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 1st dose at 12-15 months and 2nd 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 1st dose vs MMR+V. In 2009, the ACIP revised its guidance to recommend separate injections of MMR+V for the 1st 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.
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 (1st dose cohort), and/or 4-7 years (2nd dose cohort). The primary outcome measures were vaccine coverage for 1st (by 19 months) and 2nd (by 7 years) doses, percent with delays in vaccination, and length of vaccine delay.
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).
MMRV vaccine is used infrequently as a 1st dose in this commercially insured population. Despite the ACIP recommendation to use MMRV for 2nd dose, this vaccine is underutilized; use of MMR and V instead may result in delayed vaccination. Increased use of MMRV vaccines for the 2nd dose between 4-6 years of age has the potential to improve vaccine compliance and coverage, and reduce the number of physician office visits.
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