A study published in Pediatrics today confirms a slightly elevated risk in febrile seizures in children who receive the combo MMRV (Measles-Mumps-Rubella-Varicella) shot between 1 and 2 years of age. If it were my child, I would NOT get the combo MMRV shot, even if the elevated risk of seizure is extremely low. The American Academy of Pediatrics will likely recommend the same. None of us ever want our child to be put at increased risk. Or to be part of a statistic.
This study found children receiving the combo MMRV had double the risk of febrile seizure compared with those children who got the MMR and Varicella (Chicken Pox) shots individually. Data shows 1 in 2300 children could have a febrile seizure after the combo shot. So, like journalist Madonna Behen reported today, I do not recommend the combo.
From the way I see it, both as a mom and as a pediatrician, if the risk is increased, it is meaningful. And, because children who get the 2 shots separately are equally protected against Measles, Mumps, Rubella, and Chicken Pox (Varicella) I recommend the safer route of 2 shots.
Why the hype today? When new information is published about shots, many parents become hesitant. News on immunization is often confusing and seemingly scary. I am not hesitant about shots, but I will always recommend the full immunization conferring the lowest-risk. For my patients and for my own kids. (It is unlikely that you need to ask your pediatrician about the combo MMRV, as supply is low and likely not even in your pediatrician’s office.) This new data on the MMRV shot is apart from other recommended combination shots given during infancy and childhood. (See recommended shot schedule here.)
With no increased benefit from the combination shot vs. the 2 shot dosage, I can’t recommend the combination MMRV simply to avoid one less poke at the office visit. That’s how I have counseled families over the last two years; In February 2008, studies with similar results propelled the ACIP to step away from recommending the combination MMRV over the individual shots. My boys got both their MMR and Varicella shots after they turned 1 year of age. But because of this data, I didn’t ask for the MMRV shot…
- Febrile seizures are relatively common in young children between 6 months to 5 years. They are usually self-limited (seizure stops without any intervention) and cause no long-term problems or epilepsy. Febrile seizures are short seizures that occur in up to 4-5% of all young children. Although they do not cause long-standing damage or disability, they can be very frightening to parents.
- Measles, Mumps, Rubella, and Varicella infections cause far worse outcomes. Did you know that before the introduction of the chicken pox vaccine in 1995, more than 100 people died in the US every year? And since measles vaccine started in the 1960’s, there has been a 99% decline in the number of cases in the US?
- Immunizations work to prevent illness in nearly all children (95%) who get them. But, nothing is perfect: 5% of children who get a particular shot are not protected. We have to rely on immunized members of the community to protect us all, particularly young infants (too young to be vaccinated) and sick children (can’t receive the shots).
Children need 2 doses of MMR and 2 doses of Varicella to protect them against the illnesses. Starting at age 12-15 months, we recommend the first dose of MMR and the first dose of Varicella. Children then need a second dose, or “booster” of each shot, prior to kindergarten or sometime between age 4 and 6 years.
Resources if you feel like reading more:
I spoke with Madonna Behen last week and she reported my thoughts while outlining the findings of the study for Health Day.
You can also read a summary here by Liz Szabo.
Concerns about vaccine safety.
Can the first dose of MMR and the first dose of Varicella be given on the same day (just not as a combo shot)? The way I read the immunization schedule suggests that my toddler could have his first shots of both at his 15-month appointment.
Wendy Sue Swanson, MD says
Yes! In my office I give MMR and Varicella at the 12 month visit, on the same day. However, The AAP (American Academy of Pediatrics) and the CDC recommend them any time between 12 and 15 months. Some offices do the Varicella at 15 months.
The CAVEAT is this:
If you do MMR at the 12 month visit and chose not to do varicella at the same time, you’ll need to wait 28 days until you do the Varicella to get the proper immune response. The same is true if you choose to do Varicella and not MMR at the 12 month or 15 month visit. If dosed separately and NOT on the same day, there has to be 1 month in between them.
thank you for the info!
A friend’s child who was born one day prior to my toddler (16 months) received the MMRV shot 2 weeks ago and had a severe rash and seizures as a side effect. Even though the risk is low (1 in 2300) you would never want this to happen to your child! Thanks for giving out this recommendation, in the world of vaccinations it is hard to know what to do… vaccinate/don’t vaccinate/split up shots, etc.
