Version May 2024
Note: Consult CDC/ACIP annual immunization schedules or National Advisory Committee on Immunization (NACI) guidelines (Canada) for additional information, including specific detailed recommendations for catch-up scenarios and/or care of patients with high-risk conditions. According to ACIP, doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (ACIP [Kroger 2023]).
Primary immunization: Children 12 months to 12 years: ProQuad: IM, SUBQ: ~0.5 mL (entire contents of reconstituted vial) per dose. A complete immunization series for measles, mumps, rubella, and varicella requires 2 doses of all components, administered as either the combination product (MMRV [ProQuad]) or as separate MMR and varicella vaccines. The first dose is usually administered at 12 to 15 months of age. The second dose is administered at 4 to 6 years of age; second dose may be administered before age 4 if needed, as long as ≥3 months have elapsed since the first dose.
ACIP recommendations: For children receiving their first dose at 12 to 47 months of age, either the MMRV combination vaccine or separate MMR and varicella vaccines can be used; however, the ACIP prefers administration of separate MMR and varicella vaccines as the first dose in this age group unless the parent or caregiver expresses preference for the MMRV combination. For children receiving the first dose at ≥48 months or their second dose at any age, use of MMRV is preferred. The ACIP recommends that children with a personal or family history of seizures be vaccinated with separate MMR and varicella vaccines, as opposed to the MMRV combination vaccine (CDC/ACIP [Marin 2010]).
Allow at least 1 month between administering a dose of a measles-containing vaccine (eg, M-M-R II) and ProQuad.
Allow at least 3 months between administering a varicella-containing vaccine (eg, Varivax) and ProQuad.
Canadian labeling:
Priorix-Tetra: Infants ≥9 months and Children: SUBQ or IM: 0.5 mL per dose; 2 doses administered 6 weeks apart (minimum interval between doses: 4 weeks).
ProQuad: Children: SUBQ: 0.5 mL per dose; 2 doses administered ≥4 weeks apart.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Also refer to Measles, Mumps, and Rubella Vaccine (M-M-R II) and Varicella Virus Vaccine (Varivax) monographs for additional adverse reactions reported with those agents.
>10%:
Local: Erythema at injection site (11% to 24%), local soreness/soreness at injection site (≤22%), pain at injection site (≤41%), swelling at injection site (8% to 16%), tenderness at injection site (≤22%)
Miscellaneous: Fever (≥38.9°C [≥102°F]: 3% to 22%)
1% to 10%:
Dermatologic: Morbilliform rash (≤4%), rubella-like rash (≤4%), skin rash (≤2%), varicella-like rash (≤2%), vesicular eruption (≤2%), viral exanthem (1%)
Gastrointestinal: Diarrhea (≤1%)
Local: Bruising at injection site (1% to 2%, including ecchymoses and injection site injury), injection-site pruritus (1%), rash at injection site (2%)
Nervous system: Irritability (1% to 7%)
Respiratory: Cough (1%), rhinorrhea (≤1%), upper respiratory tract infection (1%)
<1%:
Gastrointestinal: Vomiting
Infection: Herpes zoster infection
Nervous system: Febrile seizure, headache
Respiratory: Nasopharyngitis
Postmarketing:
Cardiovascular: Peripheral edema, syncope
Dermatologic: Cellulitis, erythema multiforme, impetigo, pruritus, skin infection, skin sclerosis, Stevens-Johnson syndrome
Gastrointestinal: Abdominal pain, hematochezia, oral mucosa ulcer, parotitis, sore throat
Genitourinary: Epididymitis, orchitis
Hematologic & oncologic: Aplastic anemia, Henoch-Schönlein purpura, lymphadenitis, lymphadenopathy (regional), neonatal hemorrhage (acute hemorrhagic edema of infancy), purpuric disease, thrombocytopenia
Hypersensitivity: Anaphylaxis, angioedema, facial edema, nonimmune anaphylaxis
Infection: Atypical measles, candidiasis, herpes simplex infection, infection, influenza, measles, measles inclusion body encephalitis, varicella infection - chickenpox (vaccine strain)
Local: Bleeding at injection site, inflammation at injection site, postinjection flare, urticaria at injection site, warm sensation at injection site (including warm to touch)
