- The document summarizes plans for Measles Immunization Day and an MR (measles-rubella) vaccination campaign in India on March 16, 2019. It discusses measles and rubella diseases, the WHO goal to eliminate measles and control rubella by 2020, and details of the MR vaccine, including its benefits, administration, storage, adverse reactions and contraindications. The campaign aims to vaccinate over 95% of children aged 9 months to 15 years to boost population immunity against both diseases. Careful planning and coordination is underway between health departments and other stakeholders to make the campaign a success.

1. MEASLES IMMUNIZATION DAY
&
MR CAMPAIGN
16TH MARCH, 2019
BY
DR. KRITI SINGH
JR-1
GSVM, MEDICAL COLLEGE, KANPUR

2. CONTENTS
• Introduction
• Who plan
• Measles disease
• Rubella disease
• What, Who and Where of MR Vaccination
• MR Vaccination
• MR campaign

3. INTRODUCTION
• Measles is highly contagious viral disease which affects mostly children. It is one the leading
causes of death and disability among young children.
• Measles Immunization Day is celebrated on 16th March every year to make people aware
about this deadly disease and how they can deal with this.
• Measles vaccination resulted in 80% drop in measles deaths between 2000 and 2017 worldwide
• Global measles mortality has reduced from 546, 800 in 2000 to 114,900 in 2014 (79%
reduction).
• In 2017, 85% of the world’s children received one dose of measles and 67% of children
received second dose.
• It saved 21.1 million lives in this duration making measles vaccine a success in public health.

4. WHO SOUTH-EAST ASIA REGIONAL STRATEGIC PLAN
2014–2020
GOAL: Elimination of measles and control rubella / CRS by 2020.
achieve and maintain at least 95% population immunity with two doses against
measles and rubella within each COUNTRY’S EACH DISTRICT through routine
and / or supplementary immunization.
 develop and sustain a sensitive and timely case-based measles, rubella and CRS
surveillance system in each country.
strengthen support and linkages to achieve the above three strategic objectives.

5. • As per the reported coverage in Health Management Information System (HMIS),
the country-wide coverage of measles-containing vaccine first dose (MCV1)
~90%.
• The measles-containing vaccine second dose (MCV2) national coverage
~66%.
• Following the South-East Asia (SEA) Regional Committee resolution in
September 2013, setting the goal for measles elimination and rubella /
congenital rubella syndrome (CRS) control by 2020

6. • The National Technical Advisory Group on Immunization (NTAGI) in June,
2014 recommended introduction of measles-rubella vaccine in routine
immunization program, following a nationwide MR campaign.
• The doses of measles vaccine provided at 9-12 months and 16-24 months, will be
replaced by MR vaccine under routine immunization, immediately after the
campaign.
• Phased MR campaigns will target to vaccinate approximately 410 million (41
crores) children across the country.

7. MEASLES –DISEASE
• The measles virus is a contagious agent ,exclusive human pathogen.
• No animal reservoirs or vectors.
• Transmission through respiratory route or direct contact.
• When introduced into a non-immune population,100% of individuals become
infected and develop a clinical illness.
• In areas with tropical climates, cases occur during the dry season and in areas of
temperate climates, cases occurs during late winter and early spring.

8. • The average interval from exposure to development of clinical exposure is 14 days
(range 7–18 days).
• Patients are contagious from 4 days before the onset of rash till 4 days after
rash.
• Infection spreads via bloodstream to skin, conjunctivae and respiratory tract.
• The typical maculopapular rash appears3–4 days after a high fever peaking at 39–
40°C.
• The rash spreads from face and neck to the trunk and extremities.
• Patients improve normally by third day of rash and recover fully 7–10 days from onset
of the disease.

9. RUBELLA
• Rubella disease is caused by a Toga virus(RNA virus)
• The virus is transmitted via respiratory route.
• The infectious period is7 days before to 7 days after onset of rash, which disappears after 7–
10days.
• Infections in children are less severe and believed to provide life long immunity.
• The post rubella congenital anomalies are usually a multi-organ involvement known as
congenital rubella syndrome (CRS).
• CRS includes congenital cataract, congenital glaucoma, congenitaldeafness, congenital
cardiac defects like ventricularseptal defects, atrial septal defects, patent ductus
arteriosus, hepatosplenomegaly, microcephaly, hematological disorders like purpura.

