faqs on measles rubella vaccination campaign including routine immunization

Training Workshop for Measles-Rubella Vaccination Campaigns

(FAQs) Frequently asked questions

on MR vaccination-

campaign


Who should be vaccinated?

• All children who have completed 9 months of age and are below 15 years of age regardless of previous vaccination status with measles/rubella vaccine and regardless of measles/rubella infection in the past

• Malnourished children should be vaccinated on a priority basis, as they are more likely to have complications like diarrhea and pneumonia

• Children with minor illnesses such as mild respiratory infection, diarrhea, and low grade fever

FAQs for Doctors/ Parents



Does the child need MR vaccination campaign dose even if she/he has had all her/his routine vaccinations?

• Yes, the campaign dose will be administered to all the children falling between the age group of 9 months to <15 years of age, irrespective of any past history of disease or vaccination.

• MR campaign dose is in addition to RI dose.


Who should NOT be vaccinated?

Do not vaccinate if the child has:

– High fever or other serious disease (eg: unconscious, convulsions, etc).

– Hospitalized children.

– History of a severe allergic reaction to measles/rubella vaccine in the past



FAQs for DoctorsIt is said that if rubella vaccine is given before 1 year it will interfere with persisting rubella antibodies? Then how are we vaccinating children of 10 months age?

Rubella vaccine is being given as a combined vaccine i.e. Measles-Rubella (MR) vaccine. For eliminating measles, two doses are required which are given at 9-12 months and 16-24 months. Therefore, MR vaccine will also be given as two dose schedule. As per WHO position paper on Rubella “An RCV is normally administered as a subcutaneous injection, usually at age 12–15 months, but it can also be administered to children aged 9–11 months and to older children, adolescents and adults. In some countries, rubella vaccine is given as MR or MMR, and the age of administration follows the schedule for measles –that is, the first dose is usually given at 9 months or 12–15 months and a second dose at 15–18 months or 4–6 years”

The maternal antibodies for both measles and rubella also wanes to a significant level after 9 months of age, so also reducing the antibody interference, thus making the child susceptible to both measles and rubella infection. Rubella vaccine efficacy has also been proven to be above 90% when given at 9-12 months of age. Thus there is no harm in giving rubella vaccine at 9 months of age, as this protects the child from both measles and rubella disease.


FAQs for Doctors

Why is it necessary to immunize male children against rubella?

If a male child develops rubella there is a chance that he may infect other individuals like a pregnant mother which may result in Congenital Rubella Syndrome. Thus, it is important that everyone is protected against rubella. If male children are not protected, then the transmission of rubella virus will not stop and continues to circulate among male children. Those constitute nearly 50 percent population and enough to sustain ongoing rubella transmission leading to outbreaks. This sustained rubella transmission in the community is a potential threat to antenatal mothers in early pregnancy, living in the family and community. So, if we do not stop transmission in the population, we cannot control or eliminate rubella/CRS in our country.


FAQs for Parents

How many days of gap should be given if a child is already vaccinated, and what is the percentage of immunity that will be added for another dose if it is administered?

No gap is required for campaign dose administration. The additional dose is to create the herd immunity through increased population immunity, that prevents transmission of measles and rubella virus, thus everyone in community is protected against measles and rubella. The aim of additional dose is to stop transmission and eliminate measles and control rubella in our country population.


What should be the minimum time interval between a routine vaccination and campaign vaccination?

• If the campaign dose is due as per the guideline, it will be given irrespective of any gap between the last RI received by the child, as this is a one-time activity and there is no harm done to the child with an extra dose.

• However, following a campaign vaccination, the next due date for RI dose can be deferred to a minimum gap of 4 weeks as a standard recommendation between two doses of live injectable vaccines.

FAQs for Parents/ Doctors


FAQs for Parents

A 14 year old girl is having menses. Should the girl get the MR vaccine during campaign?

– Yes, this girl should be immunized with the campaign MR vaccine. There is no harm in vaccinating girls who are having menses.


Can MR and JE vaccine be given together in Routine Immunization?

• Yes,

• In JE endemic districts, both MR and JE vaccine should be given together at the same time but on different arms.

• When for any reason vaccines couldn’t be given at the same time/day, then a minimum gap of 4 weeks has to be maintained as a standard practice between any two live vaccines.

FAQs for Doctors


FAQs for Parents/ DoctorsFollowing MR vaccination, what type of adverse events may happen after mandatory observation period in school?

Adverse reactions following MR vaccination are generally mild and transient and can be as follows:

Slight pain and tenderness at the site of injection may occur within 24 hours, sometimes followed by mild fever.

About 7–12 days after vaccination, up to 5% of measles vaccine recipients may experience fever of at least 39.4 °C for 1–2 days. The fever may occasionally (1 in 3,000 injections) induce febrile seizures.

