title: Reactogenicity and immunogenicity of a live attenuated tetravalent measles-mumps-rubella-varicella (MMRV) vaccine.
abstract: In countries where routine varicella vaccination is implemented, it is usually given at the same age as that recommended for measles-mumps-rubella (MMR) vaccination. A combined multivalent measles-mumps-rubella-varicella (MMRV) vaccine would offer the convenience of a single injection and facilitate implementation of varicella vaccination into routine childhood immunisation schedules. We evaluated the immunogenicity and reactogenicity of a tetravalent MMRV candidate vaccine compared to an extemporaneous mix of a measles-mumps-rubella vaccine and varicella vaccine (MMR/V), and to a measles-mumps-rubella (MMR) vaccine alone. A multicentre study was conducted in which a total of 240 healthy children aged 12 months (80 per group) were randomised to receive MMRV, MMR/V, or MMR alone. Active surveillance for adverse events was undertaken for 43 days post-vaccination. Blood samples were taken prior to vaccination and at 60 days post-vaccination. There were no significant differences between groups in rates of pain, redness, or swelling at the site of vaccination. There was no significant difference in the rate of any fever (axillary temperature >or=37.5 degrees C) and grade 3 fever (axillary temperature >39.0 degrees C) between the groups receiving MMRV and MMR during the 43-day follow-up period. Although, a significant increase was found for fever of any cause with onset between days 0 and 14 for MMRV compared to the MMR group, there was no significant difference in grade 3 fever rates during the same period. With respect to immunogenicity, MMRV and MMR/V demonstrated similar seroconversion rates to each component compared to MMR alone, with at least 91.9% of subjects in all groups seroconverting to each vaccine component 60 days after vaccination. Decreased GMTs for varicella antibody at day 60 indicated that there may have been inhibition of this response compared to MMR/V. This tetravalent MMRV candidate vaccine showed promising results, although further examination of the possible increase in minor fever and decreased varicella immunogenicity should be assessed in future studies.
authors.affiliation: The University of Melbourne, Department of Paediatrics, and Murdoch Children's Research Institute at the Royal Children's Hospital, Melbourne, Australia. t.nolan@unimelb.edu.au
authors.forename: Terry
authors.initials: T
authors.lastname: Nolan
authors.forename: Peter
authors.initials: P
authors.lastname: McIntyre
authors.forename: Don
authors.initials: D
authors.lastname: Roberton
authors.forename: Dominique
authors.initials: D
authors.lastname: Descamps
mesh_terms: D000914:Antibodies, Viral / Q000096:biosynthesis; D002644:Chickenpox / Q000276:immunology / Q000517:prevention & control; D019433:Chickenpox Vaccine; D005069:Evaluation Studies as Topic; D005076:Exanthema / Q000139:chemically induced; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D007223:Infant; D008297:Male; D008457:Measles / Q000276:immunology / Q000517:prevention & control; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D015337:Multicenter Studies as Topic; D009107:Mumps / Q000276:immunology / Q000517:prevention & control; D010146:Pain / Q000139:chemically induced; D011897:Random Allocation; D012409:Rubella / Q000276:immunology / Q000517:prevention & control; D012449:Safety; D016037:Single-Blind Method; D014613:Vaccines, Attenuated / Q000009:adverse effects / Q000276:immunology; D017778:Vaccines, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D014765:Viral Vaccines / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*
chemical_list: D000914:Antibodies, Viral; D019433:Chickenpox Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D014613:Vaccines, Attenuated; D017778:Vaccines, Combined; D014765:Viral Vaccines; C050102:measles, mumps, rubella, varicella vaccine