2467. Timeliness of Childhood Vaccination With the Combination Measles–Mumps–Rubella–Varicella Vaccine vs. the Separate Measles–Mumps–Rubella and Varicella Vaccines in the United States

Abstract

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 first dose at 12–15 months and second 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 first dose vs. MMR+V. In 2009, the ACIP revised its guidance to recommend separate injections of MMR+V for the first 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 and 2016. Methods This was a retrospective study of health insurance claims data in the MarketScan® Commercial Claims and Encounters Database from 2006 to 2016. Two cohorts were defined: children eligible for vaccination with continuous enrollment during ages 12–23 months (first dose cohort), and/or 4–7 years (second dose cohort). The primary outcome measures were vaccine coverage for first (by 19 months) and second (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 second dose cohorts, respectively. Of the children in each dose cohort (1st/second), 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 (first/second dose, respectively). Conclusion MMRV vaccine is used infrequently as a first dose in this commercially insured population. Despite the ACIP recommendation to use MMRV for second dose, this vaccine is underutilized; use of MMR and V instead may result in delayed vaccination. Increased use of MMRV vaccines for the second dose between 4 and 6 years of age has the potential to improve vaccine compliance and coverage, and reduce the number of physician office visits.