Immunogenicity and reactogenicity of tetravalent vaccine for measles, mumps, rubella and varicella (MMRV) in healthy children: a meta-analysis of randomized controlled trials

Abstract

Background: Varicella is a highly infectious childhood disease. Tetravalent measles–mumps–rubella–varicella (MMRV) vaccine was introduced as one-syringe dose. Objective: To evaluate the immunogenicity and reactogenicity of MMRV vaccine versus trivalent MMR with varicella (V) vaccines in healthy children and to assess the respective safety issue. Methods: Randomized controlled trials (RCTs) were searched from the OVID databases. Trials were eligible if healthy children were randomized to receive MMRV or MMR+V vaccine. Seroconversions in serum antibody titers were the primary outcomes; adverse events were the secondary outcomes. Results: Ten RCTs with 8961 healthy children were identified. MMRV and MMR+V vaccines showed comparable immunogenicity against measles (relative risk [RR] = 0.99, 95% CI = 0.98–1.00), mumps (RR = 0.99, 95% CI = 0.97–1.00), rubella (RR = 1.00, 95% CI = 1.00–1.01) and varicella (RR = 0.98, 95% CI = 0.95–1.01). At least 93% of children in both groups had seroconverted within 6 weeks. MMRV group showed significantly higher incidences of fever (RR = 1.19, 95% CI = 1.09–1.31) and rash (RR = 1.23, 95% CI = 1.06–1.43). Conclusions: The immunogenicities of MMRV and MMR+V vaccines were comparable in healthy children; however, MMRV vaccination showed higher incidences of fever and rash.

Keywords:

• immunogenicity
• measles–mumps–rubella
• reactogenicity
• tetravalent vaccine
• varicella

Financial & competing interest disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• The immunogenicities of measles–mumps–rubella–varicella (MMRV) and MMR+V vaccine are comparable in healthy children after the first dose.

• MMRV vaccination is associated with higher incidences of fever and rash after vaccination.

• MMRV and MMR+V have similar incidence of post-vaccination febrile seizure.

• Healthcare providers should fully elaborate on the risks of post-vaccination fever, rash and febrile seizure to parents.

Notes