A transient rash may occur in about 2% of vaccinated children.

Thrombocytopenic purpura occurs in approximately 1 in 30,000 vaccinated individuals.

Arthralgia/ Joint pain can also occur when given in adolescent children or adults.

Anaphylaxis is a very rare event that can happen in 1 in 1- 3 million MR vaccine doses, for which there is an AEFI management kit available for use by the trained medical officers during the campaign. Adverse events, with the exception of anaphylactic reactions, are less likely to occur after receipt of a second dose of MR containing vaccine.


FAQs of Parents/ Doctors

How Government has set-up AEFI centres/teams to tackle AEFI?

All districts have prepared campaign micro-plan and also formed AEFI committees. The district officials will make sure that all the session sites are linked to the nearest AEFI management centres. In addition, all the medical officers will be trained in management of AEFI and all the session sites will have contact details of the AEFI centres including a specially prepared AEFI Management kit.


FAQs for Doctors

How can we enhance knowledge of medical practitioners on adverse events following MR vaccine?

The workshops and training sessions have been held in the states giving information on MR campaign which included information on AEFI also. These workshops have been attended by the medical officers and members of IAP and IMA. In addition there will be a special half day training & orientation of all the doctors both from government and private sectors in AEFI management, using the standard AEFI management-kit, before the campaign start date.


FAQs for Parents

Whether vaccinating additional dose of MR causes any adverse reactions?

No. MR vaccine is a safe vaccine used world-wide across all countries and any adverse events reported following vaccine administration, will be reported and managed according to existing national AEFI surveillance guidelines and management protocols.


FAQs for DoctorsHow much diluent to be used for reconstitution of MR vaccine?

• Use full quantity of supplied diluent for reconstitution of MR vaccine. e.g. for 10 dose MR diluent bundled with the vaccine .

• The reason for this is to take care of the unavoidable vaccine wastage that occurs due to:

o some dead space in the hub and needle

o sticking of the vaccine to the inner wall of the vaccine vial

• Therefore, it is important to draw the entire amount of diluent from the ampoule to reconstitute MR vaccine .


If a child received one dose of MR vaccine during the MR Campaign, should he/she receive the routine dose of measles/MR vaccine?

• Yes, the child will receive routine doses of MR vaccine according to the National Immunization Schedule, irrespective of any MR campaign dose in the past.

FAQs for Parents/ Doctors


FAQs for Parents/ DoctorsWhat are the plans for parents’ presence during immunizing Pre-school children?

Parents may come for their children‘s vaccination if interested, although this is not mandatory.

We observed different words used in communications for MR Campaign -‘mandatory’ v/s ‘support sought for elimination’. Can you clarify?

After eradicating polio from the country, India is committed to eliminate measles and control rubella and CRS in the country. Therefore, every parent is requested to get their child/children vaccinated for Measles and Rubella during the Campaign; i.e. an additional MR vaccine dose given to every child in the age group of 9 months to less than 15 years.


Why MR and not MMR vaccination?

• Measles kills nearly 49,200 children every year in India.

• Rubella infection during pregnancy can cause abortion, still birth and may lead to multiple birth defects in the new born, like blindness/deafness heart defects (known as Congenital Rubella Syndrome)

• However, there is no enough evidence to suggest that mumps is a disease of public health importance.

• Therefore, MR vaccine is being introduced instead of MMR vaccine.

FAQs for Doctors


FAQs for Parents/ DoctorsA 11-month old child has got one dose of measles vaccine through routine immunization one week before start of campaign. Should the child get the campaign dose now?

– Yes, this child should be immunized with the campaign MR dose too. There is no added risk of side effects because of the second dose. In addition, the child should be brought for routine 2nd dose of MR vaccine at 16-24 months of age.


FAQs for Doctors

If a child due for measles vaccine comes to the Routine Immunization session during MR campaign, should the child receive measles dose?

• During MR campaign, measles vaccination in Routine Immunization will be withheld.

• No measles/MR vaccination will be done during RI.

• MR vaccine will be introduced in RI after completion of campaign.

• However, ANM should ensure that child receives MR campaign dose during the campaign period.


If a child received one dose of MR vaccine during the MR Campaign, should he/she receive the routine dose of MR vaccine?

• Yes, the child should receive routine doses of MR vaccine according to the National Immunization Schedule, irrespective of any MR campaign dose in the past.

FAQs for Doctors


FAQs for Doctors/ Parents If a child has received MR vaccine before 9 months of age, is it necessary to repeat the vaccine later?

• Yes.

• According to the Immunization Schedule, the MR vaccine needs to be administered as MR-1 at 9-12 months of age and MR-2 at 16–24 months


What should be the minimum time interval between a campaign vaccination and routine vaccination?

