Timeliness of Childhood Vaccination with the Combination Measles-Mumps-Rubella-Varicella Vaccine versus the Separate Measles-Mumps-Rubella and Varicella Vaccines in the United States

Background:

A combination measles mumps rubella varicella (MMRV) vaccine was first licensed for use in the United States in 2006. The ACIP has recommended that all children receive 2 doses of measles mumps rubella (MMR) and varicella (V) vaccines on the same schedule, with the 1^st dose at 12-15 months and 2^nd dose at 4-6 years and that MMRV vaccine could be used for each dose. Post-licensure studies suggested a small increased rate of febrile seizure when MMRV is used as the 1^st dose vs MMR+V. In 2009, the ACIP revised its guidance to recommend separate injections of MMR+V for the 1^st dose unless the parent or caregiver expressed a preference for MMRV. The objective of this study was to evaluate patterns of coverage and product utilization between 2006-16.

Methods:

This was a retrospective study of health insurance claims data in the MarketScan® Commercial Claims and Encounters Database from 2006-16. Two cohorts were defined: children eligible for vaccination with continuous enrollment during ages 12-23 months (1^st dose cohort), and/or 4-7 years (2^nd dose cohort). The primary outcome measures were vaccine coverage for 1^st (by 19 months) and 2^nd (by 7 years) doses, percent with delays in vaccination, and length of vaccine delay.

Results:

The analysis included 850,779 and 1,403,139 children in the 1st and 2nd dose cohorts, respectively. Of the children in each dose cohort (1st/2nd), 7%/14% received MMRV vaccines, 77%/62% received MMR and/or V, and 17%/24% had no records of receiving any of the vaccines by the milestone age. Of those receiving MMR and/or V vaccines, 9%/21% were missing one of the two vaccines, 70%/65% had both on the same day, and 21%/14% received them on different days with median delays of 3 months/1 year (1st/2nd dose, respectively).

Conclusion:

MMRV vaccine is used infrequently as a 1^st dose in this commercially insured population. Despite the ACIP recommendation to use MMRV for 2^nd dose, this vaccine is underutilized; use of MMR and V instead may result in delayed vaccination. Increased use of MMRV vaccines for the 2^nd dose between 4-6 years of age has the potential to improve vaccine compliance and coverage, and reduce the number of physician office visits.