of injectable vaccinations, and syncope has been known to occur within 15 minutes of immunisation. This condition is frequently described in teenagers and young adults.
  • In the event of syncope, precautions should be taken to prevent injuries from falling and to restore cerebral circulation.

• Acute illness:

  • on the basis of severity of symptoms and the underlying cause of the illness, it is decided whether to provide or postpone vaccination in cases of recent or ongoing febrile illness.
  • Individuals with moderate to severe acute illnesses should have their vaccinations postponed; patients with mild acute illnesses shouldn't have their vaccinations delayed (with or without fever).
  • Fever greater than 38.5°C (101.3°F) is a contraindication.

• CNS disorders:

  • Patients who have had seizures, cerebral damage, or other circumstances where stress brought on by fever should be avoided, should be used with caution.
  • Children with a personal or family history of seizures should receive individual MMR and varicella immunizations rather than the MMRV combination vaccine.

• HIV:

  • In individuals with HIV infection, the combination vaccine's effectiveness and safety have not been shown.
  • In individuals with AIDS or symptomatic HIV, use is contraindicated.

• Thrombocytopenia:

  • Use with caution in individuals with thrombocytopenia who already have it as well as in those who develop it after getting the first dose; the condition could get worse.

• Tuberculosis:

  • Patients with active, untreated TB should postpone immunisation.
  • Individuals with active, untreated TB should not use this medication.

Monitoring parameters:

• Rash
• Fever
• 15 minutes after treatment, keep an eye out for syncope and anaphylaxis.
• If seizure-like behaviour linked with syncope manifests, keep the patient in a supine or Trendelenburg position to maintain proper cerebral perfusion.

How to administer?

Parenteral:

• Note:
  • The attenuated viruses in the vaccination may become inactive if you apply disinfectants like alcohol.
  • Before administering, give the disinfectant enough time to evaporate off the skin.
  • Use distinct needles and syringes for each injection; do not combine them with other injections or immunizations.
  • Adolescents and adults should receive their vaccinations while sitting or laying down to prevent syncope-related injuries.

SubQ:

• 30 minutes after reconstitution, give.
• The anterolateral side of the thigh or the deltoid region of the arm should receive the drug subcutaneously.

NOT for IV administration

Canadian labeling:

• Priorix-Terta [Canadian product]:
  • Only for SubQ or IM injection; place needle in deltoid area of upper arm.
    IM injections shouldn't be given to people who have bleeding issues.

Mechanism of action:

Active immunity against illnesses brought on by the measles, mumps, rubella, and varicella-zoster viruses is provided by a live, attenuated virus vaccination.

Duration of action:

• In the majority of healthy patients, antibody levels last for at least ten years.

The onset of action:

• In healthy children aged 12 to 23 months, the antibody response rate was between 91% and 99% six weeks after receiving a single dose of the vaccine.
• Children under the age of three received a second dosage, and the reported antibody response rate ranged from 98% to 99%.

International Brand Names 

• ProQuad
• Priorix-Tetra

Brand Names in Pakistan:

It is provided by WHO to the designated centers.