Measles, Mumps, Rubella, and Varicella Virus Vaccine

Dosage Forms

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)]

Pharmacology

Mechanism of Action

A live, attenuated virus vaccine that induces active immunity to disease caused by the measles, mumps, rubella, and varicella-zoster viruses.

Pharmacokinetics/Pharmacodynamics

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.

Use: Labeled Indications

Measles, mumps, rubella, and varicella vaccination: To provide active immunization for the prevention of measles, mumps, rubella, and varicella in children 12 months to 12 years of age.

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination against measles, mumps, rubella, and varicella 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 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. For children receiving the first dose at ≥48 months or their second dose at any age, use of MMRV is preferred. For children with a personal or family history of seizures, the ACIP recommends vaccination with separate MMR and varicella vaccines, as opposed to the MMRV combination vaccine (CDC/ACIP [Marin 2010]).

Canadian labeling (not in US labeling): MMRV combination vaccine is approved for use in healthy children (Priorix-Tetra: 9 months to 6 years; ProQuad: 12 months to 6 years); may consider use in healthy children ≤12 years of age based upon prior experience with the separate component (live-attenuated MMR or live-attenuated varicella [OKA-strain]) vaccines.

Contraindications

US labeling: Hypersensitivity to this vaccine, measles-, mumps-, rubella-, and/or varicella-containing vaccines, or any component of the formulation, including gelatin; history of anaphylactic reactions to neomycin; individuals with blood dyscrasias, leukemia, lymphomas, or other malignant neoplasms affecting the bone marrow or lymphatic systems; those receiving immunosuppressive therapy (including high-dose systemic corticosteroids); primary and acquired immunodeficiency states (including AIDs or symptomatic HIV; cellular immune deficiencies; hypogammaglobulinemic and dysgammaglobulinemic states); family history of congenital or hereditary immunodeficiency (until immune competence in the vaccine recipient is demonstrated); active untreated tuberculosis; current febrile illness with fever >38.5°C (>101.3°F); pregnancy

Canadian labeling: Priorix-Tetra: Hypersensitivity to this vaccine, measles-, mumps-, rubella-, and/or varicella-containing vaccines, or any component of the formulation, including neomycin; pregnancy; severe humoral or cellular (primary or acquired) immunodeficiency.

Dosage and Administration

Dosing: Pediatric

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 2017]).

Primary immunization: Children 12 months to 12 years: ProQuad: SubQ: 0.5 mL 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.

CDC (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 ≤6 years: SubQ or IM: 0.5 mL per dose; 2 doses administered at least 4 to 6 weeks apart (minimum interval between doses: 4 weeks)

ProQuad: Children 12 months to 6 years: SubQ: 0.5 mL per dose; 2 doses administered at least 4 weeks apart; may be used in children up to 12 years of age

Storage

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: 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]).

Drug Interactions

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. Consider therapy modification

Axicabtagene Ciloleucel: May enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of infection may be increased. Axicabtagene Ciloleucel may diminish the therapeutic effect of Vaccines (Live). Management: Avoid live virus vaccines for at least 6 weeks prior to initiation of lymphodepleting therapy, during axicabtagene ciloleucel infusion, and after treatment until full immune recovery is achieved. Consider therapy modification

AzaTHIOprine: May enhance the adverse/toxic effect of Vaccines (Live). AzaTHIOprine may diminish the therapeutic effect of Vaccines (Live). Management: Low-dose azathioprine (3 mg/kg/day or less) is not considered sufficiently immunosuppressive to create vaccine safety concerns and is not a contraindication for administration of zoster vaccine. Higher doses of azathioprine should be avoided. Consider therapy modification

Belimumab: May enhance the adverse/toxic effect of Vaccines (Live). Avoid combination

Corticosteroids (Systemic): May enhance the adverse/toxic effect of Vaccines (Live). Corticosteroids (Systemic) may diminish the therapeutic effect of Vaccines (Live). Management: Doses equivalent to less than 2 mg/kg or 20 mg per day of prednisone administered for less than 2 weeks are not considered sufficiently immunosuppressive to create vaccine safety concerns. Higher doses and longer durations should be avoided. Consider therapy modification

Daclizumab: May enhance the adverse/toxic effect of Vaccines (Live). Daclizumab may diminish the therapeutic effect of Vaccines (Live). 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: Canadian labeling for dimethyl fumarate states that live attenuated vaccine administration is not recommended during treatment. U.S. labeling does not mention this. Consider therapy modification

Dupilumab: May enhance the adverse/toxic effect of Vaccines (Live). Avoid combination

