(FAQs) Frequently

asked questions
on
MR vaccination-
campaign

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Doctors/ Parents
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

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Doctors/ Parents
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

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Doctors
It 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Parents/ Doctors
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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Doctors
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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Parents/ Doctors
Following 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Doctors
How 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 .

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Parents/ Doctors
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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Parents/ Doctors
What 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Doctors
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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Parents/ Doctors
A 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Doctors
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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Doctors
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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Parents
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

Vaccination Campaign is from 7th to 28th February 2017

Training Workshop for Measles-Rubella Vaccination Campaigns

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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Parents/ Doctors
When 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 .

Training Workshop for Measles-Rubella Vaccination Campaigns

 FAQs for Doctors
Till 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 Revised National Immunization Schedule
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

Training Workshop for Measles-Rubella Vaccination Campaigns

 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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 Frequently asked questions
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.

Training Workshop for Measles-Rubella Vaccination Campaigns

 Key Messages
 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)

Training Workshop for Measles-Rubella Vaccination Campaigns

 Thank You
Training Workshop for Measles-Rubella Vaccination Campaigns