Approved indication: immunisation
vials containing whitish pink pellet for reconstitution
Australian Medicines Handbook section 20.1
Previously children were vaccinated against measles, mumps and rubella (MMR) at 12 months with a booster at four years, and against chickenpox at 18 months (Aust Prescr 2000;23:45-6). From July 2013, a vaccine which combines these immunisations was added to the National Immunisation Program for children aged 18 months.1
This is a live attenuated vaccine containing the following viruses:
- Schwarz measles
- RIT 4385 mumps
- Wistar RA 27/3 rubella
- varicella-zoster OKA.
The National Immunisation Program recommends children receive the MMR vaccine at 12 months and this new tetravalent vaccine at 18 months.1 The tetravalent vaccine is also recommended for four-year-olds who have not been previously vaccinated against varicella. Injections should be given subcutaneously in the anterolateral thigh of children under one year and in the deltoid area of children over one year.
In children aged 11–23 months, immune responses to the tetravalent vaccine were comparable to immune responses to the MMR and varicella vaccines given separately.2 However after the first dose, fever was more common with the tetravalent vaccine.
Other studies have shown that the tetravalent vaccine can be given to children as a second dose to the MMR vaccine regardless of whether they have also received the varicella vaccine.
The vaccine is contraindicated in pregnant women or people with immunosuppression. This includes those with immunodeficiencies or untreated malignant disease, or those receiving immunosuppressive therapy, high dose steroids or radiotherapy. The vaccine should also not be given to people with hypersensitivity to neomycin or egg.
This combination vaccine appears to be comparable to the individual MMR and varicella vaccines, but may be preferable as one less injection is required. However, caution is urged in children with a history of febrile convulsions as there is an increased risk of fever with the first dose. Temperature should be monitored for 5–12 days after vaccination. Giving the vaccines separately may be a better option in some children.
The Transparency Score is explained in New drugs: transparency', Vol 37 No 1, Aust Prescr 2014;37:27.
- Strassels SA, Sullivan SD. Clinical and economic considerations of vaccination against varicella. Pharmacotherapy 1997;17:133-9.
- Scuffham P, Devlin N, Eberhart-Phillips J, Wilson-Salt R. The cost-effectiveness of introducing a varicella vaccine to the New Zealand immunisation schedule. Soc Sci Med 1999;49:763-79.
Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.