What is MR vaccine?
Measles and Rubella vaccine together is called MR vaccine.
What is the MMR Vaccine?
MMR vaccine has Measles, Mumps, and Rubella.
This is not included in the Universal Immunization Programme(UIP) in India till date.Only Measles Is included in UIP in the government sector.This new MR drive aims to include Rubella too.So that eventually MR, that is measles and Rubella will be a part of UIP.
According to Indian Association of Pediatrics (IAP), the MMR vaccine should be a part of all kids immunization programme after one to one discussion with parents.
Doses of MMR :
- Two doses with at least 4 weeks gap.
- As early as 9 months(IAP recommendation)
- The second dose must follow in the 2nd year of life. Can be given at any time, 4-8 weeks after the 1st dose.
- No need to give stand-alone measles vaccine
- The maternal immunity is said to be there until 9 months.
Benefits of MMR :
Protection against, Measles, Mumps, and Rubella.
Measles can cause:
Serious complications and death.
- SSPE(Subacute sclerosing panencephalitis) is a very serious long-term sequela
- Otitis media
Mumps can cause:
- Fever with painful parotid inflammation
- Brain infection(encephalitis)
- Infection of gonads(oophoritis/orchitis) which can lead to sterility in pubertal kids.
Other complications of Mumps
- Aseptic meningitis
Rubella can cause:
- Mild infection in adults.
- Most common presentation: Low-grade fever, Lymph node swelling, and malaise.
- Up to 50% infection may be subclinical.
Complications of Rubella infection :
- Thrombocytopenic purpura
The danger of Rubella infection :
Teratogenic infection in pregnant women.If infection occurs in unimmunized mothers in the first trimester , it can cause
- Birth defects including cataracts, hearing loss, mental retardation, congenital heart defects.
Measles is very infectious. It is mainly transmitted from person to person by a cough and cold.Through large respiratory droplets. Transmission through aerosol for up to 2 hours after a person with measles occupied the area has been documented.
After exposure, 90% or more susceptible people can have measles. The virus is transmitted from 4 days before the rash becomes visible to 4 days after the rash appears.
Measles vaccine is now provided free in India Universal Immunisation Programme in all Government Immunization facilities.
About Measles vaccine
- Two doses
- 1st at 9 to 12 months
- Second at 15 to 18 months
- At least 4 weeks gap between the two doses.
The second dose is not a booster. 2% and 5% of children don’t develop measles immunity after the first dose. The second dose of measles vaccine aims to immunize those ,not protected by the first dose.
In India, children are given measles vaccine (MV) after 9 months of age. Measles has serious mortality and morbidity stats.
Seroconversion for measles is lower in children receiving first dose before or at 12 months of age.This is suspected to be due to persisting maternal antibodies.But even then it is given as early as 9 months because of the serious nature of the infection.
The rate of seroconversion with different ages of measles vaccination:
- 87% at 9 months,
- 95% at 12 months
- 98% at 15 months
Infants who receive measles vaccine before 12 months of age , should be given two additional doses of measles antigen-containing vaccine at 12-15 months and 4-6 yr of age(2,3).
Mumps is as infectious as influenza and rubella, but less than measles or varicella.
2 Doses of mumps vaccine are needed for a long-lasting protection(4)
RA27/3 vaccine for rubella is highly seroconverting. Immunity after a single dose is lifelong. But rubella antibodies may fall below detectable levels with time
The MR Vaccine Campaign: Why are they doing it?
Polio, Measles, and Rubella are 3 diseases which occur in humans. So if it’s controlled in humans we have a great chance of eradicating it. On 5th February 2017, the Union Health Ministry launched the measles-rubella (MR) vaccination campaign in Bengaluru.
This campaign started from Karnataka, Tamil Nadu, Puducherry, Goa, and Lakshadweep.That’s about 3.6 crore children. Following the campaign, the measles-rubella vaccine will be introduced in routine universal immunization.
Kerala starting the Measles-Rubella (MR) vaccine drive campaign in October (part of National Immunisation Programme).
MR Vaccine campaign plan :
Children between 9 months and less than 15 years: a single shot of measles-rubella vaccination.
Will they need it even if they have taken earlier vaccination against Measles and Rubella?
Yes, irrespective of their previous measles/rubella vaccination status or measles/rubella disease status this vaccine will be given.
How much will this cost?
MR vaccine will be free across the states. At school health facilities.
Does the extra dose cause problems ?
The vaccine contains attenuated (non-virulent) viruses. If a child is already immune, the body will not respond to the extra dose.So the new MR in already vaccinated children is unnecessary, but harmless.
If a child has received no MMR vaccine previously they should get the MR vaccine.
If a child has received 2 doses of MMR vaccine, with at least 4 weeks gap in between, then he/she need not take any further dose of MMR /MR. But the government recommends blanket coverage irrespective of earlier immunization status.
MMR was given only in the private healthcare sector. The private sector covers only 25% of children. So it makes administrative sense to try for universal coverage through this special drive.
Also read vaccine and immunity
1)If a child has no previous Measles vaccine, MMR vaccine: Child gets MR vaccine
2)If a child has previous 1 measles vaccine: Child gets MR vaccine
3)If a child has 1 previous, MMR Vaccine:
- The child needs the other dose of MMR vaccine for complete protection against mumps. Since 2 doses of the mumps vaccine are needed for adequate protection.
- The child gets MR vaccine. The Government suggests blanket coverage. It will be an extra dose, but experts opine it is harmless
4)The child is less than 15 years and has received all doses of measles vaccine or MMR vaccine
- The child gets MR vaccine. Again the Government suggests blanket coverage.
The Government aims to give immunization schools, hospitals, and health centers. It’s important that proper vaccine chain, sterility, and infrastructure for managing any vaccine-related event is properly planned(especially in schools) to avoid MR Vaccine side effects and complications. The lack of awareness drive or poor planning should not cripple an otherwise great initiative.
For parents: Don’t forget to talk to your doctor before deciding.
Do you know about the MR vaccine? What’s your child’s immunization status?Comment below to let me know.
Reader Query :
T K ANUJEE
Dr. Amrita, your article is very informative. I would like to know other than preventing diseases, does vaccination boost the immunity of children? if vaccination is aimed at boosting immunity, by announcing blanket MR, should we infer that the earlier MMR was futile? You have stated the experts opined the extra dose ” harmless”. Is it same as taking one more roti for company sake, on a full stomach?
Vaccination does provide protection and improves the immunity of an adequately vaccinated person. But there are exceptions. Government health policy recommends the best practices. Blanket MR helps to avoid confusion and missed dose. Your pediatrician can help you decide accordingly. In cases like these, an inadvertent miss is more worrying than the extra dose.
Updated 2018 November
All information provided is for awareness and educational purposes.All immunization or health decisions should be taken after consultation.
2)Mason WH. Measles. In: Kliegman RM, Behrman RE, Stanton BF, Jenson HB, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia Pa: Saunders Elsevier; 2007. pp. 1331–7.
3)Response to second dose of MMR vaccine in Indian children Sunil Gomber, Shilpa Khanna Arora, Shukla Das, and V. G. Ramachandran Pubmed
4) Antibody response to measles immunization in India J. S. Job, T. J. John, and A. Joseph Pubmed