Issue: October 2011
October 01, 2011
1 min read

AAP updates varicella vaccine recommendations

Committee on Infectious Diseases. Pediatrics. 2011;doi:10.1542/peds.2011-1968.

Issue: October 2011
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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.

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