Measles, Mumps, Rubella and Varicella vaccine (live) powder and solvent for suspension for injection 0.5ml pre-filled syringes

BackgroundThis study provides a comprehensive review of studies comparing the effectiveness of varicella vaccinations and the duration of their protection.MethodsWe conducted a systematic literature review to identify comparative studies evaluating the effectiveness of the varicella vaccine. A meta-analysis was performed to assess the effectiveness of one-dose and two-dose vaccinations, as well as the outcomes for moderate and severe illness, and the duration of protection, using random effects models.ResultsOut of 66 studies, 57 reported the effectiveness of a single-dose varicella vaccine, 28 examined the two-dose vaccination, and 25 focused on effectiveness against moderate to severe disease. Of these, 59 were observational studies and 7 were trials. Thirteen studies reported the duration of protection. The overall vaccine effectiveness for a single dose was 79% (76-82%; I² = 97.2%), while for two doses, it was 94% (93-96%; I² = 90.8%). The overall effectiveness against moderate or severe illness was 92% (90-94%; I² = 90.3%). The duration of protection showed a slight decline over time. Evidence suggests that both one and two doses of the varicella vaccine offer short-term protection, though this protection wanes rapidly.ConclusionThe two-dose vaccination demonstrated superior clinical efficacy compared to the one-dose vaccination, with protection slightly diminishing over time. These findings highlight the importance of implementing universal two-dose varicella vaccination programs in countries.Trial registrationPROSPERO Identifier: CRD42024589864.

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BackgroundAcute lymphoblastic leukemia is the most prevalent childhood cancer and the leading cause of cancer mortality before the age of 20. Although therapeutic advances have significantly improved survival, children and adolescents treated for acute lymphoblastic leukemia remain vulnerable to infections, largely preventable by vaccination, due to humoral and cellular immune dysfunction induced by disease and treatment.Materials and methodsThis systematic review, based on electronic databases, aims to evaluate antibody levels associated with potential protective immunity against vaccine antigens for diphtheria, pertussis, tetanus, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, influenza, varicella-zoster virus, yellow fever, pneumococcal, and meningococcal diseases in children and adolescents treated for acute lymphoblastic leukemia after completion of chemotherapy.ResultsA total of twenty-four studies published between 1981 and 2023 were included, comprising 1110 children and adolescents. Protective antibody levels ranged from 11% to 97% for diphtheria, 0% to 90% for pertussis, 20% to 100% for tetanus, and 11% to 95% for poliomyelitis. Haemophilus influenzae type b, protection ranged from 16.7% to 100%. Viral vaccines also showed heterogeneous responses, with protection rates of 25-79% for mumps, 16-86% for measles, 35-98% for rubella, and 23-75% for varicella-zoster virus. Antibody responses to pneumococcal and meningococcal vaccines were consistently low, with protection rates of 5-38% for pneumococcal studies and 12% in a single meningococcal study.ConclusionsThis review found a consistent and clinically relevant loss of vaccine-induced immunity in children and adolescents treated for acute lymphoblastic leukemia. The recommendation of vaccine booster doses for this vulnerable population, irrespective of serological status, may represent a more practical approach to ensuring adequate post-chemotherapy treatment protection.

