AAP updates varicella vaccine recommendations
Committee on Infectious Diseases. Pediatrics. 2011;doi:10.1542/peds.2011-1968.
The combination measles-mumps-rubella-varicella vaccine is preferred
over separate injections of measles-mumps-rubella and varicella vaccines for
children aged older than 4 years, unless the child has a familial history of
seizures, according to a policy statement by the American Academy of Pediatrics
published online this week.
The AAP’s Committee on Infectious Diseases said post-licensure data
indicate a slightly higher incidence of febrile seizures in children aged 1 to
2 years in the MMRV vaccine (ProQuad, Merck) group, which reported at seven to
nine febrile seizures per 10,000 children after MMRV. In contrast, three to
four per 10,000 children reported seizures after separate MMR (M-M-R II, Merck)
and varicella (Varivax, Merck) vaccinations. Therefore, the policy statement
recommends either MMR and varicella or MMRV can be administered as first doses
from age 12 months to 47 months.
However, the committee stated a preference for MMRV for the first dose
in children aged at least 48 months and for the second dose at any age.
The recommendations are in line with similar recommendations from the
CDC’s Advisory Committee on Immunization Practices
adopted 2 years ago.
“Providers who are considering administering MMRV should discuss
the benefits and risks of both vaccination options with the parents or
caregivers. Because parents need to be fully aware of the slight increase in
risk of febrile seizures with the combination MMRV compared with separate MMR
and varicella injections at the same visit, providers who face barriers to
clearly communicating these benefits and risks for any reason (eg, language
barriers) should administer
MMR and varicella vaccines separately,” the
committee wrote.
Disclosure: The researchers all serve on the AAP’s Committee
on Infectious Diseases.
Febrile seizures are common, occurring in about 5% of young children. A pediatric practice that sees about 200 newborns a year will experience about one excess febrile seizure from MMRV -compared with MMR plus V - every 8 years. Further, febrile seizures are benign. Therefore, the convenience of giving one shot instead of two outweighs the small increased risk of febrile seizures following MMRV.
Paul A. Offit, MD
Infectious Diseases in Children Editorial Board member
Disclosures: Dr. Offit reports no relevant financial disclosures.