Jay Gordon says
Excellent comments, Dr. Swanson. A loaded query, if the CDC, ACIP or AAP recommended the combination as safe, would you still disdain the MMRV?
Wonderful site and Tweets,
Wendy Sue Swanson, MD says
You’re right, Dr Gordon, a loaded query…Thanks for the question.
I stand by my principals, particularly when I have science to back me up. BUT, and this is a big BUT, I can’t imagine a scenario where I would go against what the AAP, ACIP, and CDC recommend. They read (and write/prove) the science I believe in. I believe wholeheartedly in the process by which the ACIP vets vaccines and evaluates risk. I know that they too, are looking out for the welfare of children.
Like you, as a trained physician, I realize and take seriously, my role in helping families make informed decisions for themselves and help parents interpret recommendations, risk, etc. I understand that they might experience risk (or the numbers) differently than I do.
For example, I always marvel in telling families risks in different ways:
“There is a 10% chance of fever after this shot.”
“90% of Children do not have fever after this shot.”
“Only 1/10 children will have fever after this shot.”
How we counsel matters! We all think about number differently….So in regards to MMR+VZV versus MMRV, I’ll never recommend it at this point at 12 months of age. Precisely because at that age with rising fever, it seems to be more seizure-provoking that the two vaccines separately. What I don’t get (and maybe exactly what you are really asking) is why–given the rising amount of data that MMRV is more provoking in toddlers than the individual doses–we even keep it in the list of shots offered at the 12-15mo WCC. Why not just eliminate the excess risk? As I said in the post, although the risk is small (1 in 2300 doses for febrile seizure) it is still real. With a clear and safer choice, why not only choose to offer separate doses at that age?
Maybe time will bring that recommendation.
As a first-time mom, someone recommended the Sears vaccine book to me, and of course I immediately panicked after reading it. I was so lucky to have a pediatrician who sat me down and was willing to talk real risk/benefit with me about each vaccine. Our end result was not messing with some (HIB), delaying others (Hep B) and separating some combos out. I really appreciated a few things about her approach with me:
*She did not discount the resources I had gotten my info from, but gave me additional information. Keep in mind, parents that come in armed with wrong or misleading info are just as likely to follow up with information and resources that you offer, provided you offer something other than a judgmental stare. 🙂
*She acknowledged the risks and offered ways to mitigate them (an alternative vaccine schedule) so that I felt like I still had the power to make the decision regarding my child’s care: I had options.
* She appreciated my interest and involvement in my child’s well-being rather than seeing it as troublesome.
My current pediatrician (we moved from that state for a job) has never ceased to chide me for the way this was handled. He makes a big deal about it every time my daughter has to have shots because she hadn’t had this on time, or we have to do this shot 6 months later than normal. I understand an alternative schedule is more work for doctors and clinician, but, it’s more work for parents, too.
Bottom line, give parents options. We are responsible for our child’s care. We need to make the decisions. I don’t like walking out of the pediatrician’s office (as I have at the new Dr’s) wondering if I should have spoken up and feeling like crap because I didn’t. It’s hard to speak up when the only thing you could possibly say is “no.” Give parents options and they will respond favorably.
Thank you for this. I wish I would’ve seen this earlier, I just recently (2 days ago) brought my 15 month old in for the mmrv shot. I feel awfully worried now and wish I would’ve went with my gut instinct and got the two seperate shots. What can I do in the meantime since she’s still within the timeframe for a possible reaction?
Wendy Sue Swanson, MD, MBE says
I suspect your 15 month old got the MMR and the Varicella (separately).The recommendations now suggest not giving the MMRV at the toddler dose, only at the 4-6 year-old dose. Perhaps call your pediatrician’s office to confirm.
That being said, if your toddler got the combo vax, the risk for increased side effects are still very low (VERY RARE) and it is a safe vaccine! No intervention is necessary. If you have any concerns about fever or side effects, I suggest you call your 15 month-old’s doc to discuss.
Hi Dr. Thank you for this information. I realize this article is a number of years old and was wondering if your opinion has changed on getting MMRV vs. the 2 injections? Thank you.