3.1.5 Measles_Rubella NSCH

Learning Outcomes

  • Understand key immunisation practices and management of side effects for measles and rubella vaccines.

Study Material

  • Key References:
    • Clarke, 2016 (Vlok), Chapters 8, 13
    • Kortenbout et al., 2009, Chapter 5
    • DOH Powerpoint, 2023 (Rubella-containing Vaccine introduction in EPI Schedule, South Africa)
    • Primary Health Care Level, 2020, Chapter 13
    • Road to Health Booklets, various years
    • Vaccinators’ Manual 2015
    • IMCI Manual, 2019

Measles

  • Overview:
    • Highly contagious viral infection.
    • Symptoms include:
    • Prodromal fever
    • Coryza
    • Koplik spots on oral mucosa
    • Conjunctivitis
    • Ocular photo-sensitivity
    • Red macular rash (appears on day 3-7, spreads downward)
  • Transmission:
    • Airborne via aerosolized droplets
    • Close respiratory contact
    • Indirect contact with contaminated surfaces
  • Complications:
    • Serious: Pneumonia, diarrhoea, otitis media, encephalitis, blindness, death.
    • Risk factors for complications: Undernutrition, Vitamin A deficiency.

Rubella

  • Overview:
    • Initially termed "German measles".
    • Typically mild in children and adults, with symptom onset over 2-5 days:
    • Low-grade fever
    • Malaise
    • Lymphadenopathy
    • Upper respiratory symptoms
    • Conjunctivitis
    • Anorexia and fatigue
  • Complications:
    • Arthritis, hemorrhagic manifestations, orchitis, neuritis, Progressive panencephalitis, Congenital rubella syndrome (CRS).

Congenital Rubella Syndrome (CRS)

  • Severities:
    • Linked to maternal rubella infection, especially in first 12 weeks of gestation.
    • Can lead to miscarriages, stillbirths, and severe birth defects.
    • WHO estimates over 100,000 infants born with CRS yearly.

Vaccine Information

  • Vaccine Name: Measles and Rubella Vaccine (abbreviated as MR)
  • Administration Schedule:
    • Given at 6 months (subcutaneously in right thigh) and again at 12 months (in right deltoid).
  • Dose: 0.5 ml (not to be given simultaneously with other vaccinations).
  • Route: Subcutaneous administration recommended.

Cold Chain Requirements

  • Storage:
    • Store vaccine at 2°C-8°C, protect from light.
    • Reconstituted vaccine to be discarded after 6 hours.
    • Avoid freezing; discard if frozen.

Contraindications

  • Not Recommended For:
    • Known hypersensitivities to the vaccine or its components,
    • Severe allergic reactions to neomycin or gelatin.
  • Precautions:
    • Supervision required during immunisation.
    • Delay in vaccination if febrile illness present.

Possible Side Effects

  • Common:
    • Mild pain at injection site, mild fever, rash.
  • Uncommon:
    • Severe swelling, allergic reactions.
  • Serious Risks:
    • Encephalitis and anaphylaxis.

Health Education for Parents

  • Post-Vaccination Care:
    • Symptomatic treatment for fever (fluids, paracetamol).
    • No ointments on injection site; can use cool cloth.
  • Awareness: Inform parents about normal post-vaccine reactions (e.g., mild rash).

Injection Technique

  • Method:
    • Subcutaneous injection at a 45° angle.
    • For children under 1 year: Inject in the thigh; over 1 year: Inject in the arm.
  • Injection Procedure:
    • Pinch skin to elevate; insert needle slowly. Clean area with gauze post-injection.