Indian Pediatrics

, Volume 54, Issue 12, pp 1041–1046 | Cite as

A new combined vaccine against measles, mumps, rubella and varicella in India

  • Nitin Shah
  • Raunak Parikh
  • Giacomo Casabona
  • Shafi Kolhapure
Drug Review


A quadrivalent MMRV (measles-mumps-rubella-varicella) combination vaccine has recently been launched in India. This vaccine is highly immunogenic, with seroconversion rates against all antigens reaching 96.6-100% at 42 to 56 days after the second vaccine dose in unvaccinated children or in those previously vaccinated with MMR+/-V. Two doses efficacy, against all varicella is 94.1% and effectiveness reaches 91%. The most frequent solicited local adverse event after MMRV vaccine is redness, and fever is the most common solicited general symptom. Higher rates of fever and febrile convulsions compared to MMR+/-V have been reported when used as first dose but not when used as the second of a measles containing vaccine, irrespective of age of the second dose.


Chicken pox Measles-Mumps-Rubella vaccine Prevention Varicella 


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  1. 1.
    World Health Organisation. Mumps Virus Vaccines: WHO Position Paper. Wkly Epidemiol Rec. 2007;82:51-60.Google Scholar
  2. 2.
    World Health Organisation. Measles Vaccines: WHO Position Paper. Wkly Epidemiol Rec. 2009;84:349-60.Google Scholar
  3. 3.
    World Health Organisation. Rubella Vaccines: WHO Position Paper. Wkly Epidemiol Rec. 2011;86:301-16.Google Scholar
  4. 4.
    World Health Organisation. Varicella and Herpes zoster Vaccines: WHO Position Paper. Wkly Epidemiol Rec. 2014;89:265-87.Google Scholar
  5. 5.
    Historic Dates and Events Related to Vaccines and Immunization. Available from: Accessed July 18, 2016.Google Scholar
  6. 6.
    World Health Organization. Global Measles and Rubella Strategic Plan, 2012–2020. Geneva; WHO 2012. Available from: Accessed July 18, 2016.Google Scholar
  7. 7.
    IAP Immunization Timetable 2016. Available from: Accessed April 13, 2017.Google Scholar
  8. 8.
    Mathew JL. Evidence-based options to improve routine immunization. Indian Pediatr. 2009;46:993–6.PubMedGoogle Scholar
  9. 9.
    Marshall GS, Happe LE, Lunacsek OE, Szymanski MD, Woods CR, Zahn M, et al. Use of combination vaccines is associated with improved coverage rates. Pediatr Infect Dis J. 2007;26:496–500.CrossRefPubMedGoogle Scholar
  10. 10.
    Ma SJ, Li X, Xiong YQ, Yao AL, Chen Q. Combination measles-mumps-rubella-varicella vaccine in healthy children: A systematic review and meta-analysis of immunogenicity and safety. Medicine. 2015;94:e1721.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Czajka H, Schuster V, Zepp F, Esposito S, Douha M, Willems P. A combined measles, mumps, rubella and varicella vaccine (Priorix-Tetra): Immunogenicity and safety profile. Vaccine. 2009;27:6504–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Priorix Tetra Full Prescribing Information Version PRT/PI/IN/2017/02. Available from: GlaxoSmithKline Pharmaceuticals Ltd Dr. Annie Besant Road, Worli, Mumbai-400030 (India).Google Scholar
  13. 13.
    Knuf M, Zepp F, Meyer CU, Habermehl P, Maurer L, Burow HM, et al. Safety, immunogenicity and immediate pain of intramuscular versus subcutaneous administration of a measles-mumps-rubella-varicella vaccine to children aged 11-21 months. Eur J Pediatr. 2010;169:925–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Schuster V, Otto W, Maurer L, Tcherepnine P, Pfletschinger U, Kindler K, et al. Immunogenicity and safety assessments after one and two doses of a refrigeratorstable tetravalent measles-mumps-rubella-varicella vaccine in healthy children during the second year of life. Pediatr Infect Dis J. 2008;27:724–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Knuf M, Habermehl P, Zepp F, Mannhardt W, Kuttnig M, Muttonen P, et al. Immunogenicity and safety of two doses of tetravalent measles-mumps-rubella-varicella vaccine in healthy children. Pediatr Infect Dis J. 2006;25:12–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Knuf M, Zepp F, Helm K, Maurer H, Prieler A, Kieninger-Baum D, et al. Antibody persistence for 3 years following two doses of tetravalent measles-mumpsrubella-varicella vaccine in healthy children. Eur J Pediatr. 2012;171:463–70.CrossRefPubMedGoogle Scholar
  17. 17.
    Halperin SA, Ferrera G, Scheifele D, Predy G, Stella G, Cuccia M, et al. Safety and immunogenicity of a measlesmumps-rubella-varicella vaccine given as a second dose in children up to six years of age. Vaccine. 2009;27:2701–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Gillet Y, Steri GC, Behre U, Arsene JP, Lanse X, Helm K, et al. Immunogenicity and safety of measles-mumpsrubella-varicella (MMRV) vaccine followed by one dose of varicella vaccine in children aged 15 months-2 years or 2-6 years primed with measles-mumps-rubella (MMR) vaccine. Vaccine. 2009;27:446–53.CrossRefPubMedGoogle Scholar