Fingolimod: May enhance the adverse/toxic effect of Vaccines (Live). Vaccinal infections may develop. Fingolimod may diminish the therapeutic effect of Vaccines (Live). Avoid combination

Guselkumab: May enhance the adverse/toxic effect of Vaccines (Live). Avoid combination

Immune Globulins: May diminish the therapeutic effect of Vaccines (Live). Management: Consult full interaction monograph for dose interval recommendations. This interaction does not apply to oral Ty21a typhoid vaccine or others listed as exceptions. Consider therapy modification

Immunosuppressants: May enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Exceptions: AzaTHIOprine; Beclomethasone (Oral Inhalation); Betamethasone (Systemic); Budesonide (Systemic); Corticotropin; Cortisone; Cytarabine (Liposomal); Deflazacort; DexAMETHasone (Systemic); Fludrocortisone; Fluticasone (Oral Inhalation); Hydrocortisone (Systemic); Leflunomide; Mercaptopurine; Methotrexate; MethylPREDNISolone; PrednisoLONE (Systemic); PredniSONE; Triamcinolone (Systemic). Avoid combination

Leflunomide: May enhance the adverse/toxic effect of Vaccines (Live). Leflunomide may diminish the therapeutic effect of Vaccines (Live). Management: The ACIP guidelines state that live-attenuated vaccines should generally be avoided for at least 3 months after cessation of immunosuppressant therapy. However, the ACR does not recommend avoiding live vaccines in patients being treated with leflunomide. Consider therapy modification

Mercaptopurine: May enhance the adverse/toxic effect of Vaccines (Live). Mercaptopurine may diminish the therapeutic effect of Vaccines (Live). Management: Low-dose 6-mercaptopurine (1.5 mg/kg/day or less) is not considered sufficiently immunosuppressive to create vaccine safety concerns and is not a contraindication for administration of zoster vaccine. Higher doses of mercaptopurine should be avoided. Consider therapy modification

Methotrexate: May enhance the adverse/toxic effect of Vaccines (Live). Methotrexate may diminish the therapeutic effect of Vaccines (Live). Management: Low-dose methotrexate (0.4 mg/kg/week or less) is not considered sufficiently immunosuppressive to create vaccine safety concerns. Higher doses of methotrexate should be avoided. Consider therapy modification

Ocrelizumab: May enhance the adverse/toxic effect of Vaccines (Live). Ocrelizumab may diminish the therapeutic effect of Vaccines (Live). Avoid combination

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. 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. Consider therapy modification

Risankizumab: May enhance the adverse/toxic effect of Vaccines (Live). Avoid combination

Salicylates: May enhance the adverse/toxic effect of Varicella Virus-Containing Vaccines. Specifically, the risk for Reye's syndrome may increase. 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). Avoid combination

Tisagenlecleucel: May enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of infection may be increased. Tisagenlecleucel may diminish the therapeutic effect of Vaccines (Live). Management: Avoid live virus vaccines for two weeks prior to initiation of lymphodepleting therapy, during tisagenlecleucel infusion, and after treatment until full immune recovery is achieved. Consider therapy modification

Tuberculin Tests: Vaccines (Live) may diminish the diagnostic effect of Tuberculin Tests. Management: If a parenteral live vaccine has been recently administered, a scheduled PPD skin test should not be administered for at least 4-6 weeks following the administration of the vaccine. 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. Exceptions: Adenovirus (Types 4, 7) Vaccine; Cholera Vaccine; Rotavirus Vaccine. Monitor therapy

Venetoclax: May enhance the adverse/toxic effect of Vaccines (Live). Venetoclax may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live, attenuated vaccines before, during, or after (prior to B-cell recovery) venetoclax treatment. Avoid combination

Test Interactions

May interfere with sensitivity to tuberculin skin test; administer at separate sites before, simultaneously with, or at least 4 to 6 weeks after vaccine.

