ou are aware that Government of India, Ministry
of Health & Family Welfare, has launched one of the world’s largest
measles–rubella (MR) vaccination campaigns as part of its national
strategy to eliminate measles and rubella disease from the country by
2020 – a truly remarkable, world-beating effort. The oversight for this
mass campaign is being provided by Hon’ble Prime Minister’s office.
The phased MR campaign will target to vaccinate
approximately 41 crore children in the age group of 9 months to <15
years across the country over a period of 2 years (2017-18), and is a
massive public health undertaking. MR vaccine is a safe and effective
vaccine that has been in use for over 40 years, and in more than 100
countries across the world. An additional MR campaign dose is a onetime
opportunity to boost population immunity in our country to stop endemic
circulation of both measles and rubella virus, through addressing the
challenges of both vaccine failure and failure to vaccinate. The first
phase of wide age-range MR vaccination campaign commenced in the five
states: Tamil Nadu, Karnataka, Goa, Lakshadweep and Puducherry. The
states have managed to vaccinate more than 3 crore children through
school- and outreach-based vaccination approach.
Recently convened meeting of the Indian Expert
Advisory Group for Measles and Rubella (IEAG-MR) recommended high
quality MR campaigns, strengthen surveillance, and improve measles
second dose coverage to achieve the 2020 target. Being a core member of
IEAG-MR and the National Task Force on MR Vaccination, Indian Academy of
Pediatrics (IAP) strongly supported and endorsed measles elimination and
rubella control by 2020. These platforms also include other
development partners such as WHO, UNICEF, UNDP, Center for Disease
control (CDC) and other civil society organizations such as Indian
Medical Association (IMA) and Lions Club international. I am glad that
our inputs have led in steering and guiding the strategic planning for
MR campaigns.
MR Vaccination Campaign: Key Facts
• Age group between 9 months and less than 15
years.
• One dose campaign, irrespective of previous
measles/rubella vaccination or disease status.
• Dose: 0.5 mL, subcutaneous route using
auto-disable syringes.
• Vaccine: 10 dose MR vial (WHO prequalified,
manufactured by Serum Institute of India)
• The MR campaign will be conducted for a period
of 4-5 weeks. Vaccination will be conducted in schools during the
first few weeks, and later in community through outreach sessions.
• Immediately after the completion of campaign,
MR vaccine will be introduced in routine immunization, replacing the
currently given two doses of measles vaccine – at 9-12 mo and 16-24
mo.
• Vaccination will be provided free of cost.
• Following vaccination, each child will be
marked with indelible ink on left thumb nail.
Role of IAP Members
With the successful completion of first phase of MR
campaign in five states, the Government of India now plans to roll out
the MR campaign across the country in different phases. Ministry and
partners are heavily relying on us to make this campaign a success.
I shall like to acknowledge the contribution of state
and district IAP chapters of the five states for their proactive
engagement and collaboration with the government and other development
partners in helping to achieve desired outcomes. For the forthcoming MR
campaigns in the states, as IAP member you are requested to kindly
provide the following support:
• State/district IAP representatives actively
participate in state/district task force and other platforms, and
provide necessary advocacy towards MR campaigns.
• Strongly endorse and advocate administration of
an additional MR dose (irrespective of previous dose status) to
parents and schools seeking your opinion about the MR campaign.
• Reassure parents that MR vaccine is safe and
highly effective, and that vaccination in schools and outreach
sessions will be given under medical supervision through trained and
skilled staff, and that standard safety procedures and best
injection practices will be followed.
• To strongly dispel myths or anti-vaccine rumors
being spread on social media or among parents, caregivers and
teachers.
• Solicit cooperation to play a pivotal role in
strengthening communication regarding MR vaccine through personal
communication, sharing pre-recorded videos in mobile-based groups,
putting information on social media platforms, mass media
(television and press), and displaying standardized IEC material
(banners, posters) in your facilities.