10. WHAT IS A MR VACCINATION CAMPAIGN?
A MR Vaccination Campaign is a special campaign to vaccinate all children in a wide
age group with MR vaccine in all states.
MR campaign dose - given to all children,(both previously vaccinated and
unvaccinated), who belong to the target age group (9 months to <15years).
The goal of the MR campaign is to quickly enhance the population immunity to both
measles and rubella in order to reduce deaths from measles and disabilities like CRS
due to rubella infection in early pregnancy.
The campaign must immunize more than 95% of the target age group children in
schools as well as outreach session sites with a country goal to achieve 100% coverage
of targetedchildren with safety.

11. WHO SHOULD BE VACCINATED WITH MR
VACCINE
Campaign :All children in the target age group are vaccinated irrespective of
previous immunization status or history of measles / rubella disease;
Routine program, MR vaccine will be administered in two doses. The first dose is
given to children between 9 and 12 months of age and a second dose is given at
16-24 months of age.

12. MEASLES–RUBELLA (MR) VACCINE
• The Measles-rubella (MR) vaccine used is live attenuated vaccine and safe and
effective.
• It is available either as single antigen vaccines or in combination with either
rubella(MR) or mumps and rubella (MMR) vaccines and with mumps, rubella
and varicella (MMRV) vaccine.
• The protective immune response to each of the components remains same in all
forms
• Most of the live, attenuated measles vaccines used are the Edmonston Zagrab
strain of measles virus.

13. • Currently licensed vaccines are live, attenuated RA 27 / 3 strain of rubella virus.
• Other vaccine strains include the Matsuba, DCRB19, Takahashi, Matsuura and
TO-336 strains in Japan. The BRD-2 strain in China.
• Vaccination results in high (>95%) seroconversion rates and protection is
generally assumed to be lifelong.

14. MR VACCINE CHARACTERISTICS
• MR vaccine (before reconstitution) is stable and stored between 2 °C to 8 °C
and the reconstituted vaccine is to be used within 4 h.
• The open vial policy is NOT applicable to reconstituted MR vaccine.
• It is very sensitive to sunlight.
• Vaccine induces both humoral and cellular immune responses for both measles
as well as rubella.

15. MR VACCINE DOSAGE, FORMULATION AND
ADMINISTRATION
DOSE:
-MR vaccine is lyophilized , each containing
-MR vaccine dose of 0.5 ml and reconstituted with diluent
- Each ampoule of diluent for 10-dose vials of MR vaccine contains more than 5ml
diluent
-It is used to dilute a single vial of MR vaccine.
-The diluent should be kept at 2–8°C at least 24 h before use
 ROUTE OF ADMINISTRATION :Subcutaneous in the right upper arm.

16. MR VACCINE STORAGE AND SUPPLY
• The MR vaccine is very sensitive and should always be protected from sunlight.
• MR vaccine can be safely frozen and diluents should never be frozen.
• MR vaccine should always be reconstituted only with the diluent provided by the
manufacturer.
• Before reconstitution, diluents need to be stored in the cold chain between 2 and 8 ºC at least
24h prior to reconstitution, to be transported at 2–8 ºC (inside vaccine carriers/ cold boxes).
• The peak antibody response occurs 6 to 8 weeks after infection or vaccination.
• Immunity conferred by vaccination persist for at least 20 years or may be lifelong for most
individuals.

18. ADVERSE REACTIONS TO MR VACCINE
• Pain and tenderness at the site of injection followed by mild fever.
• About 5% may experience fever of at least 39.4°C for 1–2 days inducing febrile
seizures 1 / 3000. In 2% vaccinated children a transient rash may develop.
• Thrombocytopenic purpura occurs in 1 in 30 000 vaccinated individuals
• Arthralgia / joint pain occurs in adolescent children or adults.
• One serious and rare adverse effect is anaphylaxis(1 in a million)is less likely
after second dose of MR vaccine.

