Measles is rightly called as captain of killer team in India. We used to see measles cases mostly between 1 to 3 years of age group and mumps in school going children. Morbidity due to measles and mumps is very well known. Nowadays there is distinct change in the measles and mumps disease pattern due to measles and MMR vaccination. Both these vaccine were supposed to offer lifelong immunity to the children. But now-a-days we see measles in 7 to 10 years age group children who received only measles vaccine by 9 months of age. Those children who received both measles and MMR vaccines, contracted measles and/or mumps by 12 to 15 years so it is obvious from our field experience that measles vaccines immunity wanes away by 7 to 8 years of age and when both measles and MMR vaccines are given to the children according to our IAP schedule(1) immunity against measles and mumps lasts up to 12 to 15 years of age. Mumps was the disease of school going children, but now we see mumps patients in much older age group children. So introduction of MMR is very useful, but it falls short of our expectation. Therefore, why not give booster dose of MMR say by 10 years of age? There is a strong recommendation of rubella vaccine in adolescent girls. But why only rubella? Measles, mumps are also troubling our adolescents. If we start repeating booster dose of MMR vaccine, say by 10 years of age, then there is no need of rubella vaccination as well. The immunity from MMR lasts for 10-15 yrs of age. Then a booster dose at 10 years of age will give a life long immunity. Our children should not suffer from measles, mumps and rubella during the crucial period of their life is the thought behind this communication.

While going through the literature it was found that American Academy of Pediatrics and most of the western countries are following the revaccination schedule since 1989(2-4). They are revaccinating their children either by 5 years of age or when they become adolescents. IAP has not recommended a booster dose of MMR vaccine. This is because routine coverage by measles and MMR vaccine is poor. Therefore naturally occurring sub clinical measles, mumps and rubella are common which act like a natural booster in vaccinees. In future high percentage of immunization amongst our people will take away the advantage of natural sub clinical infections and then second dose of MMR may be considered.

Our experience is not in favor of these natural sub clinical infections working as booster doses. There are so many grown up adolescents we see suffering from full-blown picture of measles or mumps. Our appeal to IAP is kindly give due consideration to recommend the booster dose of MMR vaccine at 10 years of age.

Vinayak Deshmukh,
Jawahar Lal Nehru Medical College,
Sawangi Meghe, Wardha 442 002,
Maharashtra,
India.
E-mail: [email protected]

1. Recommendation. In: Dubey AP, Surjit S, editors. IAP Guidebook on Immunization, 3rd edn. New Delhi: IAP Committee on Immunication, p. 17-19.

2. Johnson CE, Kumar ML, Whitwell JK, Staehle BO, Rome LP, Dinkar C, et al. Antibody persis-tence after primary measles-mumps-rubella vaccine and response to second dose given at four to six vs eleven to thirteen years. Pediatr Infect Dis J 1996; 15: 687-692.

3. Davidkin I, Peltola H, Leinikki P,Valle M. Duration of rubella immunity by two-dose measles, mumps, rubella (MMR) vaccine. A 15 year follow up in Finland. Vaccine2000; 18: 3106-3112.

4. Cote TR, Sivertson D, Horan JM, Lindegren ML, Dwyer DM. Evaluation of two doses of measles,mumps and rubella vaccination schedule in a cohort of college athletes. Public Health Resp 1993; 4: 431-435.