MR Campaign

Short presentation describing the observance of Measles Immunization Day and also discussing MR Campaign for the year 2019

1. MEASLES IMMUNIZATION DAY & MR CAMPAIGN 16th March, 2019 BY Dr. KRITI SINGH JR-1 GSVM, Medical College, Kanpur

2. CONTENTS Introduction Who plan Measles disease Rubella disease What, Who and Where of MR Vaccination MR Vaccination MR campaign

3. INTRODUCTION Measles is highly contagious viral disease which affects mostly children. It is one the leading causes of death and disability among young children. Measles Immunization Day is celebrated on 16 th March every year to make people aware about this deadly disease and how they can deal with this. Measles vaccination resulted in 80% drop in measles deaths between 2000 and 2017 worldwide Global measles mortality has reduced from 546, 800 in 2000 to 114,900 in 2014 ( 79% reduction ). In 2017 , 85% of the world’s children received one dose of measles and 67% of children received second dose . It saved 21.1 million live s in this duration making measles vaccine a success in public health.

4. WHO SOUTH-EAST ASIA REGIONAL STRATEGIC PLAN 2014–2020 GOAL: Elimination of measles and control rubella / CRS by 2020. achieve and maintain at least 95% population immunity with two doses against measles and rubella within each COUNTRY’S EACH DISTRICT through routine and / or supplementary immunization. develop and sustain a sensitive and timely case-based measles, rubella and CRS surveillance system in each country. strengthen support and linkages to achieve the above three strategic objectives.

5. As per the reported coverage in Health Management Information System (HMIS), the country-wide coverage of measles-containing vaccine first dose (MCV1) ~ 90%. The measles-containing vaccine second dose (MCV2) national coverage ~66%. Following the South-East Asia (SEA) Regional Committee resolution in September 2013, setting the goal for measles elimination and rubella / congenital rubella syndrome (CRS) control by 2020

6. The National Technical Advisory Group on Immunization (NTAGI) in June , 2014 recommended introduction of measles-rubella vaccine in routine immunization program, following a nationwide MR campaign. The doses of measles vaccine provided at 9-12 months and 16-24 months, will be replaced by MR vaccine under routine immunization, immediately after the campaign. Phased MR campaigns will target to vaccinate approximately 410 million (41 crores) children across the country.

7. Measles –disease The measles virus is a contagious agent ,exclusive human pathogen. No animal reservoirs or vectors. Transmission through respiratory route or direct contact. When introduced into a non-immune population,100% of individuals become infected and develop a clinical illness. In areas with tropical climates , cases occur during the dry season and in areas of temperate climates , cases occurs during late winter and early spring.

8. The average interval from exposure to development of clinical exposure is 14 days (range 7–18 days). Patients are contagious from 4 days before the onset of rash till 4 days after onset of rash . Infection spreads via bloodstream to skin, conjunctivae and respiratory tract. The typical maculopapular rash appears3–4 days after a high fever peaking at 39–40°C. The rash spreads from face and neck to the trunk and extremities. Patients improve normally by third day of rash and recover fully 7–10 days from onset of the disease.

9. RUBELLA Rubella disease is caused by a Toga virus(RNA virus) The virus is transmitted via respiratory route. The infectious period is7 days before to 7 days after onset of rash, which disappears after 7–10days. Infections in children are less severe and believed to provide life long immunity. The post rubella congenital anomalies are usually a multi-organ involvement known as congenital rubella syndrome (CRS). CRS includes congenital cataract, congenital glaucoma, congenital deafness, congenital cardiac defects like ventricular septal defects, atrial septal defects, patent ductus arteriosus, hepatosplenomegaly, microcephaly, hematological disorders like purpura.

10. What is a MR Vaccination Campaign? A MR Vaccination Campaign is a special campaign to vaccinate all children in a wide age group with MR vaccine in all states. MR campaign dose - given to all children,(both previously vaccinated and unvaccinated), who belong to the target age group ( 9 months to <15years) . The goal of the MR campaign is to quickly enhance the population immunity to both measles and rubella in order to reduce deaths from measles and disabilities like CRS due to rubella infection in early pregnancy. The campaign must immunize more than 95% of the target age group children in schools as well as outreach session sites with a country goal to achieve 100% coverage of targeted children with safety.

11. Who should be vaccinated with MR vaccine Campaign :All children in the target age group are vaccinated irrespective of previous immunization status or history of measles / rubella disease; Routine program , MR vaccine will be administered in two doses. The first dose is given to children between 9 and 12 months of age and a second dose is given at 16-24 months of age.

12. Measles–rubella (MR) vaccine The Measles-rubella (MR) vaccine used is live attenuated vaccine and safe and effective. It is available either as single antigen vaccines or in combination with either rubella(MR) or mumps and rubella (MMR) vaccines and with mumps, rubella and varicella (MMRV) vaccine. The protective immune response to each of the components remains same in all forms Most of the live, attenuated measles vaccines used are the Edmonston Zagrab strain of measles virus.

13. Currently licensed vaccines are live, attenuated RA 27 / 3 strain of rubella virus. Other vaccine strains include the Matsuba , DCRB19, Takahashi, Matsuura and TO-336 strains in Japan. The BRD-2 strain in China. Vaccination results in high (>95%) seroconversion rates and protection is generally assumed to be lifelong.

14. MR vaccine characteristics MR vaccine (before reconstitution) is stable and stored between 2 °C to 8 °C and the reconstituted vaccine is to be used within 4 h. The open vial policy is NOT applicable to reconstituted MR vaccine. It is very sensitive to sunlight. Vaccine induces both humoral and cellular immune responses for both measles as well as rubella.