Nervous system: Acute disseminated encephalomyelitis, agitation, apathy, aseptic meningitis, ataxia, Bell palsy, cerebrovascular accident, dizziness, encephalitis, encephalopathy, Guillain-Barré syndrome, hypersomnia, meningitis, nervousness, paresthesia, polyneuropathy, retrobulbar neuritis, seizure, subacute sclerosing panencephalitis, transverse myelitis, tremor
Neuromuscular: Arthralgia, arthralgia of hip, arthritis, lower extremity pain, musculoskeletal pain, myalgia, neck pain, panniculitis, stiffness (at injection site)
Ophthalmic: Eye irritation, eyelid edema, necrotizing retinitis, optic nerve palsy, optic neuritis, retinitis
Otic: Otalgia, sensorineural hearing loss
Respiratory: Bronchitis, bronchospasm, epistaxis, pneumonia, pneumonitis, pulmonary congestion, respiratory tract infection, rhinitis, sinusitis, wheezing
Hypersensitivity to this vaccine; measles-, mumps-, rubella-, and/or varicella-containing vaccines; or any component of the formulation, including gelatin; history of anaphylaxis to neomycin; immunodeficiency or immunosuppression due to disease or medical therapy; untreated tuberculosis (TB) disease (active TB); current febrile illness with fever >38.5°C (>101.3°F); pregnancy (or planning to become pregnant in the next 3 months).
Canadian labeling: Additional contraindications (not in US labeling): ProQuad: Blood dyscrasias, leukemia, lymphomas of any type, or other malignancies affecting the bone marrow or lymphatic system; family history of congenital or hereditary immunodeficiency (unless immune competence of vaccine recipient is demonstrated).
Concerns related to adverse effects:
• Anaphylactoid/hypersensitivity reactions: Immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use (ACIP [Kroger 2023]).
• CNS infection: Although not reported with the combination product MMRV, cases of encephalitis or meningitis caused by vaccine strain varicella virus have been reported in immunocompetent individuals previously vaccinated with varicella virus vaccine months to years after vaccination. Cases are often associated with preceding or concurrent herpes zoster rash.
• Febrile seizures: Children 12 to 23 months of age have been reported to have a higher risk of developing febrile seizures with the use of the combination product (MMRV) compared to administration of MMR and varicella separately. Because it is uncommon for a child to have their first febrile seizure after 4 years of age, the ACIP recommends the use of the combination MMRV vaccine for children receiving their first dose at ≥48 months or their second dose at any age. The ACIP recommends that children with a personal or family history of seizures be vaccinated with separate MMR and varicella vaccines, as opposed to the MMRV combination vaccine. For children receiving their first dose at 12 to 47 months of age, either the MMRV combination vaccine or separate MMR and varicella vaccines can be used. The ACIP prefers administration of separate MMR and varicella vaccines as the first dose in this age group unless the parent or caregiver expresses preference for the MMRV combination. Parents and caregivers should be provided with the benefits and risks of both options (CDC/ACIP [Marin 2010]).
• Shoulder injury related to vaccine administration: Vaccine administration that is too high on the upper arm may cause shoulder injury (eg, shoulder bursitis, tendinopathy) resulting in shoulder pain and reduced range of motion following injection. Use proper injection technique for vaccines administered in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
• Syncope: Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in adolescents and young adults and within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs (ACIP [Kroger 2023]).
Disease-related concerns:
• Acute illness: The decision to administer or delay vaccination because of current or recent febrile illness depends on the severity of symptoms and the etiology of the disease. Defer administration in patients with moderate or severe acute illness (with or without fever); vaccination should not be delayed for patients with mild acute illness (with or without fever) (ACIP [Kroger 2023]). Use is contraindicated with fever >38.5°C (>101.3°F).
