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New combined measles mumps rubella varicella vaccine introduced

A combination vaccine for measles, mumps, rubella and varicella (MMRV) for children 18 months of age will be added to the National Immunisation Program (NIP) schedule from 1 July 2013.

What's changing?

As a result of its introduction, the second dose of the measles, mumps, rubella (MMR) vaccine, previously given at four years of age, will be brought forward to 18 months of age and will be delivered with the varicella vaccine (already scheduled at 18 months) as the combination MMRV vaccine. This move will provide earlier two-dose protection for children against measles, mumps and rubella, and is likely to result in an increased uptake of the second dose of MMR.

Children who have already received their 18 month varicella vaccination should still be immunised for measles, mumps and rubella (MMR) at four years of age. The four year MMR schedule point will remain until all children aged between 18 months and four years of age, as at 1 July 2013, reach the age of four years—that is, 31 December 2015.

Who is eligible to receive free MMRV vaccine?

A child presenting after 1 July 2013 who has received his or her 12 month MMR vaccination, but not the18 month varicella vaccine, should be vaccinated with MMRV at 18 months. Children aged between 18 months and 4 years who have missed the scheduled 18 month old varicella vaccine should receive MMRV as soon as possible.

Prior varicella infection is not a contraindication to vaccination; children who have been infected with chickenpox can still receive the MMRV vaccine. There is no known increase in adverse events from vaccinating those with pre-existing immunity to one or more of the vaccine components. Monovalent varicella vaccine will only be routinely available to the school immunisation program where a catch up program is delivered to children aged 10–13 years.

MMRV must be given as a second dose schedule vaccine following vaccination with MMR vaccine offered to children at 12 months of age. This is due to a small but increased risk of fever and febrile seizures when this combined vaccine was given as a first MMR-containing vaccine dose in one year olds.

A child aged between 18 months and 14 years who has never had the MMR vaccine (or whose vaccination status is unclear or unknown) should be administered MMR as a first dose. The MMRV vaccine can then be administered four weeks later as the second dose of MMR-containing vaccine. If MMR has previously been given, MMRV can be administered as the second dose.

If MMRV vaccine is inadvertently administered at 12 months of age as a first MMR dose, the dose does not need to be repeated. However, parents/carers should be advised of the small but increased risk of fever and febrile seizures compared with that expected following MMR vaccine.

Background

Measles immunity induced by one dose vaccination provides long-term immunity in most recipients. However, approximately 5% of recipients fail to develop immunity to the first dose of measles vaccine but achieve 99% immunity following a second dose of vaccine.

The combination MMRV vaccine has been shown in clinical trials (conducted in children 12 months to 6 years) to produce simular rates of seroconversion to all four vaccine components compared with MMR and monovalent varicella vaccines administered concomitantly at separate injection sites.

Further information

The Commonwealth Government plans to write to parents of children approaching 18 months of age in June 2013 to alert them to this change in schedule and advise them to make appointments with their immunisation service providers to obtain the new MMRV vaccine. This mail-out will occur monthly until June 2014.

Other campaign resource material, such as posters, an updated schedule for providers, media releases and website information has also been developed to raise awareness of the new vaccine’s availability. For further information see the Australian Immunisation Handbook 10th Edition 2013.

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