Adverse Reactions

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: Pain at injection site (≤41%), erythema at injection site (11% to 24%), local soreness/soreness at injection site (≤22%), tenderness at injection site (≤22%), swelling at injection site (8% to 16%)

Miscellaneous: Fever (8% to 22%; ≥38.9°C [≥102°F])

1% to 10%:

Central nervous system: Irritability (2% to 7%), drowsiness (1%)

Dermatologic: Morbilliform rash (≤5%), rubella-like rash (≤4%), varicella-like rash (≤2%), rash at injection site (2%), skin rash (≤2%), vesicular eruption (≤2%), injection site pruritus (1%), viral exanthem (1%)

Gastrointestinal: Vomiting (1%), diarrhea (≤1%)

Local: Bruising at injection site (1% to 2%)

Respiratory: Upper respiratory tract infection (1%), rhinorrhea (1%)

<1%, postmarketing, and/or case reports: Abdominal pain, acute disseminated encephalomyelitis, agitation, anaphylactoid shock, anaphylaxis, angioedema, apathy, aplastic anemia, arthralgia, arthritis, aseptic meningitis, ataxia, atypical measles, Bell palsy, bleeding at injection site, bronchitis, bronchospasm, burning sensation at injection site, candidiasis, cellulitis, cerebrovascular accident, dizziness, encephalitis, encephalopathy, epididymitis, epistaxis, erythema multiforme, eye irritation, eyelid edema, facial edema, febrile seizures, Guillain-Barré syndrome, headache, hematochezia, hematoma at injection site, hemorrhage, Henoch-Schonlein purpura (including acute hemorrhagic edema of infancy), herpes simplex infection, herpes zoster infection, hypersomnia, impetigo, induration at injection site, infection, inflammation, influenza, localized vesiculation, localized warm feeling (includes warmth to the touch), lower extremity pain, lymphadenitis, lymphadenopathy (regional), measles, measles inclusion body encephalitis, meningitis, musculoskeletal pain, myalgia, neck pain, necrotizing retinitis, nervousness, nonthrombocytopenic purpura, optic nerve palsy, optic neuritis, oral mucosa ulcer, orchitis, otalgia, pain (hip), panniculitis, paresthesia, parotitis, peripheral edema, pneumonia, polyneuropathy, pruritus, pulmonary congestion, residual mass at injection site, respiratory tract infection, retinitis, retrobulbar neuritis, rhinitis, seizure, sensorineural hearing loss, sinusitis, skin discoloration at injection site, skin infection, skin sclerosis, sore throat, Stevens-Johnson syndrome, stiffness, subacute sclerosing panencephalitis, syncope, thrombocytopenia, transverse myelitis, tremor, urticaria at injection site, varicella infection - chickenpox (vaccine strain), wheezing

Warnings/Precautions

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 2017]).
• 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]).
• 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 2017]).

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 2017]). 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]).
• HIV: Safety and efficacy of this combination vaccine have not been established in patients with HIV infection. Use is contraindicated in patients with AIDS or symptomatic HIV.
• Thrombocytopenia: Use with caution in patients with thrombocytopenia and those who develop thrombocytopenia after first dose; thrombocytopenia may worsen.
• Tuberculosis: Defer vaccination in patients with active untreated tuberculosis. Use is contraindicated in patients with active untreated tuberculosis.

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 2017]).
• Salicylates: Avoid use of salicylates for 6 weeks following vaccination; varicella may increase the risk of Reye's 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 inactivated) for which a person is eligible at a single clinic 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 2017]).

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 2017]; 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 2017]).
• Gelatin: Some products may contain gelatin. Use is contraindicated in patients with a history of anaphylactic/anaphylactoid reaction to gelatin.
• Neomycin: Manufactured with 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 2017]). 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.
• Appropriate use: Use of this vaccine for specific medical and/or other indications (eg, immunocompromising conditions, hepatic or kidney disease, diabetes) is also addressed in the annual ACIP Recommended Immunization Schedules (refer to CDC schedule for detailed information).
• Blood products: Recent administration of blood or blood products may interfere with immune response. Guidelines with suggested administration intervals are available (ACIP [Kroger 2017]).
• 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 2017]).
• Transmission of virus: Vaccinated individuals should not have close association with susceptible high-risk individuals for 6 weeks following vaccination. High-risk individuals susceptible to the varicella virus include immunocompromised persons, pregnant women without evidence of immunity to varicella, newborns of mothers without evidence of varicella immunity, and infants born <28 weeks' gestation (regardless of maternal immunity); transmission of varicella virus may occur.

Monitoring Parameters

Rash, fever; monitor for anaphylaxis and syncope for 15 minutes following administration (ACIP [Kroger 2017]). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.

Pregnancy

Pregnancy Considerations

Use is contraindicated in pregnant females and 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.

Patient Education

• Discuss specific use of vaccine and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience injection site pain, redness, edema, or irritation or fussiness. Have patient report immediately to prescriber seizures, bruising, flat spots under skin, pale skin, abnormal gait, severe skin irritation, skin infection, headache, chills, severe nausea, vomiting, stiff neck, fatigue, confusion, or sensitivity to light (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.