• CNS disorders: Use with caution in patients with history of cerebral injury, seizures, or other conditions where stress due to fever should be avoided. Children with a personal or family history of seizures should be vaccinated with separate MMR and varicella vaccines, as opposed to the MMRV combination vaccine (CDC/ACIP [Marin 2010]).
• Immunodeficiency: Defer use in patients with family history of congenital or hereditary immunodeficiency until patient determined to be immunocompetent. In patients with HIV, refer to ACIP guidelines for age-specific CD4 counts when patients may be considered for varicella vaccination. Use is contraindicated in patients with HIV infection who are severely immunocompromised (CDC/ACIP [Marin 2007]; CDC/ACIP [McLean 2013]).
• Thrombocytopenia: Transient thrombocytopenia may occur within 4 to 6 weeks following vaccination; use with caution in patients with thrombocytopenia and/or in those who experienced thrombocytopenia after a previous dose of measles, mumps, and rubella-containing vaccine; evaluate risks and benefits prior to use.
Concurrent drug therapy issues:
• Immune globulins: Recent administration of immune globulins may interfere with immune response. Guidelines with suggested administration intervals are available (ACIP [Kroger 2023]).
• Salicylates: Avoid use of salicylates for 6 weeks following vaccination; varicella may increase the risk of Reye syndrome.
• Vaccines: In order to maximize vaccination rates, the ACIP recommends simultaneous administration (ie, >1 vaccine on the same day at different anatomic sites) of all age-appropriate vaccines (live or non-live) for which a person is eligible at a single visit, unless contraindications exist. The use of combination vaccines is generally preferred over separate injections, taking into consideration provider assessment, patient preference, and potential adverse events. When using combination vaccines, the minimum age for administration is the oldest minimum age for any individual component; the minimum interval between dosing is the greatest minimum interval between any individual components. The ACIP prefers each dose of a specific vaccine in a series come from the same manufacturer when possible (ACIP [Kroger 2023]).
Special populations:
• Altered immunocompetence: Use is contraindicated in patients with immunosuppression, including those receiving immunosuppressive therapy (including high-dose systemic corticosteroids). In general, live vaccines should be administered ≥4 weeks prior to planned immunosuppression and avoided within 2 weeks of immunosuppression when feasible; live vaccines should not be administered for at least 3 months after immunosuppressive therapy (ACIP [Kroger 2023]; IDSA [Rubin 2014]).
Dosage form specific issues:
• Albumin: Some products may contain albumin; products containing human albumin may carry a remote risk of viral transmission, including a theoretical risk of Creutzfeldt-Jakob disease transmission.
• Egg allergy: Vaccine contains trace amounts of chick embryo antigen. Use caution in patients with history of immediate hypersensitivity/anaphylactic reactions following egg ingestion. Generally, the vaccine can be safely administered to persons with an egg allergy (ACIP [Kroger 2023]).
• Gelatin: Some products may contain gelatin. Use is contraindicated in patients with a history of anaphylactic/anaphylactoid reaction to gelatin.
• Neomycin: Some products may contain neomycin. Use is contraindicated in patients with history of anaphylactic/anaphylactoid reactions to neomycin. Contact dermatitis due to neomycin is not a contraindication to the vaccine.
Other warnings/precautions:
• Antipyretics: Antipyretics have not been shown to prevent febrile seizures; antipyretics may be used to treat fever or discomfort following vaccination (ACIP [Kroger 2023]). One study reported that routine prophylactic administration of acetaminophen prior to vaccination to prevent fever decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Prymula 2009).
• Appropriate use: The safety and efficacy of this combination vaccine has not been established for postexposure prophylaxis.
