affecting bone marrow/lymphatic system Primary and acquired immunodeficiency states including AIDS, cellular immune deficiencies, hypogammaglobulinemic and dysgammaglobulinemic states, or family history of congenital or hereditary immunodeficiency Individuals taking immunosuppressive drugs; may be used with topical corticosteroids or low-dose corticosteroids (as commonly used for asthma prophylaxis) or in patients who are receiving corticosteroids as replacement therapy (eg, Addison disease) Concurrent illness Active untreated TB Fever >101.3°F (38.5°C) Cautions Caution when administering MMRV to persons with a history of cerebral injury, individual or family history of convulsions, or any other condition in which stress due to fever should be avoided History of anaphylactic or other immediate hypersensitivity reactions (eg, hives, laryngeal edema, difficulty breathing, hypotension, or shock) subsequent to egg ingestion may be at an enhanced risk of immediate-type hypersensitivity reactions after receiving vaccines containing traces of chick embryo antigen; carefully evaluate the potential risk-to-benefit ratio before considering vaccination Neomycin allergy most often manifests as contact dermatitis, which is not a contraindication to receiving the vaccine Caution in children with thrombocytopenia, of those who experienced thrombocytopenia after vaccination Avoid close contact with high-risk individuals susceptible to varicella since transmission of varicella vaccine virus may occur between vaccinees and susceptible contacts Safety and efficacy for postexposure prophylaxis have not been established Safety and efficacy in HIV-infected children have not been established Postmarketing reports suggest transmission of vaccine virus may occur to high risk individuals (eg, immunocompromised, pregnant women without positive varicella history or vaccination, or newborn infants of mothers without positive varicella history) Contains albumin; theoretical risk for transmission Creutzfeldt-Jacob disease Febrile seizures Administration of MMRV (dose 1) to children aged 12-23 months who have not been previously vaccinated against measles, mumps, rubella, or varicella, nor had a history of the wild-type infections, is associated with higher rates of fever and febrile seizures at 5-12 days after vaccination when compared with children vaccinated with dose 1 of both MMR and varicella vaccine administered separately Drug interactions overview Immune globulins and transfusion Immune globulins (IG) coadministered with MMRV contain antibodies that may interfere with vaccine virus replication and decrease the expected immune response Defer vaccination; appropriate suggested interval between transfusion or IG administration and vaccination will vary with the type of transfusion or indication for, and dose of, IG (eg, 5 months for varicella zoster immune globulin) Refer to prescribing information for specific recommendations Salicylates Reye syndrome reported following salicylate administration during wild-type varicella infection Avoid salicylates for 6 weeks after vaccination Corticosteroids and immunosuppressive drugs Do not administer to individuals receiving immunosuppressive doses of corticosteroids or other immunosuppressive drugs Can result in a more extensive vaccine-associated rash or disseminated disease in individuals on immunosuppressive drugs (see Contraindications) Use with other vaccines At least 1 month should elapse between a dose of a measles-containing vaccine (eg, MMR) and a dose of MMRV, and at least 3 months should elapse between administration of 2 doses of MMRV or varicella-containing vaccines Lab tests MMR vaccine given individually may result in a temporary depression of tuberculin skin sensitivity Therefore, if a tuberculin test is to be done, it should be administered either any time before, simultaneously with, or at least 4 to 6 weeks after MMRV Pregnancy Contraindicated during pregnancy; avoid pregnancy for 3 months following vaccination In a 10-year survey involving over 700 pregnant women who received rubella vaccine within 3 months before or after conception (of whom 189 received the Wistar RA 27/3 strain), none of the newborns had abnormalities compatible with congenital rubella syndrome Mumps infection during the first trimester of pregnancy may increase the rate of spontaneous abortion Although mumps vaccine virus has been shown to infect the placenta and fetus, there is no evidence that it causes congenital malformations in humans Reports have indicated that contracting wild-type measles during pregnancy enhances fetal risk; increased rates of spontaneous abortion, stillbirth, congenital defects and prematurity have been observed subsequent to infection with wild-type measles during pregnancy There are no adequate studies of the attenuated (vaccine) strain of measles virus in pregnancy; however, it would be prudent to assume that the vaccine strain of virus is also capable of inducing adverse fetal effects Lactation Unknown if measles or mumps vaccine is secreted in human milk The prescribing information describes studies that have shown lactating postpartum women immunized with live attenuated rubella vaccine may secrete the virus in breast milk and transmit it to breastfed infantsPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Vaccine containes live, attenuated viruses that stimulate active immunity Pharmacokinetics Duration: At least 1 year; not studied for longer periods These products convey active immunity via stimulation of production of endogenously produced antibodies Onset of protection from disease is relatively slow, but duration is long lasting (years) Pharmacogenomics HLA-B7, HLA-B51, HLA-DRB1*13, and HLADQA1*01 is associated with a measles vaccine response Homozygosity at HLA-B, HLA-DR, and HLA-DQA1 has been associated with a measles vaccine nonresponse SC or IM Preparation Withdraw the entire volume of the supplied diluent into a syringe; use only the diluent supplied with the vaccine since it is free of preservatives or other antiviral substances Inject the entire content of the syringe into the vial containing the powder Gently agitate to dissolve completely Visually inspect the resulting solution; when reconstituted, the solution is a clear pale yellow to light pink liquid Administer immediately after reconstitution; if not used immediately, may be stored at room temperature, protected from light, for up to 30 min Discard if not used within 30 minutes SC or IM