Measles is an airborne disease which spreads easily through the coughs and sneezes of those infected. It may also be spread through contact with saliva or nasal secretions. it is a highly contagious infection caused by measles virus. Primary signs and symptoms typically include cough, fever, inflamed eyes, and runny nose. 2 or 3 days after the start of symptoms, small white spots may form inside the mouth, known as Koplik’s spots. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins 3 to 5 days after the start of symptoms in order to develop this symptoms it will take around 10-12 days of the first exposure. Complications occur in about 30% and may include diarrhoea, blindness, inflammation of the brain, and pneumonia among others Nine out of ten people who are not immune and share living space with an infected person will catch it. People are infectious to others from four days before to four days after the start of the rash. People usually do not get the disease more than once. Testing for the virus in suspected cases is important for public health efforts.

Rubella is an infection caused by the rubella virus. This disease is often mild with half of people not realizing that they are sick. A rash may start around 2 weeks after exposure and last for 3 days. It usually starts on the face and spreads to the rest of the body. The rash is not as bright as that of measles and is sometimes itchy. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. In adults joint pain is common. Complications may include bleeding problems, testicular swelling, and inflammation of nerves. Infection during early pregnancy may result in a child born with congenital rubella syndrome (CRS) or miscarriage. Symptoms of CRS include problems with the eyes such as cataracts, ears such as deafness, heart, and brain. Problems are rare after the 20th week of pregnancy. It is usually spread through the air via coughs of people who are infected.  People are infectious during the week before and after the appearance of the rash. Babies with CRS may spread the virus for more than a year. Only humans are infected. Insects do not spread the disease. Once recovered, people are immune to future infections. Testing is available that can verify immunity. Diagnosis is confirmed by finding the virus in the blood, throat, or urine. Testing the blood for antibodies may also be useful.

History of MR vaccine into India: India’s Universal Immunization Programme (UIP)  received a new addition the Measles Rubella (MR) vaccination. The vaccine will replace the current two doses of measles vaccines given at 9-12 months and 16-24 months of age, and will offer dual protection, against measles and rubella.

The first phase of Measles Rubella (MR) vaccination campaign has been started  in Karnataka, Tamil Nadu, Pondicherry, Goa and Lakshadweep, covering nearly 3.6 crore target children. “This campaign will be taken up in a mission mode and has been rolled out in partnership with States, NGOs and development partners such as WHO, UNICEF, Gates Foundation, Lions Club, IPA, and IMA. As part of a nationwide campaign, the health ministry will reach out to and cover 41 crore children, the largest ever in any campaign,” Faggan Singh Kulaste, Minister of State for Health and Family Welfare said.

In second phase nearly 3.4 crore children across eight states and union territories — Andhra Pradesh, Chandigarh, Himachal Pradesh, Kerala, Telangana, Uttarakhand, Dadra and Nagar Haveli and Daman and Diu has been covered.

“Children in the age group of 9 months to 15 years will be given a single shot of MR vaccination irrespective of their previous measles/rubella vaccination status or measles/rubella disease status,” he said. The vaccine will be provided free of cost across the States from session sites at schools and health facilities and outreach session sites.

“The vaccine protects against two deadly diseases—measles and rubella, only preventable through vaccination. There is no specific treatment for the diseases. MR vaccination is an essential investment by the government in children’s lives and will ensure that as future healthy citizens they contribute to the development of the country,” said Dr Yaron Wolman, Chief of Health, and UNICEF India.

After the completion of the campaign, MR vaccine will be introduced in routine immunization and will replace measles vaccine, given at 9-12 months and 16-24 months of age of child. Measles is a deadly disease and one of the important causes of death in children. It is highly contagious and spreads through coughing and sneezing by an infected person. Measles can make a child vulnerable to life threatening complications such as pneumonia, diarrhoea and brain infection. Globally, in 2015, measles killed an estimated 1, 34,200 children—mostly under the age of 5 years. In India, it killed an estimated 49,200 children.

MR vaccination

The measles-rubella vaccine used in immunization programme is live attenuated vaccine, safe and effective. Measles vaccines are available either as single antigen vaccine or in combination with either rubella (MR) or mumps and rubella (MMR) vaccines and with mumps, rubella and varicella (MMRV). Measles vaccines are available either as single- antigen vaccines or in combination with either rubella (MR) or vaccine. Most of the live, attenuated measles vaccines used now originate from the Edmonston strain of measles virus isolated by Enders and Peebles in 1954. A number of rubella vaccines are available either as single component or combined with measles vaccine (MR) or measles and mumps vaccines (MMR) or measles, mumps and varicella (MMRV). Most of the currently license vaccines are based on the live, attenuated RA 27 / 3 strain of rubella virus propagated in human diploid cells. Other attenuated rubella vaccine strains include the Matsuba, DCRB19, Takahashi, Matsuura and TO-336 strains used primarily in Japan, and the BRD-2 strain used primarily in China. Vaccination results in high (>95%) seroconversion rates and protection is generally assumed to be lifelong, although rubella antibodies may fall below detectable levels.

Likely to: MR vaccination is given to all  children  in  the  target  age  group  are  vaccinated  irrespective of  previous immunization status or history of measles / rubella disease. 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.  Asymptomatic HIV infection not a contraindication for MR vaccination. Ideally, the vaccine should be offered as early as possible in the course of HIV infection, HIV-infected infants should receive measles vaccine at 6 months of age, followed by an additional dose of MR vaccine at 9 months, in case they are not severely immune-compromised.

Storage: MR vaccine (before reconstitution) is stable when stored between 2 °C to 8 °C. Vaccine potency is dependent on the vial being stored at the recommended temperature. Following reconstitution, the vaccine must be stored at +2 to +8°C and used within 4 h. At the session site the reconstituted vaccine should be kept inside the well of icepack. The open vial policy is NOT applicable to reconstituted MR vaccine. The MR vaccine is very sensitive to sunlight. Hence it comes in colored glass vials.

Formulations and dosage: MR  vaccine  is  lyophilized  and  reconstituted  with  diluents  (provided  by  the  manufacturer)immediately prior to administration by injection. Diluent should be kept at 2–8°C at least 24 h before use and thus should be carried to session site at the same temperature as the vaccine (Inside vaccine carrier) .each ampoule of diluents for 10-dose vials of MR vaccine contains more than 5ml diluents that is used to dilute a single vial of MR vaccine. The entire amount of diluents in each ampoule provided by the manufacturer should be used to reconstitute the vaccine. Each MR dose is 0.5 ml and should be administered subcutaneously in the right upper arm. The site is important for standardization and survey purposes.

Adverse effects: slight pain and tenderness at the site of injection may occur within 24 h, sometimes followed by mild fever about 7–12 days after vaccination, up to 5% of measles vaccine recipients may experience fever of at least 39.4°C for 1–2 days. The fever may occasionally (1 / 3000) induce febrile seizures. A transient rash may occur in about 2% of vaccinated children thrombocytopenic purpura occurs in approximately 1 in 30 000 vaccinated individuals, one serious but extremely rare adverse effect is anaphylaxis due to measles vaccine. The risk is as low as to 1 in 1 million children vaccinated, arthralgia / joint pain can also occur when given in adolescent children or adults, adverse events, with the exception of anaphylactic reactions, are less likely to occur after receipt of a second dose of MR containing vaccine.

source: http://www.searo.who.int/india/topics/measles/measles_rubella_vaccine_guidelines.pdf?ua=1