• Blood products: Recent administration of blood or blood products may interfere with immune response. Guidelines with suggested administration intervals are available (ACIP [Kroger 2023]).
• Effective immunity: Vaccination may not result in effective immunity in all patients. Response depends upon multiple factors (eg, type of vaccine, age of patient) and may be improved by administering the vaccine at the recommended dose, route, and interval. Vaccines may not be effective if administered during periods of altered immune competence (ACIP [Kroger 2023]).
• Transmission of virus: Transmission of varicella vaccine virus resulting in varicella infection may rarely occur between vaccine recipients (with or without varicella-like rash) and contacts susceptible to varicella (including healthy and high-risk individuals). Vaccinated individuals should not have close association with susceptible high-risk individuals for up to 6 weeks following vaccination. High-risk individuals susceptible to the varicella virus include immunocompromised persons, pregnant persons without evidence of immunity to varicella, newborns of mothers without evidence of varicella immunity, and infants born <28 weeks' gestation (regardless of maternal immunity).
MMR and MMRV vaccines are both associated with febrile seizures, which may occur during the first 2 weeks following vaccination. Based on preliminary information, fever ≥102°F occurs more often with MMRV (21.5%) compared to separate MMR and varicella vaccines (14.9%) in children 12 to 23 months of age. Measles-like rash also occurs more often with MMRV (3%) than with separate MMR and varicella vaccines (2.1%) in this age group. Most cases resolve spontaneously. The risk of febrile seizures may be increased 2-fold in children receiving MMRV at age 12 to 23 months in comparison to separate MMR and varicella vaccines (risk is highest 5 to 12 days after first dose). This is not observed in older children (≥47 months of age). Immunization with either MMRV or separate MMR and varicella vaccines offers equivalent immunity with the first dose. Using the combination vaccine provides the child with one less injection. Parents and/or caregivers should be provided with information related to the benefits and risks of both options. The ACIP prefers administration of separate MMR and varicella vaccines as the first dose in this age group unless the parent or caregiver expresses preference for the MMRV combination. Children with a personal or family history of seizures should be vaccinated with separate MMR and varicella vaccines, as opposed to the MMRV combination vaccine (CDC/ACIP [Marin 2010]). Results from a larger study confirm that children who were 12 to 23 months of age when receiving their first dose of MMRV vaccine were at an increased risk of fevers and seizures within 7 to 10 days after vaccination. Health care visits for fever and seizures were associated with both MMRV and separate MMR and varicella vaccines; however, the relative risk for seizures following vaccination was most significant with the MMRV vaccine. Seizures occurred most often 8 to 10 days following MMRV vaccination (RR 7.6, P<0.0001), 7 to 10 days following separate MMR and varicella vaccination (RR 4, P<0.0001), and 7 to 11 days following MMR vaccination (RR 3.7, P<0.0001); no peak in seizures was observed following varicella vaccine alone. Health care visits due to fever also clustered between 7 to 10 days after vaccination with any measles-containing vaccine (MMRV RR 6.1, MMR and varicella RR 4.4, MMR RR 4.3). Following a chart review for verification of seizure type, the rate of febrile seizures was 87% following both MMRV and separate MMR and varicella vaccine administration (Klein 2010).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, powder for reconstitution [preservative free]:
ProQuad: Measles virus ≥3.00 log10 TCID50, mumps virus ≥4.3 log10 TCID50, rubella virus ≥3.00 log10 TCID50, and varicella virus ≥3.99 log10 PFU [contains albumin (human), bovine serum, chicken egg protein, gelatin, neomycin, sorbitol, and sucrose (≤21 mg/vial)] [DSC]
ProQuad: Measles virus ≥3.00 log10 TCID50, mumps virus ≥4.3 log10 TCID50, rubella virus ≥3.00 log10 TCID50, and varicella virus ≥3.99 log10 PFU [contains recombinant albumin (human), bovine serum, chicken egg protein, gelatin, neomycin, sorbitol, and sucrose (≤21 mg/vial)]
No
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, powder for reconstitution [preservative free]:
Priorix-Tetra (CAN): Measles virus ≥3.00 log10 CCID50, mumps virus ≥4.4 log10 CCID50, rubella virus ≥3.00 log10 CCID50, and varicella virus ≥3.3 log10 PFU [contains chicken egg protein, neomycin, sorbitol, and lactose]
ProQuad (CAN): Measles virus ≥3.00 log10 TCID50, mumps virus ≥4.3 log10 TCID50, rubella virus ≥3.00 log10 TCID50, and varicella virus ≥3.99 log10 PFU [contains hydrolyzed gelatin, urea, sorbitol, monosodium L-glutamate, recombinant human albumin, neomycin, bovine serum albumin, and MRC-5 cell residuals]
Parenteral: Note: Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope-related injuries, adolescents should be vaccinated while seated or lying down (ACIP [Kroger 2023]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.
