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Choice between MMRV and separate MMR and varicella vaccines for routine immunization in children[1]

Choice between MMRV and separate MMR and varicella vaccines for routine immunization in children[1]
This figure summarizes the approach to choosing between MMRV vaccine and separate MMR and varicella vaccines for routine immunization of children ≥12 months and <13 years of age. Refer to UpToDate's topic on MMR immunization in children for details.
MMRV: combination measles-mumps-rubella-varicella vaccine; MMR: combination measles-mumps-rubella vaccine.
* There is a slightly increased risk of febrile seizures 1 to 2 weeks after the first dose with MMRV compared with separate MMR and varicella vaccines (approximately 1 additional febrile seizure for every 2300 to 2800 doses of MMRV). MMRV is an alternative for caregivers who prefer to avoid an extra injection.[1-4]
¶ The risk of febrile seizures is not increased with MMRV compared with separate MMR and varicella vaccines for the second dose or among children age ≥4 years.[1,5]
References:
  1. Marin M, Broder KR, Temte JL, et al. Use of combination measles, mumps, rubella, and varicella vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59:1.
  2. Jacobsen SJ, Ackerson BK, Sy LS, et al. Observational safety study of febrile convulsion following first dose MMRV vaccination in a managed care setting. Vaccine 2009; 27:4656.
  3. Klein NP, Fireman B, Yih WK, et al. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics 2010; 126:e1.
  4. MacDonald SE, Dover DC, Simmonds KA, Svenson LW. Risk of febrile seizures after first dose of measles-mumps-rubella-varicella vaccine: A population-based cohort study. CMAJ 2014; 186:824.
  5. Klein NP, Lewis E, Baxter R, et al. Measles-containing vaccines and febrile seizures in children age 4 to 6 years. Pediatrics 2012; 129:809.
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