Rates for febrile seizures are lower among children aged 4--6 years (the recommended age for the second dose of MMRV vaccine, MMR vaccine, and varicella vaccine) than among children aged 12--15 months。

First Dose at Age 12--47 Months

The routinely recommended age for the first dose of measles, mumps, rubella, and varicella vaccines is age 12--15 months; children not vaccinated according to the routine schedule may receive the first dose of MMRV vaccine up to age 12 years. For the first dose of measles, mumps, rubella, and varicella vaccines at age 12--47 months, either MMR vaccine and varicella vaccine or MMRV vaccine may be used.

The 47-month cutoff was selected on the basis of the epidemiology of febrile seizures. Approximately 97% of febrile seizures occur in children aged ≤47 months.

Second Dose at Any Age and First Dose at Age ≥48 Months

Although the routinely recommended age for the second dose of measles, mumps, rubella, and varicella vaccines is 4--6 years, the second dose may be administered before age 4 years, provided ≥3 months have elapsed since the first dose. MMRV vaccine is licensed for use among children through age 12 years.

Contraindications and Precautions for MMRV Vaccine Use

Contraindications for use of MMRV vaccine include

• history of anaphylactic reaction to neomycin;
• allergic reaction to gelatin, other component of the vaccine, or after previous vaccination with MMRV vaccine, varicella vaccine or MMR vaccine;
• altered immunity (i.e., blood dyscrasias, leukemia, lymphomas of any type, or other malignant neoplasms affecting the bone marrow or lymphatic system);
• primary or acquired immunodeficiency including HIV infections/AIDS, cellular immune deficiencies, hypogammaglobulinemia, and dysgammaglobulinemia;
• family history of congenital or hereditary immunodeficiencies, unless the immune competence of the potential vaccine recipient has been demonstrated;
• systemic immunosuppressive therapy, including oral steroids ≥2 mg/kg of body weight or ≥20 mg/day of prednisone or equivalent for persons who weigh >10 kg, when administered for ≥2 weeks); and
• pregnancy.

Precautions for use of MMRV vaccine include

• recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on dose administered);
• history of thrombocytopenia or thrombocytopenic purpura;
• moderate or severe acute illness with or without fever; and
• a personal or family (i.e., sibling or parent) history of seizures of any etiology.

本文引自http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5903a1.htm 

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