MR vaccine drive : What you need to know

What is the MR vaccine?

Measles and Rubella vaccine together is called the MR vaccine.

What is the MMR Vaccine?

MMR vaccine has Measles, Mumps, and Rubella.

Updated 14th January 2023

This was not previously included in the Universal Immunization Programme(UIP) in India. Only Measles was included in UIP in the government sector. Now in the Revised National Immunization Programme Measles/MR is being given in a phased manner. This new MR  drive aims to have Rubella too. So that eventually, MR, that is, measles and Rubella, will be a part of UIP. The MR vaccine drive aims to immunize 100% of at-risk children.

According to the Indian Association of Pediatrics (IAP), the MMR vaccine should be a part of all kid’s immunization programs after one-to-one discussions 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 a stand-alone measles vaccine
• 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.

• Encephalitis
• SSPE(Subacute sclerosing panencephalitis)  is a very serious long-term sequela
• Pneumonia
• Otitis media
• Diarrhea

Mumps can cause:

• Fever  with painful parotid inflammation
• Brain infection(encephalitis)
• Infection of gonads(oophoritis/orchitis) can lead to sterility in pubertal kids.

Other complications of Mumps

• Pancreatitis
• Deafness
• Aseptic meningitis

Rubella can cause:

• Mild infection in adults.
• Most common presentation: Low-grade fever, Lymph node swelling, and malaise.
• Up to 50% infections may be subclinical.

Complications of Rubella infection :

• Encephalitis
• 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 Congenital Rubella syndrome if the mother gets a Rubella infection in early pregnancy. These preconception tests are recommended to check for Rubella antibody levels.

• miscarriage
• stillbirth
• Birth defects include cataracts, hearing loss, mental retardation, and 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.

The measles vaccine is now provided free in India’s 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 four 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 the measles vaccine aims to immunize those, not protected by the first dose.

In India, children are given the measles vaccine (MV) after nine months of age. Measles has serious mortality and morbidity stats.

Seroconversion for measles is lower in children receiving the 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 nine months because of the severe nature of the infection.

The rate of seroconversion with  different ages of measles vaccination:

• 87% at nine months,
• 95% at 12 months
• 98% at 15 months

Infants who receive the 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 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 three diseases that occur in humans. So if it’s controlled in humans, we have a great chance of eradication. On 5th February 2017, the  Union Health Ministry launched the measles-rubella (MR) vaccination campaign in Bengaluru.

This campaign started in 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 started the Measles-Rubella (MR) vaccine drive campaign in October of that year (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 earlier vaccinated 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

FAQ:

1)If a child  has no previous Measles vaccine, MMR vaccine: Child gets MR vaccine

2)If a child has a previous one dose of the measles vaccine: The child gets MR vaccine

3)If a child has one previous MMR Vaccine:

• The child needs the other dose of MMR vaccine for complete protection against mumps. Since two doses of the mumps vaccine are needed for adequate protection.
• The child gets the 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 the measles vaccine or MMR vaccine

• The child gets the MR vaccine. Again the Government suggests blanket coverage.

5.If it’s a girl child and has her periods, can she get the vaccine?

Yes, she can. Having periods is not a contraindication to receiving the MR vaccine.

6. If the Child has a history of a severe allergy to MMR or MR vaccine previously, what will the parents do?

In that case, the MR vaccine may be avoided in case of a history of allergy to previous doses.

7. Who doesn’t get the vaccine now?

Any seriously ill child hospitalized, unconscious, or has seizures will not be given this vaccine at the present time . Consult your doctor about this.

The Government aims to give immunization to schools, hospitals, and health centers. Proper vaccine chain, sterility, and infrastructure for managing any vaccine-related event must be adequately planned (especially in schools) to avoid MR Vaccine side effects and complications. The lack of drive awareness 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.

Healthwealthbridge  Disclaimer health information provided on this blog is for general awareness and doesn’t in any way replace a doctor’s professional medical advice. Kindly consult your doctor in case of any decision regarding your health, and diet.

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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 is” harmless”. Is it the same as taking one more roti for company’s sake, on a full stomach?

Our Answer

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.

Disclaimer:

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Disclaimer:

All information provided is for awareness and educational purposes. All immunization or health decisions should be taken after consultation.

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Reference:

1)http://www.newindianexpress.com/nation/2017/feb/05/union-health-ministry-launches-vaccine-for-dual-protection-against-measles-rubella-1567286–1.html0

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

5)IAP MMR schedule

6)FAQ about MR vaccine campaign

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