Measles and Rubella

Approved Indications:

• Routine immunization against measles and rubella in children, adolescents, and adults without documented immunity.
• Catch-up vaccination for individuals who missed scheduled childhood doses.
• Outbreak control to limit transmission of measles and rubella in affected communities.

Target Populations:

• Children: As part of the routine childhood immunization schedule (typically at 9–12 months and again at 15–18 months or school entry).
• Women of childbearing age: To prevent congenital rubella syndrome (CRS), especially in non-pregnant, seronegative individuals.
• Healthcare workers and travelers: Without documented immunity.

Off-label / Expanded Use:

• Post-exposure prophylaxis (PEP): Within 72 hours of exposure to measles in susceptible individuals.
• Supplementary Immunization Activities (SIAs): Mass campaigns targeting children to close immunity gaps.

Route: Subcutaneous injection, preferably in the upper arm (deltoid region) or outer thigh (anterolateral thigh in young children).

Routine Schedule:

• First dose: At 9–12 months of age (varies by country immunization program).
• Second dose: At 15–18 months or at school entry (ages 4–6 years).

Catch-up Schedule:

• Individuals aged ≥1 year without vaccination history: Two doses, at least 4 weeks apart.

Adults:

• Non-immune adults: Two doses, 4 weeks apart.

Pregnancy:

• Contraindicated. Delay until postpartum period.

Immunocompromised Patients:

• Generally contraindicated, especially in severe immunodeficiency. Live attenuated vaccines can pose risks.

The Measles and Rubella (MR) vaccine contains live attenuated viruses of measles (Edmonston-Zagreb or Schwarz strain) and rubella (RA27/3 strain). Following subcutaneous injection, these attenuated viruses replicate locally and stimulate the host’s immune system, generating a robust humoral (IgG) and cellular immune response. This leads to long-lasting immunity by inducing memory B and T cells that recognize and rapidly neutralize wild-type viruses upon future exposure. Protective antibodies against measles and rubella generally develop within 10–14 days after vaccination.

As a live attenuated vaccine, traditional pharmacokinetics (ADME) are not applicable. However:

• Onset of Immunity: Protective antibodies typically appear within 10–14 days post-vaccination.
• Duration of Immunity: Often lifelong after two doses; booster not typically required.
• Distribution: Local replication at injection site, followed by immune response activation in lymphoid tissue.

• Pregnancy:
  Contraindicated. Live rubella virus may pose a theoretical risk to the fetus, though no confirmed congenital rubella cases have resulted from vaccination. Women of childbearing age should avoid pregnancy for 1 month after vaccination.
• Lactation:
  Generally considered safe. Rubella vaccine virus may be excreted in breast milk but has not been associated with adverse effects in breastfeeding infants.

• Primary Class: Vaccine
• Subclass: Live Attenuated Viral Vaccine (Measles + Rubella)

• Known hypersensitivity to neomycin, gelatin, or any vaccine component
• History of severe allergic reaction (e.g., anaphylaxis) to prior measles or rubella vaccine
• Pregnancy
• Severe immunosuppression (e.g., HIV with low CD4, cancer chemotherapy, organ transplantation)
• Acute febrile illness (postpone vaccination)

• Immunocompromised Individuals: May develop vaccine-related disease; use is contraindicated in severe cases.
• Thrombocytopenia: Use with caution in individuals with history of vaccine-related thrombocytopenia or ITP.
• Seizure History: Post-vaccine fever may provoke febrile seizures in predisposed children.
• Close contacts of pregnant or immunocompromised persons: Generally safe, but minor risk of viral shedding.
• Anaphylaxis Management: Facilities for treating severe allergic reactions should be available at vaccination site.

Common (Mild to Moderate):

• Fever (5–15%)
• Rash (1–5%)
• Pain, redness, or swelling at injection site
• Irritability or fatigue

Less Common / Serious:

• Febrile seizures (especially after first dose, 1 in 3,000–4,000 cases)
• Transient lymphadenopathy
• Thrombocytopenia or ITP (rare)
• Allergic reactions (rash, urticaria)

Rare Serious Reactions:

• Anaphylaxis
• Aseptic meningitis (extremely rare)
• Encephalitis (estimated 1 in 1,000,000)

Onset Timing:

• Fever and rash typically occur 7–12 days after vaccination
• Allergic reactions usually occur within 1–2 days

• Immunoglobulin (IG) Therapy: Avoid MR vaccination within 3–11 months after receiving immune globulin products, as these may interfere with immune response.
• Other Live Vaccines: Can be given simultaneously, or must be spaced ≥28 days apart if not given on the same day.
• Immunosuppressive drugs (e.g., corticosteroids, chemotherapy): May impair vaccine efficacy—delay vaccination until recovery.

• WHO/UNICEF Immunization Schedule Update (2023): Reaffirmed the two-dose MR schedule as part of global measles and rubella elimination strategy.
• GAVI and WHO SIAs (2024): Expanded measles-rubella catch-up campaigns across high-risk populations in Africa and Southeast Asia.
• Surveillance Emphasis: Countries urged to integrate measles-rubella serosurveillance to guide supplemental immunization activities (SIAs).

• Temperature: Store refrigerated at 2°C to 8°C (36°F to 46°F).
• Light Sensitivity: Protect from light. Store in original carton.
• Do Not Freeze: Freezing may damage the live virus.
• Reconstitution:
• Use only the diluent provided.
• Reconstitute just before use.
• Use within 6 hours of reconstitution.
• Discard unused vaccine after 6 hours or at the end of the immunization session.