Immunogenicity and reactogenicity of tetravalent vaccine for measles, mumps, rubella and varicella (MMRV) in healthy children: a meta-analysis of randomized controlled trials

Abstract

Background: Varicella is a highly infectious childhood disease. Tetravalent measles–mumps–rubella–varicella (MMRV) vaccine was introduced as one-syringe dose. Objective: To evaluate the immunogenicity and reactogenicity of MMRV vaccine versus trivalent MMR with varicella (V) vaccines in healthy children and to assess the respective safety issue. Methods: Randomized controlled trials (RCTs) were searched from the OVID databases. Trials were eligible if healthy children were randomized to receive MMRV or MMR+V vaccine. Seroconversions in serum antibody titers were the primary outcomes; adverse events were the secondary outcomes. Results: Ten RCTs with 8961 healthy children were identified. MMRV and MMR+V vaccines showed comparable immunogenicity against measles (relative risk [RR] = 0.99, 95% CI = 0.98–1.00), mumps (RR = 0.99, 95% CI = 0.97–1.00), rubella (RR = 1.00, 95% CI = 1.00–1.01) and varicella (RR = 0.98, 95% CI = 0.95–1.01). At least 93% of children in both groups had seroconverted within 6 weeks. MMRV group showed significantly higher incidences of fever (RR = 1.19, 95% CI = 1.09–1.31) and rash (RR = 1.23, 95% CI = 1.06–1.43). Conclusions: The immunogenicities of MMRV and MMR+V vaccines were comparable in healthy children; however, MMRV vaccination showed higher incidences of fever and rash.