• Offer your clinics to be part of vaccination
center for MR campaign and also as one of the AEFI management center
(if required).
• Provide your clinic as a site for immunization
sessions and offer/MR/MMR as additional dose.
• Participate in orientation of the doctors on
panels for the schools.
I thank you in advance for your cooperation.
Rationale for MR Campaign
This MR campaign is significant as it is expected to
accelerate the country’s efforts to eliminate measles that affects an
estimated 0.25 crore children every year, killing nearly 49 000 of them.
The campaign also marks the introduction of rubella vaccine in India’s
childhood immunization program to address congenital rubella syndrome
(CRS) that is responsible for irreversible birth defects such as
deafness and blindness in nearly 40 000 children every year. Measles
vaccine is currently provided under Universal Immunization Program
(UIP). However, rubella vaccine will be a new addition. This additional
campaign dose will boost the immunity of child and protect the entire
community by eliminating transmission of measles and rubella. Apart from
improving the life-chances of millions of children in India, the
campaign is expected to have a substantial effect on global measles
mortality and rubella control target as India accounted for 37% of
global measles deaths in 2015.
The following are some of the Frequently Asked
Questions (FAQs) related to MR campaign:
Q-What is MR campaign?
• It is a special campaign to vaccinate all
children aged 9 mo - <15y with one dose of MR vaccine.
• The MR campaign dose is given to all targeted
children, both immunized and unimmunized, irrespective of prior
measles/ rubella infection.
• The goal of MR campaign is to accelerate
population immunity by reaching 100% target children with MR vaccine
that will reduce cases and deaths from measles and disabilities from
CRS.
Q- What is the rationale for MR campaign?
• Country Population Immunity is insufficient to
stop ongoing MR transmission as evident from MR surveillance data.
• MR outbreaks are wide spread across the entire
country.
• Population immunity has waned after the last
MCV (Measles containing vaccine) campaign.
• Rubella vaccine introduction requires high
level of population immunity to prevent the paradoxical effect as a
risk mitigation strategy.
• NTAGI has recommended wide age range MR
vaccination campaign targeting 9 mo - <15y before introducing
Rubella-containing vaccine (RCV) in routine immunization in all the
states of India.
• MR vaccine will be available for administration
under the routine immunization (RI) program after the completion of
MR campaign.
Q-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.
• Every child who is eligible for either 1st dose
or 2nd dose of measles vaccine in his/her RI schedule will be
provided with combined MR vaccine.
• Malnourished children should be vaccinated on a
priority basis, as they are more likely to have measles-related
complications like diarrhea and pneumonia.
• Children with minor illnesses such as mild
respiratory infection, diarrhea, and low grade fever.
• Even those children who have documentation of
receiving one dose of Measles/MMR at 9 months and/or MMR at 15
and/or again at 4-6 years must also be offered this vaccine.
Q-When should the MR vaccine not be given?
MR vaccine should not be given to children who have a
history of allergy or reactions to measles vaccines. Immunization is
deferred for children with high fever and/or symptoms of other serious
illness. Mothers and caregivers should consult a doctor before
proceeding further.
Q-Where will the children be vaccinated?
• From fixed posts only. No house-to-house
vaccination.
• During the first week in schools.
• Non-school-going and left-out children will be
vaccinated in the following two weeks.
• If, at any place, 4 or >4 children have been
found missed during Rapid Convenience Monitoring, the MR campaign
activity should be repeated in the area during fourth week of the MR
campaign to cover these missed children.
Q-Are there any side effects of the MR vaccine?
The MR vaccine which is being used in the campaign is
completely safe. Like with any other injectable vaccine, there could be
mild pain and redness at the injection site, low-grade fever, rash and
muscle aches, which subsides on its own. The vaccine is not known to
cause any other adverse event. However, all immunization sessions –
whether in schools or outreach – are linked to fully equipped health
centers to handle any adverse event.
Link to WHO FAQs for MR campaign: http://www. searo.who.int/india/topics/measles/FAQs/en/.
