Measles FAQ

Measles Vaccine 2nd dosein Routine immunization

Ministry of Health and Family WelfareGovernment of India 2010

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Guide for Health Workers, with answers to Frequently asked Questions

2dosesand full protectionfrom measles

Measles Vaccine: 2nd Dose in Routine Immunization

Guide for Health Workers, with Answers to Frequently Asked Questions2


The Government of India (GoI) had introduced measles vaccine in its

Universal Immunization Programme (Routine Immunization) in 1985. GoI has now decided to introduce a second dose of measles vaccine in Routine Immunization (RI) following recommendations from national expert committees.

Twenty-one states and union territories (UTs) have >80% coverage of measles containing vaccine first dose (MCV1). These states are Andhra Pradesh, Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu, Delhi, Goa, Haryana, Himachal Pradesh, Jammu and Kashmir, Maharashtra, Orissa, Uttarakhand, Punjab, West Bengal, Tamil Nadu, Kerala, Karnataka, Lakshadweep, Puducherry, and Sikkim. These states will include the second dose of measles in RI for children between 16 and 24 months of age. Of these 21, four states/UTs (Goa, Delhi, Sikkim & Puducherry) have already introduced MCV2 in their RI schedule. The remaining 17 states/UTs will introduce this soon. In 14 states with MCV1 coverage <80%, MCV2 will be given phase-wise during measles catch-up campaigns. Later, these states will also introduce MCV2 in their RI programme.

This guide has two parts:Part 1 focuses on key operational aspects on measles 1. 2nd dose in Ri. Part 2 gives answers to frequently asked questions on 2. measles 2nd dose in Ri.

Key facts on measles 2nd dose in Ri are listed on the back cover.

Measles Vaccine: 2nd Dose in Routine Immunization Measles Vaccine: 2nd Dose in Routine Immunization

Guide for Health Workers, with Answers to Frequently Asked Questions 3

Part 1

Measles is one of the most infectious diseases. Measles is an acute viral illness. Transmission of the measles virus is by respiratory droplets or through direct contact. Measles virus reduces immunity, and children may die of pneumonia, diarrhea and encephalitis after they get measles. Children inflicted with measles may also suffer permanent disability (blindness, encephalitis). In impoverished areas, persistent diarrhea with protein-losing enteropathy may ensue, particularly in young infants.

While India has made significant progress in child survival, measles remains a leading cause of death and disability among young children. An estimated 50,000 to 100,000 children die from measles annually in India, making it a leading cause of child deaths. The national routine measles vaccination coverage is 69% (DLHS-3). When vaccine efficacy of 85% at 9 months of age is taken into account, approximately 46% (31% un-immunized plus 15% of immunized who failed to seroconvert) of children in each birth cohort remain susceptible to measles due to drop out, left out, and failure to develop immunity.

Revised routine immunization scheduleIn the revised routine immunization schedule, every child will get two doses of measles vaccine: the first dose between 9 and 12 months of age and the second dose between 16 and 24 months of age along with DPT booster dose. If a child has missed the first or the second dose, both doses can be given up to 5 years of age maintaining a gap of at least 4 weeks between the doses.

The recommended childhood vaccination schedule under RI is given on page 4 (see table).




child immunization scheduleVaccine ScheduleBCG, OPV-0, HepB-0 At birthDPT-1,2,3, Hepatitis-1,2,3, and OPV-1,2,3

6 weeks, 10 weeks and 14 weeks

Measles and Vitamin A 9-12 monthsVitamin A (total 9 doses)* 1st dose with measles vaccine at

9 month, subsequently, every six months till 5 years of age

DPT booster, OPV booster, Measles 2nd dose**, JE***

16-24 months

DPT booster 5-6 yearsTT 10 years and 16 years

*The 2nd to 9th doses of Vitamin A can be administered to children 1-5 years old during biannual rounds.**Measles second dose which can be Measles alone or Measles-Rubella (MR) or Measles-Mumps-Rubella (MMR)***JE vaccine in select endemic districts after the campaign.

Points to remember during measles vaccination Write the time of reconstitution on the vials.1. Use the reconstituted measles vaccine, within 4 hrs of 2. reconstitution. At the end of 4 hrs, discard the vaccine and reconstitute a new one if required. Don’t prefill syringes in advance. Reconstitute the 3. vaccine even when only one eligible child is present. Safe vaccination is more important than wastage.The dose of 0.5 ml will be given subcutaneously in the 4. upper outer quadrant of the right arm.IEC material, immunization cards, MCH registers, vaccine 5. stock and issue registers should be modified to include measles 2nd dose.Ask beneficiaries to wait for 30 minutes after vaccination to 6. observe for any AEFI.