IM, SUBQ: Administer within 30 minutes of reconstitution. Administer SUBQ over the anterolateral thigh or into the upper arm over the triceps area, or administer IM into the anterolateral aspect of the thigh or the outer aspect of the upper arm (ACIP [Kroger 2023]; manufacturer's labeling).
Canadian labeling:
Priorix-Tetra: For SUBQ or IM injection only; inject in the deltoid region of upper arm. Do not administer by IM injection in patients with bleeding disorders.
ProQuad: For SUBQ administration only; do not inject intravascularly. Administer in the deltoid region of the upper arm or in the higher anterolateral area of the thigh.
Powder for injection: Before reconstitution, store the lyophilized vaccine between -50°C and -15°C (-58°F and 5°F) in a reliably maintained freezer (eg, chest, frost-free) for up to 18 months. Use of dry ice may subject the vaccine to temperatures colder than -50°C (-58°F).
May store refrigerated at 2°C to 8°C (36°F to 46°F) for up to 72 hours prior to reconstitution. Discard any vaccine stored at 2°C to 8°C (36°F to 46°F) that is not used within 72 hours of removal from -15°C (5°F) storage.
Protect the vaccine from light at all times.
Canadian products:
ProQuad: During shipment, vaccine must be maintained at a temperature between -50°C and +8°C (-58°F and 46°F). Use of dry ice may subject the vaccine to temperatures colder than -50°C. Before reconstitution, store refrigerated at a temperature of 2°C to 8°C (36°F to 46°F) or in a freezer at temperatures above -50°C (-58°F); if subsequently transferred to a refrigerator, the vaccine may be placed back in the freezer. May administered provided total (cumulative multiple excursions) time out of refrigeration (prior to reconstitution, at temperatures between 8°C and 25°C) does not exceed 14 hours. These are not, however, recommendations for storage. Protect the vaccine from light at all times.
Priorix-Tetra: Store refrigerated at 2°C to 8°C (36°F to 46°F). Do not freeze. Store in the original packaging in order to protect from light.
Reconstituted vaccine: If not used immediately, may store at room temperature for up to 30 minutes; discard reconstituted vaccine if it is not used within 30 minutes. Do not freeze reconstituted vaccine. Protect from light at all times.
Canadian products:
ProQuad: Use as soon as possible after reconstitution. Discard if not used within 30 minutes. Store reconstituted vaccine in the vaccine vial in a dark place at room temperature. Do not freeze reconstituted vaccine.
Priorix-Tetra: Administer as soon as possible. May be refrigerated (2°C to 8°C; 36°F to 46°F) for up to 8 hours.
Diluent: Store diluent separately at room temperature (20°C to 25°C [68°F to 77°F]), or in a refrigerator (2°C to 8°C [36°F to 46°F]).
In the United States, the appropriate CDC-approved Vaccine Information Statement (VIS) must be provided to the patient/caregiver before administering each dose of this vaccine; the VIS edition date and date it was provided to the patient/caregiver should be recorded as required by US law; VIS is available at http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmrv.html.