19. NO EVIDENCE OF :
-Encephalitis, permanent neurological sequelae or Guillain–Barré syndrome
following vaccination.
-No risk of inflammatory bowel disease or for autism.
-No exacerbation of tuberculosis.
 The vaccine protects against SSPE by preventing measles infection and CRS by
preventing rubella infection during pregnancy

20. CONTRAINDICATIONS TO MR VACCINE
• In person having high fever (>102 °F / 38–39 °C) or pregnancy.
• Persons with a history of an anaphylactic reaction to neomycin, gelatin.
• Severely immune-compromised HIV infection(full blown AIDS), advanced leukemia
or lymphoma or receiving immunosuppressive treatment.
• Patients on treatment of high-dose steroids, alkylating agents or antimetabolites.
• Vaccination should be delayed for 3–11 months after administration of blood or
blood products.
• Following MR vaccination, administration of such blood products should be avoided
for 2 weeks, if possible.

21. CONDITION NOT C/I FOR MR VACCINATION
• Malnutrition: In fact, malnutrition is an indication to immunize.
• Minor illness: such as mild respiratory infection, diarrhoea and low-grade fever
for less than 3 days without any hospitalization.
• Asymptomatic HIV-infected children.

22. TARGET GROUPS
• All children in age group of 9months to <15 years (not reached their fifteenth birthday)
irrespective of their prior vaccination status or history of Measles / Rubella illness.
• Immunization will be conducted on 4–5working days of the week.
• All children will be immunized at fixed posts / MR vaccination session sites (at schools,
hospitals, outreach – rural villages / urban wards).
• Additional special / mobile sites will be planned for HRA / P(High Risk Areas/ Populations
wherever required.
• Immunization session sites will operate in schools during the first week and at outreach and
mobile sites in the community in the second and third weeks with local flexibility.
• The fourth week will be for sweeping / repeat activity.

23. • Mobile teams will immunize children from a fixed location in HRAs / Ps.
• The supervisors have to ensure that areas having less than 90% coverage are
visited again by immunization teams to vaccinate the missed children. This should
not compromise the daily activity plan for the vaccinator teams
It is planned to vaccinate 100–150 children per vaccinator per day at an outreach
site 150–200 children per vaccinator in a school session site, with local variations.

24. STRATEGY PLAN
The Ministry of Health & Family Welfare, Govt. of India, has constituted a National
Taskforce on Measles and Rubella including members from WHO, UNICEF,BMGF(Bill
Gates & Melinda Gates Foundation),ICMR and National CDC.
PURPOSE : To monitor and review campaign planning & surveillance data.To guide
national action plan development for measles elimination & rubella/CRS control.
In addition, a Measles-Rubella Communications group led by UNICEF comprising
representatives from UNICEF, GHS(Global Health Strategies), ITSU(Immunization
Technical Support Unit), WHO, IAP to develop communication and media strategy.
Chief Media being the MOHFW.

25. • Robust communication, media strategy, including and social media
management & revised IEC materials:
• Communication and social mobilization efforts for immunization, to increase
coverage and help achieve measles, rubella, and CRS goals.
• Emphasis on effective communication and public engagement with parents,
schools, health professionals, community leaders and media, for address vaccine
concerns.
• Mr. Amitabh Bachchan is the national ambassador for MR campaign.

26. • State Immunization Officers for: tracking state task force meeting, organizing
state planning workshops also include review of progress, problems encountered,
proposed solutions and new action point.
• The district immunization officer: for providing intersectoral coordination at
district level through micro-planning of meeting, review meets, organizing
orientation for medical officers for AEFI management. PHC-level training of
supervisors, vaccinators and volunteers.
• District Magistrate / Chief Medical Officer/ District Immunization officer: For
regularly monitoring of preparedness, progress and implementation of MR
campaign.

28. SCHOOL BASED STRATEGY
Involvement of following is needed:
• Education Department
• WCD (ICDS)
• Health Department
• Urban Development
• Panchayati Raj
• IAP/IMA
• Others
 To improve coverage at schools increase duration of school phase by at least two week

29. AEFI MANAGEMENT PLAN:
all government health facilities and centres participating in the national
immunization programme (except sub-centres) will be AEFI management
centres.
 all MOs (both government and private) will be trained in AEFI management.
 the contact details of the closest AEFI management centre should be available
at every session centre.

34. THANK YOU