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The purpose of this systematic review is to synthesize the available evidence on the immunogenicity and safety of live viral measles-mumps-rubella (MMR) booster/revaccination and varicella vaccination in children and adolescents with juvenile idiopathic arthritis. PubMed, Scopus, and Web of Science were systematically searched from inception to October 1, 2025, for studies including patients with juvenile idiopathic arthritis who had received live viral MMR or varicella vaccination and reporting immunogenicity, adverse events, vaccine-strain infection, breakthrough infection, or post-vaccination disease activity. Nine studies comprising 743 patients with juvenile idiopathic arthritis were included: five retrospective studies, three prospective cohort studies, and one open-label randomized controlled trial. Seven studies assessed MMR booster or revaccination, whereas two small prospective cohorts assessed varicella vaccination. MMR booster/revaccination was generally immunogenic and clinically safe in the short term, with no consistent increase in disease activity and no serious vaccine-related complications reported. However, 5-year seroprotection after MMR booster was lower among children receiving biologic disease-modifying antirheumatic drugs (DMARDs) at vaccination than among non-bDMARD users for measles (60% vs 86%), mumps (80% vs 94%), and rubella (60% vs 83%). Varicella vaccination induced protective antibodies in 82-83% of patients after two doses, but antibody levels were lower than those in healthy controls; VZV-specific cellular immunity was detectable in 72% in the larger cohort and appeared to persist longer than humoral immunity. No vaccine-strain varicella infection was reported, although mild breakthrough varicella occurred in some vaccinated patients.ConclusionIn clinically stable children with juvenile idiopathic arthritis, the available evidence supports the cautious use of MMR booster/revaccination and varicella vaccination under specialist supervision. The main residual concern is not a consistent safety signal but incomplete or less durable protection in selected biologic-treated patients, particularly for measles and rubella 5 years after MMR booster and for varicella in low responders. These findings support individualized vaccine timing and consideration of post-vaccination serology in selected higher-risk children.What is known• Live viral vaccines in children with juvenile idiopathic arthritis are used cautiously because of concerns about attenuated-virus-related adverse events, disease flare, and reduced immunogenicity during immunosuppressive therapy. • The evidence base is stronger for MMR booster/revaccination than for varicella vaccination, because MMR data include one randomized trial and several larger cohorts, whereas varicella data come from two small prospective cohorts.What is new• MMR booster/revaccination and varicella vaccination appeared generally safe in clinically stable children with juvenile idiopathic arthritis, with no serious vaccine-related complications or vaccine-strain infections reported in the included cohorts. • Five-year seroprotection after MMR booster was lower in biologic-treated children for measles, mumps, and rubella, supporting individualized vaccine timing and selected post-vaccination serologic monitoring.

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ObjectivesThis systematic review evaluated the efficacy and safety of vaccination in patients with paediatric, adolescent, and transitional-age rheumatic diseases as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.MethodsAn independent investigator systematically searched PubMed to identify relevant studies published by September 2022. The search results were divided into vaccines or toxoids for diphtheria, pertussis, tetanus, pneumococcus, influenza virus, hepatitis A virus, hepatitis B virus, human papillomavirus, poliovirus, measles virus, mumps virus, rubella virus, varicella zoster virus, and tuberculosis.ResultsA meta-analysis was not feasible due to the lack of randomized controlled trials with standardized patient backgrounds and conditions. Non-live vaccines are generally immunogenic and safe for patients with rheumatic diseases. In contrast, live attenuated vaccines should usually be withheld in patients on immunosuppressants, corticosteroids, biologics, or Janus kinase inhibitors. However, for necessary immunizations against measles, rubella, mumps, or varicella, live attenuated vaccines may be considered for patients receiving low-dose corticosteroids, methotrexate, or tumour necrosis factor inhibitors.ConclusionsThis review highlights the significant gap in evidence for paediatric populations compared with adults, particularly concerning new biological therapies and Janus kinase inhibitors. Further evidence is needed regarding vaccination in paediatric patients with rheumatic diseases.

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The Measles-Rubella-Zoster (MRZ) reaction is a test for the intrathecal synthesis of IgG antibodies against measles, rubella and varicella zoster viruses. Since the 1990s, it has been used as an adjunctive test to support the diagnosis of multiple sclerosis (MS), although it has no formal role in current McDonald diagnostic criteria and its clinical relevance remains debated. While early studies considered a single elevated antibody index (M, R or Z) as a positive result, the practice today requires at least two elevated antibody indices (M+R, M+Z, or R+Z), referred to as a polyspecific MRZ reaction (MRZ-2). MRZ-2 is the most specific laboratory marker for MS, with reported specificity exceeding 90%. However, sensitivity varies widely across studies, ranging from approximately 30% to over 70%. In the Czech adult MS population, MRZ-2 sensitivity was recently reported at 32%, markedly lower than the 67% pooled sensitivity reported in a meta-analysis of predominantly German cohorts. Broadening the panel of anti-viral antibodies (MRZ+) has been proposed to improve sensitivity, with parvovirus B19 and mumps virus being the most promising candidates. Further studies are required to determine whether an extended panel can increase sensitivity while maintaining high diagnostic specificity.

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