Part 2

Frequently asked questions on measles

Q1. What are the symptoms of measles?Symptoms include fever, runny nose, cough, loss of appetite, ‘redness in eye’, and a rash. The rash usually lasts 5 to 6 days and begins at the hairline, moves to the face and upper neck, and proceeds down the body.

Q2. How serious is measles?Measles can be a serious disease, with 30 out of 100 reported cases experiencing one or more complications. Complications from measles are more common among very young children (younger than 5 years of age) and adults (older than 20 years of age).

Q3. What are the possible complications from measles?Diarrhea, ear infections, and pneumonia account for 60% of measles-related deaths. Approximately, one out of one million cases will develop acute encephalitis, an inflammation of the brain. This serious complication can lead to permanent brain damage.

Q4. Who gets severe measles?Measles can be especially severe in persons with low immunity. Measles is more severe in malnourished children, particularly those with deficiency of vitamin A.

Q5. is there a treatment for measles?There is no specific treatment for measles. People with measles need bed rest with frequent food and fluid intake and control of fever. Give two doses of Vitamin A, 24 hours apart @ 50000 IU for patients less than 6 months old; 100000 IU for




patients 6-11 months; and 200000 IU for patients 12 months and above immediately after diagnosis of measles. Vitamin A administration decreases the risks of complications and death.

Q6. How long is a person with measles contagious?Measles is highly contagious and can be transmitted from four days before the rash becomes visible to four days after the rash disappears.

Q7. How is the disease prevented?Measles can be prevented by immunizing children with measles vaccine. This vaccine is safe and effective.

Q8. Why is a second dose of measles vaccine introduced in the national immunization programme?Measles is a highly infectious disease causing illness and death due to complications such as diarrhea, pneumonia or brain infection. One dose of measles vaccine at 9 months of age protects 85% of infants. With the second dose, all children who remained unprotected after the first dose will receive protection.

Q9. What side effects have been reported with the measles vaccine?The vaccine may cause slight fever, or a mild rash in some children. When these occur, fever and rash appear 7 to 12 days after vaccination. Severe reactions are rare.

Q10. if the diluent for the measles vaccine is misplaced can sterile water be used instead? is there any problem with doing this? Only the diluent supplied with the vaccine should be used to reconstitute any vaccine, otherwise the vaccine will not be effective.



Q11. if a child has received the measles vaccine before 9 months of age, is it necessary to repeat the vaccine later?Yes. The child should receive two doses of measles vaccine according to the national immunization schedule, that is after completion of 9 months until 12 months of age and at 16 to 24 months. If not administered in the ideal age for measles vaccine, it can be administered until 5 years of age.

Q12. if a child received one dose of measles vaccine during an sia (supplementary immunization activity) campaign, should the child receive the routine dose of measles vaccine?Yes, the child should receive the routine doses of measles vaccine irrespective of the SIA dose.

Q13. If a child comes late for the first dose of measles can the second dose be given?All efforts should be made to immunize children at the right age, that is the first dose at completed 9 months and second dose at 16 to 24 months. However, if a child comes late then give two doses of measles vaccine at four weeks interval until 5 years of age.

Q14. if a child comes unimmunized at completing 24 months of age, what vaccines would you give? Give three doses of DPT and OPV at intervals of four weeks and a booster dose of DPT after six months. Give two doses of measles vaccine with first two doses of DPT vaccine and Vitamin A solution with the first dose of DPT.

Q15. does the risk of adverse effect increase with the second dose? No. The risk of adverse effects of measles vaccine does not increase with the second dose.

Key facts about MeaslesMeasles 1. (Khasra) kills nearly 100,000 children every year in India.Measles is a highly infectious disease. It is caused by a virus. 2. It spreads from person to person through coughing, sneezing, etc.A person having measles shows symptoms of fever and rash, 3. cough or runny nose or redness of eyes.Measles can be prevented by a measles vaccine. Two doses 4. provide adequate protection. The first dose should be given along with Vitamin-A syrup when the child has completed 9 months of age. The second dose should be given from 16–24 months of age. Usually unimmunized children get measles.5. A measles case is infectious from 4 days before appearance 6. of rash to 4 days after the rash has disappeared.Measles can cause complications such as diarrhea, pneumonia, 7. mouth ulcers, ear infection, damage to eyes, and brain infection.Measles can lead to death from complications that it causes.8. Death from measles can occur within 30 days after onset of 9. rash. Rash may not be present at the time of death.

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