1. Measles Vaccine 2nd dose
in Routine immunization
Guide for Health Workers, with answers to
Frequently asked Questions
2doses
and full protection
from measles
Ministry of Health and Family Welfare
Government of India
2010
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2. Measles Vaccine: 2nd Dose in Routine Immunization
T he Government of India (GoI) had
introduced measles vaccine in its
Universal Immunization Programme
(Routine Immunization) in 1985. GoI has
now decided to introduce a second dose of
measles vaccine in Routine Immunization
(RI) following recommendations from
national expert committees.
Twenty-one states and union territories
(UTs) have >80% coverage of measles containing vaccine first
dose (MCV1). These states are Andhra Pradesh, Andaman
and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli,
Daman and Diu, Delhi, Goa, Haryana, Himachal Pradesh,
Jammu and Kashmir, Maharashtra, Orissa, Uttarakhand,
Punjab, West Bengal, Tamil Nadu, Kerala, Karnataka,
Lakshadweep, Puducherry, and Sikkim. These states will
include the second dose of measles in RI for children between
16 and 24 months of age. Of these 21, four states/UTs (Goa,
Delhi, Sikkim & Puducherry) have already introduced MCV2 in
their RI schedule. The remaining 17 states/UTs will introduce
this soon. In 14 states with MCV1 coverage <80%, MCV2 will
be given phase-wise during measles catch-up campaigns.
Later, these states will also introduce MCV2 in their RI
programme.
This guide has two parts:
1. Part 1 focuses on key operational aspects on measles
2nd dose in Ri.
2. Part 2 gives answers to frequently asked questions on
measles 2nd dose in Ri.
Key facts on measles 2nd dose in Ri are listed on the back
cover.
2 Guide for Health Workers, with Answers to Frequently Asked Questions

3. Measles Vaccine: 2nd Dose in Routine Immunization
Part 1
Measles is one of the most infectious diseases. Measles is
an acute viral illness. Transmission of the measles virus is
by respiratory droplets or through direct contact. Measles
virus reduces immunity, and children may die of pneumonia,
diarrhea and encephalitis after they get measles. Children
inflicted with measles may also suffer permanent disability
(blindness, encephalitis). In impoverished areas, persistent
diarrhea with protein-losing enteropathy may ensue,
particularly in young infants.
While India has made significant progress in child survival,
measles remains a leading cause of death and disability among
young children. An estimated 50,000 to 100,000 children die
from measles annually in India, making it a leading cause of
child deaths. The national routine measles vaccination coverage
is 69% (DLHS-3). When vaccine efficacy of 85% at 9 months
of age is taken into account, approximately 46% (31% un-
immunized plus 15% of immunized who failed to seroconvert)
of children in each birth cohort remain susceptible to measles
due to drop out, left out, and failure to develop immunity.
Revised routine immunization schedule
In the revised routine immunization schedule, every child
will get two doses of measles vaccine: the first dose between
9 and 12 months of age and the second dose between 16 and
24 months of age along with DPT booster dose. If a child has
missed the first or the second dose, both doses can be given up
to 5 years of age maintaining a gap of at least 4 weeks between
the doses.
The recommended childhood vaccination schedule under RI is
given on page 4 (see table).
Guide for Health Workers, with Answers to Frequently Asked Questions 3

4. Measles Vaccine: 2nd Dose in Routine Immunization
child immunization schedule
Vaccine Schedule
BCG, OPV-0, HepB-0 At birth
DPT-1,2,3, Hepatitis-1,2,3, 6 weeks, 10 weeks and 14 weeks
and OPV-1,2,3
Measles and Vitamin A 9-12 months
Vitamin A (total 9 doses)* 1st dose with measles vaccine at
9 month, subsequently, every six
months till 5 years of age
DPT booster, OPV booster, 16-24 months
Measles 2nd dose**, JE***
DPT booster 5-6 years
TT 10 years and 16 years
*The 2nd to 9th doses of Vitamin A can be administered to children 1-5 years old during
biannual rounds.
**Measles second dose which can be Measles alone or Measles-Rubella (MR) or Measles-
Mumps-Rubella (MMR)
***JE vaccine in select endemic districts after the campaign.
Points to remember during measles vaccination
1. Write the time of reconstitution on the vials.
2. Use the reconstituted measles vaccine, within 4 hrs of
reconstitution. At the end of 4 hrs, discard the vaccine and
reconstitute a new one if required.
3. Don’t prefill syringes in advance. Reconstitute the
vaccine even when only one eligible child is present. Safe
vaccination is more important than wastage.
4. The dose of 0.5 ml will be given subcutaneously in the
upper outer quadrant of the right arm.
5. IEC material, immunization cards, MCH registers, vaccine
stock and issue registers should be modified to include
measles 2nd dose.
6. Ask beneficiaries to wait for 30 minutes after vaccination to
observe for any AEFI.
4 Guide for Health Workers, with Answers to Frequently Asked Questions