• Following a campaign vaccination, the next due date for RI dose can be deferred to a minimum gap of 4 weeks as a standard recommendation between two doses of live injectable vaccines.

FAQs for Doctors


Where will the children be vaccinated during the campaign?

• All eligible children will be vaccinated at the following session sites:-

– Schools : 1st week of campaign

– Health sub-centres, anganwadi centres, fixed outreach sessions and mobile posts in villages and urban areas: 2nd & 3rd week of campaign

– 4th week/last week for sweeping/repeat activity for missed areas/pockets

FAQs for Parents

Vaccination Campaign is from 7th to 28th February 2017


FAQs for Parents/ Teachers/ Doctors

How absentees will be covered at school?

The absentees will be covered at the nearest health facility or

fixed session sites in other adjacent/nearby outreach sessions.

What is the plan to cover out of school children?

Out of school children will be covered in outreach session sites in

the second week of campaign, planned in the community and also from hospitals as fixed sites.


FAQs for Parents

Will the medical help be present at the venue of administering Injection? If yes, how many doctors per school?

All the schools will be linked to the nearest AEFI management centre. The contact details will be available with the vaccinator and school health facility. However, doctors will be on standby with vehicles to reach the school when needed following reports of any serious/sever AEFI.


FAQs of Parents/ Doctors

Is Government considering roping private medical practitioners in this drive? Do we have any such list? Can parents opt for private practitioners?

Yes, the government has sent letters to Indian Academy of Paediatrics (IAP) and Indian Medical Association (IMA) to participate in the MR campaign. The private practitioners, who will be participating in the campaign, will be provided with the MR vaccine; and at the end of each day they will have to submit the report of children vaccinated and vaccines and logistics received and utilized. They will have to follow the MR campaign guidelines laid by the GOI and State Government.

Parents can opt for private practitioners but will have to show the duly filled vaccination card for the MR campaign to the MR campaign team.


FAQs for Parents

Is it safe to give multiple injections at one visit during Routine Immunization?

• Yes, it is safe for child to receive multiple injections at one time.

• Many countries including India have immunization schedules where children receive multiple vaccine injections at one visit.


FAQs for Parents/ DoctorsWhen will MR vaccine be available for administration under the RI programme?

• MR vaccine will be available for administration under the RI programme after the completion of MR Campaign.

Which child is eligible for MR vaccine under the RI programme?

• Every child who is eligible for either first dose or second dose of measles vaccine in his/her RI schedule will be provided with combined MR vaccine .


FAQs for DoctorsTill what age MR vaccine can be given to children under Routine Immunization?

• Two doses of MR vaccine should be given at 9-12 months and 16-24 months of age. However, if a child misses the scheduled dose, MR vaccine can be given till 5 years of age.


Age Vaccines given

Birth BCG, OPV, Hepatitis B

6 Weeks OPV 1, Pentavalent 1, Rota1*, fIPV1

10 weeks OPV2, Pentavalent2, Rota2*

14 weeks OPV3, Pentavalent3, Rota3*, fIPV2

9-12 months MR1, JE1*

16-24 months MR2, JE2*, DPT-B, OPV –B

5-6 years DPT-B2

10 years TT

16 years TT

Pregnant Mother TT1, 2 or TT Booster**

*in select states /districts only** one dose if previously vaccinated within 3 years

Revised National Immunization Schedule


FAQs for Parents

What does a vaccination team consists of? How many students will be considered for vaccination by one team?

A vaccination team will have:

1 or 2 vaccinators, which are Auxiliary Nurse Midwife (ANM)/Male HWs/Lady Health Visitor (LHV)/ retired ANMs or nurses or LHVs/ Pharmacists/Doctors

1 ASHA /Link worker or similar staff (for urban areas)

1 Anganwadi Worker (AWW)

1 Volunteer

In case either ASHA or AWW is not appointed/ available she can be substituted by one volunteer

For every 100 children two teachers will be allotted

One vaccinator will target approximately 150 – 200 children in school, and approximately 100 - 150 children in outreach session/s.


What about the quality of the Vaccine given during the campaign?

• A very potent vaccine with International standards (as per WHO standards) is given during the campaign.

• There is Vaccine Vial Monitor (VVM) on top of each vial which indicates the quality of the vaccine given.

Frequently asked questions


If you have children ages less than 15 years; Keep a look out for any

advice/directive received from the child’s school/educational institute

regarding MR campaign

Permit your school-going child to be vaccinated at the school during MR

campaign

Encourage other parents with children in the target age group to participate

in the MR campaign and complete the child’s RI schedule as per the

immunization schedule

Promptly seek treatment or act as recommended by health worker during

any sign of an adverse event following immunization (if any)

Key Messages


Thank You

faqs on measles rubella vaccination campaign including routine immunization

Healthcare