title: Dose-response study of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children.
abstract: BACKGROUND
  A combined measles, mumps, rubella and varicella (MMRV) vaccine would facilitate universal immunization against 4 diseases by decreasing the number of injections and thus enhancing compliance and coverage rates. If a second dose of varicella vaccine were to be recommended, MMRV could be used to administer a routine second dose of M-M-RII with the added advantage of boosting varicella-zoster virus (VZV) antibody titers.
  
  
  METHODS
  Subjects 12-23 months of age received a single injection of 1 of 3 lots of an MMRV vaccine (ProQuad) containing high, middle or low VZV potency, or VARIVAX given concomitantly with M-M-RII. Recipients of MMRV received a second injection of MMRV approximately 90 days later.
  
  
  RESULTS
  We enrolled 1559 subjects in the study. Antibody response rates to VZV 6 weeks after 1 injection of high potency MMRV (88.6%) or 2 injections of MMRV of any varicella potency (99.7-100%) were similar to the response rates after concomitant administration of M-M-RII and VARIVAX (93.1%). The second injection of MMRV boosted VZV antibody titers. Antibody responses to measles, mumps and rubella were >or=98%, similar to the control, after 1 or 2 injections of MMRV. MMRV was generally well-tolerated during the 42 days after vaccination.
  
  
  CONCLUSIONS
  One injection of high potency MMRV resulted in antibody responses to the 4 vaccine components equivalent to those found after concomitant administration of M-M-RII and VARIVAX. A second injection of MMRV resulted in a significant boost in VZV antibody. This boost may translate into enhanced immunogenicity against varicella, which is known to correlate with increased protection.
authors.affiliation: The University of California San Francisco, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Shinefield
authors.forename: Steve
authors.initials: S
authors.lastname: Black
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Williams
authors.forename: Colin
authors.initials: C
authors.lastname: Marchant
authors.forename: Keith
authors.initials: K
authors.lastname: Reisinger
authors.forename: Tracy
authors.initials: T
authors.lastname: Stewart
authors.forename: H Cody
authors.initials: HC
authors.lastname: Meissner
authors.forename: Juan
authors.initials: J
authors.lastname: Guerrero
authors.forename: Stephanie Olsen
authors.initials: SO
authors.lastname: Klopfer
authors.forename: Jin
authors.initials: J
authors.lastname: Xu
authors.forename: Florian
authors.initials: F
authors.lastname: Schödel
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Kuter
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D019433:Chickenpox Vaccine / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D004306:Dose-Response Relationship, Immunologic; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D017778:Vaccines, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D019433:Chickenpox Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D017778:Vaccines, Combined; C050102:measles, mumps, rubella, varicella vaccine