  19. 19.
    Lalwani S, Chatterjee S, Balasubramanian S, Bavdekar A, Mehta S, Datta S, et al. Immunogenicity and safety of early vaccination with two doses of a combined measles-mumpsrubella-varicella vaccine in healthy Indian children from 9 months of age: a phase III, randomised, non-inferiority trial. BMJ Open. 2015;5:e007202.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Prymula R, Bergsaker MR, Esposito S, Gothefors L, Man S, Snegova N, et al. Protection against varicella with two doses of combined measles-mumps-rubella-varicella vaccine versus one dose of monovalent varicella vaccine: a multicentre, observer-blind, randomised, controlled trial. Lancet. 2014;383:1313–24.CrossRefPubMedGoogle Scholar
  21. 21.
    Czajka H, Brzostek J, Gabutti G, Gasparini R, Desole MG, Pazdiora P, et al. Comparison of six year efficacy between one or two doses of live varicella virus-containing vaccines: a randomized, placebo-controlled trial. Presented at European Society for Paediatric Infectious Diseases -33rd Annual Meeting. 12-16 May 2015; Leipzig Germany: ESPID-0644.Google Scholar
  22. 22.
    Spackova M, Wiese-Posselt M, Dehnert M, Matysiak-Klose D, Heininger U, Siedler A. Comparative varicella vaccine effectiveness during outbreaks in day-care centres. Vaccine. 2010;28:686–91.CrossRefPubMedGoogle Scholar
  23. 23.
    Dhillon S, Curran MP. Live attenuated measles, mumps, rubella, and varicella zoster virus vaccine (Priorix-Tetra). Paediatr Drugs. 2008;10:337–47.CrossRefPubMedGoogle Scholar
  24. 24.
    Schink T, Holstiege J, Kowalzik F, Zepp F, Garbe E. Risk of febrile convulsions after MMRV vaccination in comparison to MMR or MMR+V vaccination. Vaccine. 2014;32:645–50.CrossRefPubMedGoogle Scholar
  25. 25.
    Hense S, Schink T, Garbe E. 2nd immunization against measles, mumps, rubella with MMRV, MMR or MMR+V in Germany and risk of febrile convulsions. Presented at International Society for Pharmacoepidemiology -29th International Conference. 25-28 August 2013; Montreal, Canada: ID24.Google Scholar
  26. 26.
    Marin M, Broder KR, Temte JL, Snider DE, Seward JF. Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and Reports. 2010;59:1–12.PubMedGoogle Scholar
  27. 27.
    Recommendations of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute–2016/ 2017. Epidemiologisches Bulletin. 2016;34:301-38.Google Scholar
  28. 28.
    Measles, Mumps, Rubella, Varicella Vaccine -Information for health professionals. Available from:$File/final-mmrvprovider-booklet.pdf. Accessed April 21, 2017.Google Scholar
  29. 29.
    Zepp F, Behre U, Kindler K, Laakmann KH, Pankow-Culot H, Mannhardt-Laakmann W, et al. Immunogenicity and safety of a tetravalent measles-mumps-rubellavaricella vaccine co-administered with a booster dose of a combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-haemophilus influenzae type b conjugate vaccine in healthy children aged 12-23 months. Eur J Pediatr. 2007;166:857–64.CrossRefPubMedGoogle Scholar
  30. 30.
    Shinefield H, Black S, Thear M, Coury D, Reisinger K, Rothstein E, et al. Safety and immunogenicity of a measles, mumps, rubella and varicella vaccine given with combined Haemophilus influenzae type b conjugate/hepatitis B vaccines and combined diphtheria-tetanus-acellular pertussis vaccines. Pediatr Infect Dis J. 2006;25:287–92.CrossRefPubMedGoogle Scholar
  31. 31.
    Vesikari T, Karvonen A, Lindblad N, Korhonen T, Lommel P, Willems P, et al. Safety and immunogenicity of a booster dose of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine coadministered with measles-mumps-rubella-varicella vaccine in children aged 12 to 16 months. Pediatr Infect Dis J. 2010;29:e47–56.CrossRefPubMedGoogle Scholar
  32. 32.
    Vesikari T, Karvonen A, Bianco V, Van der Wielen M, Miller J. Tetravalent meningococcal serogroups A, C, W-135 and Y conjugate vaccine is well tolerated and immunogenic when co-administered with measles-mumpsrubella-varicella vaccine during the second year of life: An open, randomized controlled trial. Vaccine. 2011;29: 4274–84.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2017

Authors and Affiliations

  • Nitin Shah
    • 1
  • Raunak Parikh
    • 2
  • Giacomo Casabona
    • 3
  • Shafi Kolhapure
    • 2
  1. 1.PD Hinduja National HospitalMumbaiIndia
  2. 2.PD Hinduja National Hospital, GSK, Dr Annie Besant RdMumbaiIndia
  3. 3.PD Hinduja National Hospital, GSKWavreBelgium

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