Title: Measles vaccine
Course: Level 3 - Immunization > Section: Antiviral vaccines

Measles is caused by the measles virus and is highly infectious, i.e. very easily spread from person to persons. It kills more children than any other of the EPI target diseases. In the absence of immunisation, all children eventually develop measles and about 3 of every 100 will die. Unimmunized children under five years of age, and especially infants, are at highest risk for measles and its complications like Encephalitis, a dangerous swelling of the brain, Blindness even lead to death.

The first sign of infection is a high fever lasting 1 to 7 days. In order to diagnose measles, in addition to fever, there must be a generalised rash and at least one of the following: a cough, runny nose, and red eyes. These problems are prevented by providing measles vaccine.

Note: Infants born to mothers who have had measles are usually immune for six to eight months

Figure 3.2 (a) Measles rash covering the whole body of a child; (b) Conjunctivitis (red, watery eyes) caused by measles. (Photos: WHO and Ethiopian Federal Ministry of Health, 2005, Case Definition of Measles).

Storage, dosage and schedule of measles vaccine

The vials containing the dry measles vaccine powder can be frozen for long term storage, but after reconstitution with the correct diluent, measles vaccine should be kept at between +2°C and +8°C, and never frozen. Any remaining reconstituted vaccine must be thrown away after six hours, or at the end of the immunization session, whichever comes first. One dose of 0.5 ml of measles vaccine is injected subcutaneously (into the fatty layer below the skin and above the muscle) in the outer upper arm as soon as possible after nine months of age. Waiting this long is advisable because the maternal antibodies against measles that are transferred to the unborn baby before birth last longer in the blood of the baby than other antibodies. As a result, immunization with measles vaccine is often not effective before nine months of age. The aim in the EPI in Ethiopia is to give measles vaccine to all children at nine months of age. To achieve high-level herd immunity, a second dose is ideally given after 12 months of age during supplementary immunization activities.

Figure 3.2a. The position of the needle for measles injection.

Figure 3.2b. Needle position for measles injection (subcutaneous).

Summary of Measles Vaccine

Characteristics | Disruptions
Vaccine type | Live-attenuated antiviral vaccine
Amount(dose) given | 0.5 ml
Injection site | Left upper outer arm
Rout of administration | Subcutaneous
Number of doses | One in routine EPI schedule, plus one in supplementary campaigns
Schedule | At nine months in the EPI; after 12 months in campaigns
Booster(additional) dose | At 6 months in some circumstances
Storage | Store between +2°C and +8°C (Note: the vaccine powder maybe frozen for long-term storage, but not the diluent or the reconstituted vaccine) Vaccine storage is described in Study Session 4
Contra-indications | Severe allergic reaction to the previous dose
Adverse effect | Fever, rash and (rarely) severe allergic reaction or abscess
Management of adverse effect
- Mild cases give paracetamol syrup and reassure the mother
- Severe cases like Refer urgently to a higher health facility
Special precautions | None