5. Measles Vaccine: 2nd Dose in Routine Immunization
Part 2
Frequently asked questions on measles
Q1. What are the symptoms of measles?
Symptoms include fever, runny nose, cough, loss
of appetite, ‘redness in eye’, and a rash. The rash
usually lasts 5 to 6 days and begins at the hairline,
moves to the face and upper neck, and proceeds
down the body.
Q2. How serious is measles?
Measles can be a serious disease, with 30 out of
100 reported cases experiencing one or more complications.
Complications from measles are more common among very
young children (younger than 5 years of age) and adults (older
than 20 years of age).
Q3. What are the possible complications from
measles?
Diarrhea, ear infections, and pneumonia account for 60% of
measles-related deaths. Approximately, one out of one million
cases will develop acute encephalitis, an inflammation of the
brain. This serious complication can lead to permanent brain
damage.
Q4. Who gets severe measles?
Measles can be especially severe in persons with low immunity.
Measles is more severe in malnourished children, particularly
those with deficiency of vitamin A.
Q5. is there a treatment for measles?
There is no specific treatment for measles. People with measles
need bed rest with frequent food and fluid intake and control
of fever. Give two doses of Vitamin A, 24 hours apart @
50000 IU for patients less than 6 months old; 100000 IU for
Guide for Health Workers, with Answers to Frequently Asked Questions 5

6. Measles Vaccine: 2nd Dose in Routine Immunization
patients 6-11 months; and 200000 IU for patients 12 months
and above immediately after diagnosis of measles. Vitamin A
administration decreases the risks of complications and death.
Q6. How long is a person with measles contagious?
Measles is highly contagious and can be transmitted from four
days before the rash becomes visible to four days after the rash
disappears.
Q7. How is the disease prevented?
Measles can be prevented by immunizing children with measles
vaccine. This vaccine is safe and effective.
Q8. Why is a second dose of
measles vaccine introduced
in the national immunization
programme?
Measles is a highly infectious
disease causing illness and death
due to complications such as
diarrhea, pneumonia or brain
infection. One dose of measles vaccine at 9 months of age
protects 85% of infants. With the second dose, all children who
remained unprotected after the first dose will receive protection.
Q9. What side effects have been reported with the
measles vaccine?
The vaccine may cause slight fever, or a mild rash in some
children. When these occur, fever and rash appear 7 to 12 days
after vaccination. Severe reactions are rare.
Q10. if the diluent for the measles vaccine is
misplaced can sterile water be used instead? is there
any problem with doing this?
Only the diluent supplied with the vaccine should be used to
reconstitute any vaccine, otherwise the vaccine will not be
effective.
6 Guide for Health Workers, with Answers to Frequently Asked Questions

7. Measles Vaccine: 2nd Dose in Routine Immunization
Q11. if a child has received the measles vaccine
before 9 months of age, is it necessary to repeat the
vaccine later?
Yes. The child should receive two doses of measles vaccine
according to the national immunization schedule, that is after
completion of 9 months until 12 months of age and at 16 to 24
months. If not administered in the ideal age for measles vaccine,
it can be administered until 5 years of age.
Q12. if a child received one dose of measles vaccine
during an sia (supplementary immunization activity)
campaign, should the child receive the routine dose
of measles vaccine?
Yes, the child should receive the routine doses of measles
vaccine irrespective of the SIA dose.
Q13. If a child comes late for the first dose of measles
can the second dose be given?
All efforts should be made to immunize children at the right
age, that is the first dose at completed 9 months and second dose
at 16 to 24 months. However, if a child comes late then give
two doses of measles vaccine at four weeks interval until
5 years of age.
Q14. if a child comes unimmunized at completing
24 months of age, what vaccines would you give?
Give three doses of DPT and OPV at intervals of four weeks
and a booster dose of DPT after six months. Give two doses
of measles vaccine with first two doses of DPT vaccine and
Vitamin A solution with the first dose of DPT.
Q15. does the risk of adverse effect increase with the
second dose?
No. The risk of adverse effects of measles vaccine does not
increase with the second dose.
Guide for Health Workers, with Answers to Frequently Asked Questions 7

8. Key facts about Measles
1. Measles (Khasra) kills nearly 100,000 children every year in
India.
2. Measles is a highly infectious disease. It is caused by a virus.
It spreads from person to person through coughing, sneezing,
etc.
3. A person having measles shows symptoms of fever and rash,
cough or runny nose or redness of eyes.
4. Measles can be prevented by a measles vaccine. Two doses
provide adequate protection. The first dose should be given
along with Vitamin-A syrup when the child has completed 9
months of age. The second dose should be given from 16–24
months of age.
5. Usually unimmunized children get measles.
6. A measles case is infectious from 4 days before appearance
of rash to 4 days after the rash has disappeared.
7. Measles can cause complications such as diarrhea, pneumonia,
mouth ulcers, ear infection, damage to eyes, and brain
infection.
8. Measles can lead to death from complications that it causes.
9. Death from measles can occur within 30 days after onset of
rash. Rash may not be present at the time of death.
Protect children from measles !
The Right Vaccine at the Right Time
Blessings for a Healthy Life