Dosing and uses of ProQuad, MMRV (measles, mumps, rubella and varicella vaccine, live)
Adult dosage forms and strengths
Not indicated
Pediatric dosage forms and strengths
vaccine
- lyophilized single dose (supplied with sterile water diluent)
Measles, Mumps, Rubella, & Varicella Vaccination
Routine vaccination (2 doses): First dose of 0.5 mL SC between age 12-15 months; administer second dose between age 4-6 yr
Allow at least 3 months between a dose of varicella-containing vaccine and Proquad
Allow at least 4 wk between other measles-containing vaccines and Proquad
Administration
Refrigerator-stable formulation: Refrigerate at 2-8°C (36-46°F) or colder; the lyophilized vaccine may also be stored in a freezer and subsequently transferred to a refrigerator; however, the lyophilized vaccine should not be refrozen
Keep lyophilized vaccine frozen at -58°F and +5°F (-50°C to -15°C); may be stored at refrigerator temperature (36-46°F, 2-8°C) for up to 72 hr before reconstitution
Administer immediately after reconstitution
Do not freeze reconstituted vaccine, discard if not used within 30 minutes
Additional Information
Up-to-date vaccination schedules available at https://www.cdc.gov/vaccines/schedules/hcp/index.htmL
ProQuad, MMRV (measles, mumps, rubella and varicella vaccine, live) adverse (side) effects
Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967
>10%
Fever >102F (21.5%)
Inj site pain/tenderness/soreness (22%)
Inj site erythema (14%)
1-10%
Rash (9%, incl inj site, measles-like & varicella-like)
1nj site swelling (8.4%)
Irritability (6.7%)
Postmarketing Reports
Infections and infestations: Atypical measles, candidiasis, cellulitis, herpes zoster, infection, influenza, measles, orchitis, parotitis, respiratory infection, skin infection, varicella (vaccine strain)
Blood and the lymphatic system disorders: Aplastic anemia, lymphadenitis, regional lymphadenopathy, thrombocytopenia
Immune system disorders: Anaphylactoid reaction, anaphylaxis and related phenomena such as angioneurotic edema, facial edema, and peripheral edema, anaphylaxis in individuals with or without an allergic history
Psychiatric disorders: Agitation, apathy, nervousness
Nervous system disorders: Acute disseminated encephalomyelitis (ADEM), afebrile convulsions or seizures, aseptic meningitis (see below), ataxia, Bell palsy, cerebrovascular accident, convulsion, dizziness, dream abnormality, encephalitis, encephalopathy, febrile seizure, Guillain-Barré syndrome, headache, hypersomnia, measles inclusion body encephalitis, ocular palsies, paraesthesia, polyneuritis, polyneuropathy, subacute sclerosing panencephalitis, syncope, transverse myelitis, tremor
Eye disorders: Edema of the eyelid, irritation, necrotizing retinitis (reported only in immunocompromised individuals), optic neuritis, retinitis, retrobulbar neuritis
Ear and labyrinth disorders: Ear pain, nerve deafness
Vascular disorders: Extravasation
Respiratory, thoracic and mediastinal disorders: Bronchial spasm, bronchitis, epistaxis, pneumonitis, pneumonia, pulmonary congestion, rhinitis, sinusitis, sneezing, sore throat, wheezing
Gastrointestinal disorders: Abdominal pain, flatulence, hematochezia, mouth ulcer
Skin and subcutaneous tissue disorders: Erythema multiforme, Henoch-Schönlein purpura, herpes
Musculoskeletal, connective tissue and bone disorders: Arthritis and/or arthralgia (usually transient and rarely chronic, see below); musculoskeletal pain; myalgia; pain of the hip, leg, or neck; swelling
Reproductive system and breast disorders: Epididymitis
General disorders and administration site conditions: Injection-site complaints (burning and/or stinging of short duration, eczema, edema/swelling, hive-like rash, discoloration, hematoma, induration, lump, vesicles, wheal and flare), inflammation, lip abnormality, papillitis, roughness/dryness, stiffness, trauma, varicella-like rash, venipuncture site hemorrhage, warm sensation, warm to touch
Warnings
Contraindications
History of anaphylactic reaction to neomycin (may consult allergist/immunologist if absolutely necessary, give in setting where anaphylactic reaction can be immediately controlled)
Hypersensitivity to gelatin or any other component
Blood dyscrasia, leukemia, lymphoma, malignancy affecting bone marrow/lymphatic system
Immunodeficient patients, family history of immunodeficiency
Active untreated TB
Pregnancy
Fever >101.3°F (38.5°C)
Cautions
History of cerebral injury, individual/family history of convulsions, any other condition where stress due to fever needs to be avoided, hypersensitivity to eggs
Hypersensitivity to neomycin-may cause contact dermatitis
No information of safety/efficacy if given after exposure
Febrile seizures
- Early findings from an ongoing CDC study show that children who get an MMRV vaccine may be twice as likely to have a febrile seizure 7-10 days after getting the shot than children who get MMR and varicella vaccines (2 shots) at the same health care visit
- During the 7-10 days after vaccination, about one additional febrile seizure would be expected to occur among every 2,000 children vaccinated with MMRV vaccine, compared with children vaccinated with MMR and varicella administered at the same visit
Pregnancy and lactation
Pregnancy category: C (contraindicated)
Lactation: Contraindicated
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of ProQuad, MMRV (measles, mumps, rubella and varicella vaccine, live)
Mechanism of action
Vaccine containes live, attenuated viruses that stimulate active immunity
Pharmacokinetics
Duration: At least 1 year; not studied for longer periods
These products convey active immunity via stimulation of production of endogenously produced antibodies
Onset of protection from disease is relatively slow, but duration is long lasting (years)
Pharmacogenomics
HLA-B7, HLA-B51, HLA-DRB1*13, and HLADQA1*01 is associated with a measles vaccine response
Homozygosity at HLA-B, HLA-DR, and HLA-DQA1 has been associated with a measles vaccine nonresponse
