What to Know About the ProQuad Combination Vaccine

Little girl having an injection
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Proquad is indicated for use in children 12 months to 12 years of age who need to be vaccinated against the measles, mumps, rubella, and varicella viruses. This used to mean getting two separate shots, the MMR and Varivax (chickenpox) vaccines, which according to the latest immunization schedule, most kids get when they are about 12 to 15 months old, with boosters at age 4 years.

Like the separate MMR and Varivax vaccines, ProQuad is an attenuated live virus vaccine.

Other facts about ProQuad include:

  • ProQuad is made by Merck
  • You must wait at least 1 month between getting a regular MMR vaccine and ProQuad
  • ProQuad may be given at the same time as the Hib and HepB vaccines
  • ProQuad may be used as the first dose of MMR and Varivax
  • ProQuad may be used as the second dose of MMR if the child also needs a chicken pox shot

With the combination vaccines ProQuad and Kinrix (IPV plus DTaP), most preschoolers can now get away with just two shots (still getting four vaccines) before they start kindergarten.

Warnings and Side Effects

ProQuad should not be given to certain children, including children:

  • who have had anaphylactic reactions to neomycin or a hypersensitivity to gelatin or other components of ProQuad
  • with malignant neoplasms, such as leukemia and lymphoma
  • on immunosuppressive therapy
  • who have immunodeficiencies
  • who have a family history of congenital or hereditary immunodeficiency, until testing is completed

Children should also not get ProQuad if they:

  • have active untreated tuberculosis
  • have an active febrile illness and the fever is above 101.3 degrees
  • are pregnant

Your pediatrician will likely also be cautious before giving ProQuad to your child if he has a history of cerebral injury, seizures, a family history of seizures, egg allergy, contact dermatitis from neomycin, thrombocytopenia, or if he is supposed to avoid the stress from a fever.

The safety profile of ProQuad is similar to that of the separate MMR and Varivax vaccines.

Children were more likely to have a fever, a rash at the injection site, and a measles-like rash after getting ProQuad, but were less likely to have pain, tenderness, and soreness at the injection site, than if they got separate MMR and Varivax shots.

Post-marketing studies have found an increased rate of fever and febrile seizures in kids getting ProQuad vs. those getting separate MMR and Varivax shots.

The most common side effects of ProQuad include injection site reactions:

  • pain/tenderness/soreness
  • erythema (redness)
  • swelling
  • ecchymosis (bruising)
  • rash

and systemic reactions:

  • fever greater or equal to 102 degrees
  • irritability
  • measles-like rash
  • chicken pox like rash
  • rash
  • upper respiratory infection
  • viral exanthema
  • diarrhea

What You Need to Know

Other things to know about ProQuad include that:

  • Unlike other combination vaccines, the Advisory Committee on Immunization Practices (ACIP) does not recommend ProQuad vs. the separate MMR and chickenpox vaccines for the first dose of the vaccines in young children. Because of the increased risk of fever and febrile seizures, unless a parent prefers ProQuad, they do not "express a preference for use of MMRV vaccine over separate injections of equivalent component vaccines".
  • ProQuad is still preferred for the second dose of measles, mumps, rubella, and varicella vaccines and for kids over 47 months getting their first doses.

Whichever vaccines you choose, ProQuad for separate MMR and chicken pox vaccines, get educated and get your kids vaccinated and protected.

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Article Sources
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  1. U.S. Food & Drug Administration (FDA). PROQUAD. Updated September 17, 2020.

  2. Centers for Disease Control and Prevention (CDC). Immunization Schedules. Updated February 12, 2021.

  3. Merck & Co., Inc. ProQuad® Measles, Mumps, Rubella and Varicella Virus Vaccine Live Suspension for subcutaneous injection [package insert]. Updated October 2018.

  4. Wang L, Zhu L, Zhu H. Efficacy of varicella (VZV) vaccination: an update for the clinicianTher Adv Vaccines. 2016;4(1-2):20-31.  doi:10.1177/2051013616655980