Deborah Lehman, MD

Two doses of MMRV were more protective against varicella than a single dose of monovalent varicella vaccine.

Varicella vaccine has been licensed in the U.S. since 1995, and in 2007, a two-dose schedule was adopted to decrease breakthrough disease. Other countries have been slower to incorporate varicella vaccine into their immunization schedules, and several countries only have a one-dose recommendation. In an industry-funded, randomized-controlled study, researchers randomized 5800 toddlers (age range, 12–22 months) from 10 European countries to receive two doses of measles-mumps-rubella-varicella (MMRV) vaccine, MMR followed by a single dose of monovalent varicella vaccine at dose two, or two doses of MMR (control) 6 weeks apart. The children were followed for 3 years for evidence of breakthrough varicella.

Single-dose vaccine efficacy against any disease was 65% (91% against severe disease). Two doses of MMRV resulted in 95% protection overall and almost 100% protection from severe varicella disease. Risk for breakthrough disease was almost seven times lower in recipients of two doses of MMRV than in recipients of the single monovalent varicella vaccine. As reported previously, MMRV was associated with a higher rate of fever than the other two schedules.

Citation(s):

Prymula R 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 Jan 29; [e-pub ahead of print].