Measles Vaccine : Storage,Schedule,Booster dose,efficacy

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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MEASLES - VACCINE - LATEST UPDATES

Dr Nitin Shah
Hon. Pediatrician, UHC, LTMG Hospital, Mumbai.
Treasurer, Indian Academy of Pediatrics, 1998-2001

Q. What is measles vaccine given for?
A. Measles vaccine is given for protection against measles, the typical exanthematous fever of childhood so well known to most of the people.

Q. How is measles vaccine available?
A. It is a live viral vaccine. It is available in lyophilized form as powder in a bulb. Diluent is distilled water & is available as a separate ampoule. It is available as monodose or as multidose containing 2 or 5 doses. The final volume of reconstituted vaccine is 0.5 ml per dose.

Q. How is measles vaccine stored?
A. Being a live viral vaccine it needs strict cold chain maintenance. Both the vaccine & the diluent must be stored in refrigerator. Vaccine stock can be stored frozen in freezer compartment. The working stock is kept at 2-8⁰ C in the chiller tray. The diluent is kept in the 3rd rack. No vaccine should be stored in the door compartment.

Q. How is measles vaccine given?
A. Measles vaccine is prepared by adding diluent in the bulb. Once prepared it should be used immediately within 2-3 hours, after this the vaccine should be discarded as it can lead to toxic shock syndrome (discussed later). It is given subcutaneously over the thigh or the arm. Subcutaneous injections are given using 26 no. needle by raising a fold of skin by one hand and injecting the vaccine underneath the fold. Inadvertent IM injections lead to equally effective immunity.

Q. When is measles vaccine given?
A. Measles vaccine is a part of EPI schedule. It is given at the age of completed 9 months (270+ days of life). Transplacental maternal anti-measles antibodies persist in the child for as long as 9 months. These antibodies protect the child against measles, hence measles usually occurs after 9 months. Giving vaccine before 9 months may not be very effective due to interference by the maternal antibodies. This rule is not always true. In countries like India, a mother may be malnourished & may not have good titres of anti- measles antibodies. Children born to such mothers can suffer from measles as early as 6 months of life. Hence during epidemics of measles the vaccine can be given as early as 6 months, but this should be followed by one more measles vaccine at 9 months. In west, children are given straight MMR at 12-15 months of age. That is due to lack of measles with mass measles vaccination. In our country, if one waits till 12-15 months many children will develop measles before that. Hence we advise measles vaccine at 9 months followed by MMR at 15 months. As we achieve higher coverage of measles vaccination in our country, incidence of measles will become far less. That time we can think of postponing the age of measles vaccine & even giving it as MMR at 12-15 months, as is now done in West.

Q. When is a booster dose of measles vaccine given?
A. Booster dose is not recommended in EPI schedule. However one may see modified measles in a child vaccinated with measles vaccine. Hence Indian Academy of Pediatrics recommends booster in form of MMR vaccine at 15-18 months of age

Q. What if a child has developed measles before, does he need measles vaccine?
A. A child who suffers from measles develops life long immunity. Hence such a child does not need measles vaccine. However measles is usually recognized by the clinical manifestations which are so typical. There are other exanthematous fevers of childhood, which mimic like measles. Patients may mistake them for measles. Hence rely only on a doctor's documentation & not on patient's history about past episode of measles. When in doubt it is better to give measles vaccine as no harm is done even if patient has suffered from measles in past.

Q. What is the efficacy of measles vaccine?
A. Measles vaccine is an excellent vaccine with more than 90% efficacy with a booster given in form of MMR. Even if a patient who is vaccinated develops measles, it is usually modified and mild with quick recovery & without serious complications

Next : Measles Vaccine(Contd.)

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