15. MR vaccine dosage, formulation and administration DOSE: -MR vaccine is lyophilized , each containing -MR vaccine dose of 0.5 ml and reconstituted with diluent - Each ampoule of diluent for 10-dose vials of MR vaccine contains more than 5ml diluent -It is used to dilute a single vial of MR vaccine. -The diluent should be kept at 2–8°C at least 24 h before use ROUTE OF ADMINISTRATION : Subcutaneous in the right upper arm.

16. MR vaccine storage and supply The MR vaccine is very sensitive and should always be protected from sunlight. MR vaccine can be safely frozen and diluents should never be frozen. MR vaccine should always be reconstituted only with the diluent provided by the manufacturer. Before reconstitution, diluents need to be stored in the cold chain between 2 and 8 ºC at least 24h prior to reconstitution, to be transported at 2–8 ºC (inside vaccine carriers / cold boxes). The peak antibody response occurs 6 to 8 week s after i nfection or vaccination. Immunity conferred by vaccination persist for at least 20 years or may be lifelong for most individuals.

17. Adverse reactions to MR vaccine Pain and tenderness at the site of injection followed by mild fever. About 5% may experience fever of at least 39.4°C for 1–2 days inducing febrile seizures 1 / 3000. In 2% vaccinated children a transient rash may develop. Thrombocytopenic purpura occurs in 1 in 30 000 vaccinated individuals Arthralgia / joint pain occurs in adolescent children or adults. One serious and rare adverse effect is anaphylaxis( 1 in a million)is less likely after second dose of MR vaccine.

18. NO EVIDENCE OF : -Encephalitis, permanent neurological sequelae or Guillain–Barré syndrome following vaccination. -No risk of inflammatory bowel disease or for autism. -No exacerbation of tuberculosis. The vaccine protects against SSPE by preventing measles infection and CRS by preventing rubella infection during pregnancy

19. Contraindications to MR vaccine In person having high fever (>102 °F / 38–39 °C) or pregnancy. Persons with a history of an anaphylactic reaction to neomycin, gelatin . Severely immune-compromised HIV infection(full blown AIDS), advanced leukemia or lymphoma or receiving immunosuppressive treatment. Patients on treatment of high-dose steroids, alkylating agents or antimetabolites. Vaccination should be delayed for 3–11 months after administration of blood or blood products. Following MR vaccination, administration of such blood products should be avoided for 2 weeks, if possible.

20. CONDITION NOT C/I for MR vaccination Malnutrition : In fact, malnutrition is an indication to immunize. Minor illness : such as mild respiratory infection , diarrhoe a and low-grade fever for less than 3 days without any hospitalization. Asymptomatic HIV-infected children .

21. Target groups All children in age group of 9months to <15 years (not reached their fifteenth birthday) irrespective of their prior vaccination status or history of Measles / Rubella illness. Immunization will be conducted on 4–5working days of the week. All children will be immunized at fixed posts / MR vaccination session sites (at schools, hospitals, outreach – rural villages / urban wards). Additional special / mobile sites will be planned for HRA / P(High Risk Areas/ Populations wherever required. Immunization session sites will operate in schools during the first week and at outreach and mobile sites in the community in the second and third weeks with local flexibility. The fourth week will be for sweeping / repeat activity.

22. Mobile teams will immunize children from a fixed location in HRAs / Ps. The supervisors have to ensure that areas having less than 90% coverage are visited again by immunization teams to vaccinate the missed children. This should not compromise the daily activity plan for the vaccinator teams It is planned to vaccinate 100–150 children per vaccinator per day at an outreach site 150–200 children per vaccinator in a school session site, with local variations.

23. STRATEGY PLAN The Ministry of Health & Family Welfare, Govt. of India, has constituted a National Taskforce on Measles and Rubella including members from WHO, UNICEF,BMGF(Bill Gates & Melinda Gates Foundation),ICMR and National CDC. PURPOSE : To monitor and review campaign planning & surveillance data.To guide national action plan development for measles elimination & rubella/ CRS control. In addition, a Measles-Rubella Communication s group led by UNICEF comprising representatives from UNICEF, GHS(Global Health Strategies), ITSU(Immunization Technical Support Unit), WHO, IAP to develop communication and media strategy. Chief Media being the MOHFW.

24. Robust communication, media strategy, including and social media management & revised IEC materials: Communication and social mobilization efforts for immunization, to increase coverage and help achieve measles, rubella, and CRS goals. Emphasis on effective communication and public engagement with parents, schools, health professionals, community leaders and media, for address vaccine concerns. Mr. Amitabh Bachchan is the national ambassador for MR campaign.

25. State Immunization Officers for: tracking state task force meeting, organizing state planning workshops also include review of progress, problems encountered, proposed solutions and new action point. The district immunization officer: for providing intersectoral coordination at district level through micro-planning of meeting, review meets, organizing orientation for medical officers for AEFI management. PHC-level training of supervisors, vaccinators and volunteers. District Magistrate / Chief Medical Officer / District Immunization officer: For regularly monitoring of preparedness, progress and implementation of MR campaign.

26. school BASED strategy Involvement of following is needed: Education Department WCD (ICDS) Health Department Urban Development Panchayati Raj IAP/IMA Others To improve coverage at schools increase duration of school phase by at least two week

27. AEFI management plan: all government health facilities and centres participating in the national immunization programme (except sub- centres ) will be AEFI management centres . all MOs (both government and private) will be trained in AEFI management. the contact details of the closest AEFI management centre should be available at every session centre .

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