Provide active immunity to measles, mumps, rubella, and varicella viruses (FDA approved in ages 12 months to 12 years).
The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination against measles, mumps, rubella, and varicella (MMRV) in healthy children; the first dose should be given at 12 to 15 months of age and the second dose at 4 to 6 years of age. For children receiving their first dose at 12 to 47 months of age, either the MMRV combination vaccine or separate measles, mumps, and rubella (MMR) and varicella vaccines can be used. The ACIP prefers administration of separate MMR and varicella vaccines as the first dose in this age group particularly for children with a personal or family history of seizures, unless the parent or caregiver expresses preference for the MMRV combination. For children receiving the first dose at ≥48 months or their second dose at any age, use of MMRV is preferred (CDC/ACIP [Marin 2010]).
Canadian labeling: MMRV combination vaccine is indicated for active immunization against measles, mumps, rubella, and varicella (Priorix-Tetra: 9 months to 6 years; ProQuad: 12 months to 6 years); may also be used in individuals 7 to 12 years of age based upon prior experience with the separate component (live-attenuated MMR or live-attenuated varicella [OKA-strain]) vaccines.
MMRV (measles, mumps, rubella, and varicella) vaccine may be confused with MMR (measles, mumps and rubella virus) vaccine
MMRV (measles, mumps, rubella, and varicella) vaccine may be confused with MPSV (meningococcal polysaccharide vaccine; MPSV4 is the correct abbreviation)
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs that have a heightened risk of causing significant patient harm when used in error.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
5-Aminosalicylic Acid Derivatives: May enhance the adverse/toxic effect of Varicella Virus-Containing Vaccines. The primary concern is the potential development of Reye's Syndrome, a condition that has been associated with the use of salicylates in children with varicella infections. Management: Avoid administration of salicylates for at least 6 weeks after adminstration of a varicella virus-containing vaccine. Risk D: Consider therapy modification
Acetaminophen: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Anti-CD20 B-Cell Depleting Therapies: May enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Anti-CD20 B-Cell Depleting Therapies may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Corticosteroids (Systemic): May enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Dimethyl Fumarate: May enhance the adverse/toxic effect of Vaccines (Live). Specifically, Dimethyl Fumarate may increase the risk of vaccinal infection. Dimethyl Fumarate may diminish the therapeutic effect of Vaccines (Live). Management: Non-US labeling for dimethyl fumarate states that live attenuated vaccine administration is not recommended during treatment. US labeling states that safety and effectiveness of live vaccines administered with dimethyl fumarate has not been assessed. Risk C: Monitor therapy
Dupilumab: May enhance the adverse/toxic effect of Vaccines (Live). Risk X: Avoid combination
Elivaldogene Autotemcel: May enhance the adverse/toxic effect of Vaccines. Specifically, there may be a greater risk for contracting an infection from any live vaccine. Elivaldogene Autotemcel may diminish the therapeutic effect of Vaccines. Management: Administration of vaccines is not recommended in the 6 weeks before myeloablative conditioning, and until hematologic recovery after elivaldogene autotemcel treatment. Risk X: Avoid combination
Etrasimod: May enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Etrasimod may diminish the therapeutic effect of Vaccines (Live). Risk X: Avoid combination
Immune Globulins: May diminish the therapeutic effect of Vaccines (Live). Management: Live organism vaccination should be withheld for as long as 6 to 11 months following immune globulin administration. Recommendations vary by product and immune globulin dose, see full monograph for details. Risk D: Consider therapy modification
Immunosuppressants (Cytotoxic Chemotherapy): May enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Immunosuppressants (Miscellaneous Oncologic Agents): Mumps- Rubella- or Varicella-Containing Live Vaccines may enhance the adverse/toxic effect of Immunosuppressants (Miscellaneous Oncologic Agents). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Miscellaneous Oncologic Agents) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Immunosuppressants (Therapeutic Immunosuppressant Agents): May enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Leniolisib: May diminish the therapeutic effect of Vaccines (Live). Risk C: Monitor therapy