Administration Withdraw the entire amount of the reconstituted vaccine from the vial into a syringe and inject the entire volume SC/IM Administer SC/IM in the outer aspect of the deltoid region of the upper arm or into the higher anterolateral area of the thigh Storage Unopened frozen lyophilized powder Maintain temperature at -58°F to +5°F (-50°C to -15°C) May be stored refrigerated at 36-46°F (2-8°C) for up to 72 hr before reconstitution Discard if not reconstituted and administered within 72 hr of refrigeration Protect from light Unopened refrigerator-stable lyophilized powder Shelf-life of 24 months when refrigerated at 2-8ºC or colder (36-46ºF or colder) May also be stored in a freezer; if subsequently transferred to refrigerator, DO NOT REFREEZE Protect from light Reconstituted vaccine Administer immediately after reconstitution Do not freeze reconstituted vaccine Discard if not used within 30 minutes Diluent vial Store separately at room temperature (20-25ºC [68-77ºF]), or refrigerate No images available for this drug. No images available for this drug.Print Patient Educationmeasles,mumps,rubella,varicella live vacc (PF) subcutaneous MEASLES/MUMPS/RUBELLA/VARICELLA VACCINE - INJECTION (MEE-zulz/mumps/roo-BEL-a/VAR-i-SEL-a) COMMON BRAND NAME(S): ProQuad USES: This medication is a combination of vaccines against several virus infections: measles (also known as rubeola), mumps, rubella (also known as German measles), and varicella (also known as chickenpox). These are common childhood infections that may cause serious (rarely fatal) problems. Vaccination is the best way to protect against these infections.This vaccine contains live viruses that have been weakened. It works by causing the body to produce its own protection (antibodies) against the viruses that cause measles, mumps, rubella, and chickenpox.This combination of vaccines is usually used by children between 12 months and 12 years old. HOW TO USE: Read all vaccine information available from your health care professional before receiving the vaccine. If you have any questions, ask your health care professional.This vaccine is given by injection by a health care professional. Depending on the brand of vaccine your child receives, it will be given either under the skin or into the muscle of the upper arm.Vaccines are usually given in a series of doses to provide the best protection. Closely follow the vaccination schedule provided by the health care professional. Keep all scheduled medical appointments. It may be helpful to mark a calendar as a reminder.This combination of vaccines may be given at the same time as other childhood vaccines (such as haemophilus, hepatitis B) using a separate needle and injection site.There are various combinations of vaccines available. Based on your child's age, vaccination history, and previous reaction to vaccines, the health care professional will decide which vaccines are best for your child. Discuss the risks and benefits of vaccination with the health care professional. SIDE EFFECTS: Pain/redness/swelling at the injection site, fever, rash, and fussiness may occur. If any of these effects last or get worse, tell the health care professional promptly.Rarely, some people have symptoms such as fainting, dizziness, vision changes, or ringing in the ears just after getting a vaccine injection. Tell the health care professional right away if your child has any of these symptoms. Sitting or lying down may help, since these symptoms usually don't last long.Remember that this medication has been prescribed because the health care professional has judged that the benefit to your child is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell the health care professional right away if your child has any serious side effects, including: easy bruising/bleeding, joint pain/stiffness, seizures, mental/mood changes (such as confusion).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact the health care professional.Contact the health care professional for medical advice about side effects. The following numbers do not provide medical advice, but in the US you may report side effects to the Vaccine Adverse Event Reporting System (VAERS) at 1-800-822-7967. In Canada, you may call the Vaccine Safety Section at Public Health Agency of Canada at 1-866-844-0018. PRECAUTIONS: Before your child receives this product, tell the health care professional if your child is allergic to it; or if your child has any other allergies. This product may contain inactive ingredients (such as neomycin), which can cause allergic reactions or other problems. Talk to your health care professional for more details.Before receiving this product, tell the health care professional your child's medical history, especially of: current fever/illness (such as untreated tuberculosis), bleeding/blood clotting problems (such as hemophilia, low platelets), immune system disorders (such as due to HIV infection, certain cancers such as leukemia/lymphoma, cancer or radiation treatment), scheduled organ transplant, brain/nervous system disorders (such as seizures, head injury), history of Guillain-Barre syndrome.There is a small risk that your child may expose others to infection with chickenpox for up to 6 weeks after your child has been vaccinated. If your child develops a rash after getting the vaccine, if possible, your child should avoid being in the same room with newborn babies (especially if born prematurely), pregnant women who have not had chickenpox, and people with immune system problems until the rash has dried or crusted over.Tell your health care professional if you are pregnant or plan to become pregnant. This vaccine should not be given if you are pregnant. It may harm an unborn baby. Avoid getting pregnant for 4 weeks after receiving this vaccine. Talk to your health care professional for details.This vaccine may pass into breast milk. However, it is unlikely to harm a nursing infant. Consult the health care professional before breast-feeding. DRUG INTERACTIONS: Drug interactions may change how your child's medications work or increase your child's risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products your child uses (including prescription/nonprescription drugs and herbal products) and share it with the health care professional. Do not start, stop, or change the dosage of any medicines without your child's doctor's approval.Some products that may interact with this vaccine include: drugs that weaken the immune system (such