Methotrexate: May enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Methotrexate may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Ozanimod: May enhance the adverse/toxic effect of Varicella Virus-Containing Vaccines. The risk of developing a clinical infection from the live vaccine may be increased. Ozanimod may diminish the therapeutic effect of Varicella Virus-Containing Vaccines. Risk X: Avoid combination
Propacetamol: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of propacetamol before or during vaccine administration when possible. Propacetamol is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Rabies Immune Globulin (Human): May diminish the therapeutic effect of Vaccines (Live). Management: Avoid administering the measles vaccine within 4 months after administration of rabies immune globulin. Avoid administering other live vaccines within 3 months after administration of rabies immune globulin. Risk D: Consider therapy modification
Rho(D) Immune Globulin: May diminish the therapeutic effect of Measles, Mumps, Rubella, and Varicella Virus Vaccine. Management: Do not delay administration of the measles, mumps, rubella, and varicella virus vaccine in women who have recently received Rho (D) immune globulin. If possible, women should be tested 3 or more months after vaccine administration to ensure immunity. Risk D: Consider therapy modification
Salicylates: May enhance the adverse/toxic effect of Varicella Virus-Containing Vaccines. Specifically, the risk for Reye's syndrome may increase. Risk X: Avoid combination
Teplizumab: May enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Teplizumab may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Teplizumab: May enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccines-associated infection may be increased. Teplizumab may diminish the therapeutic effect of Vaccines (Live). Risk X: Avoid combination
Tezepelumab: May enhance the adverse/toxic effect of Vaccines (Live). Risk X: Avoid combination
Tildrakizumab: May enhance the adverse/toxic effect of Vaccines (Live). The risk for contracting an infection from the vaccine may be increased. Tildrakizumab may diminish the therapeutic effect of Vaccines (Live). Risk X: Avoid combination
Tralokinumab: May enhance the adverse/toxic effect of Vaccines (Live). Risk X: Avoid combination
Tuberculin Tests: Vaccines (Live) may diminish the diagnostic effect of Tuberculin Tests. Management: It is preferable to administer live vaccines simultaneously with tuberculin tests. If a live vaccine has been recently administered, the tuberculin skin test should be administered 4 to 6 weeks following the administration of the vaccine. Risk D: Consider therapy modification
Vaccines (Live): May diminish the therapeutic effect of other Vaccines (Live). Management: Two or more injectable or nasally administered live vaccines not administered on the same day should be separated by at least 28 days (ie, 4 weeks). If not, the vaccine administered second should be repeated at least 4 week later. Risk C: Monitor therapy
Pregnancy should be avoided for 3 months following vaccination (per manufacturer labeling).
Refer to the Varicella Virus Vaccine monograph and the Measles, Mumps, and Rubella Virus Vaccine monograph for additional information.
Use is contraindicated in pregnant patients.
Refer to the Varicella Virus Vaccine monograph and the Measles, Mumps, and Rubella Virus Vaccine monograph for additional information.
Rash, fever; observe for anaphylaxis and syncope for 15 minutes following administration (ACIP [Kroger 2023]). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to re-establish adequate cerebral perfusion.
A live, attenuated virus vaccine that induces active immunity to disease caused by the measles, mumps, rubella, and varicella-zoster viruses.
Onset of action: At 6 weeks postvaccination of a single dose, the antibody response rate in healthy children 12 to 23 months of age was ~91% to 99%. Following a second dose to children <3 years of age, the observed antibody response rate was ~98% to 99%.
Duration of action: Antibody levels persist 10 years or longer in most healthy recipients. Refer to the Varicella Virus Vaccine monograph and the Measles, Mumps, and Rubella Virus Vaccine monograph for details.
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