MR vaccine campaign: Does your child need vaccination?

Measles and rubella vaccination campaign is on. This is a primer for the parents wondering about the pros and cons of participating in it.

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In mid-January 2017, social media groups in Bengaluru buzzed with posts of confused parents who sought to know whether they should vaccinate their child in school – the schools were asking their consent to vaccinate the children against Measles and Rubella. This is a part of Union government’s National Health Mission initiative to vaccinate children across India against commonly occurring diseases among children – Universal Immunisation Programme (UIP).

On February 7th, 2017, the Department of Health and Family Welfare, Karnataka launched a mass measles and rubella vaccination campaign to immunise all children in the State aged between 9 months and 15 years. Karnataka is one among the five states and Union Territories where the MR vaccination campaign is being carried out in the first phase. The two-year-long nationwide drive has been pitched to be a step towards making the country rubella and measles-free by 2020, which is also a goal of World Health Organisation.

The campaign did not go down well with a large number of parents in Bengaluru, who expressed their concerns over vaccinating their children under the mass immunisation programme. For parents who have already immunised their children with Measles, Mumps and Rubella (MMR) vaccination, the government’s immunisation campaign to give an additional dose of MR vaccine did not seem right.

There were also WhatsApp forwards that cautioned against the vaccination drive, against which cybercrime complaints were filed by the government.

Parents unwilling to vaccinate children

Following resistance, the programme gave an option for parents to express their unwillingness against the vaccination. This option was made available in the vaccination invitation card that schools sent out to parents, informing and inviting them for the vaccination drive, on behalf of the Ministry of Health and Family Welfare.

The resistance of parents in Bengaluru to vaccinate their children is also visible in the MR vaccination coverage data. In the second week of launching the drive, according to the data available with the Department of Health and Family Welfare, Bruhat Bengaluru Mahanagara Palike (BBMP) has recorded the least cumulative coverage in the entire state with 43.23 per cent of vaccination as on February 20th.

Many parents argue against vaccines, citing the emergence of vaccine-derived polio virus, which takes birth due to oral polio drive, in areas that do not have good sanitation. There are many cases of vaccine-derived polio in India, which have negated the cause of polio-free India, while the vaccine itself became the source of virus and attacked children with low immunity. Measles is not comparable to Polio, and the dynamics are different for each vaccine.

MMR not effective enough? 

One of the main concerns raised by parents belonging to middle and high income groups is why to administer MR vaccination, when their child has been already administered with MMR vaccination which also covers mumps.

The vaccination schedule mandated by the Universal Immunisation Programme of the Union Government makes it mandatory to have a Measles vaccination at the age of 9 to 12 months. Though mumps and rubella vaccines are not a part of official vaccination programme, most of the private pediatricians administer MMR vaccine instead of just measles vaccine.

The Union Health Department officials also feel the combination of MMR vaccine is better, for it covers three diseases, whereas MR leaves out mumps.

However, World Health Organisation (WHO) estimated that in 2010, India accounted for 47% of estimated measles mortality worldwide. A study by US-government-supported National Center for Biotechnology Information (NCBI) done in India in 2011 showed that the percentage of children protected against measles was alarmingly low, even after the administration of booster dose, while protection against mumps and rubella was adequate. The paper recommended further evaluation and research on the topic.

Further in 2012, the World Health Organisation estimated that about 3% of children die to due measles. We tried to get the data regarding deaths caused due to measles from Bengaluru urban district from the officials but failed. The data available in public domain for Bengaluru urban district for the period between 2011-12 and 2014-15 shows no deaths of children due to measles.

MR an advantage to unvaccinated children

The government believes that for a large majority of India’s population that relies on government’s immunisation programme, MR vaccination is an advantage. With the introduction of MR combination this year, children will be vaccinated against measles as well as rubella.

“Measles vaccination was part of our routine immunisation. But the World Health Organisation and the Central government have established that rubella too is as harmful to a child, just like measles. It has been decided to give a combination of measles and rubella vaccines in our routine immunisation. The ongoing MR vaccination campaign is the beginning. In future, all the children (who visit government hospitals) in the age group of 9 months and 12 months will be given first dose of MR vaccine and they will be administered with second dose of vaccine when the child is between 18 and 24 months,” Reproductive and Child Health (RCH) State Project Director, Dr Renuka explains.

Dr Sowmini, a private Pediatrician from Rajaji Nagar says the private practitioners however would continue to give MMR vaccination as it is a better combination for it protects children from three diseases. “MR vaccine combination is not yet available for private practitioners, therefore we have been giving MMR vaccine,” she says, adding that this practise will be continued.

So why did the government exclude vaccination for mumps when all the private medical practitioners and several countries in the world have been promoting MMR vaccination?

Reproductive and Child Health Officer (RCHO) Dr Mahesh Kumar says the reason for not including mumps in the immunisation programme is because mumps cases are not so severe and do not affect the child mortality rate. “The concern is to bring down mortality rate among children by eliminating measles and control congenital rubella syndrome,” he explains.

Will an additional dose affect the child?

“An additional dose will not adversely affect the child, it will improve the immunity status. It will not harm the child at all,” affirms Dr Renuka. She says the additional dose can be given to children who have already been administered vaccine for measles or MMR or even those children who have already suffered from measles and rubella.

Dr Sowmini agrees that taking an additional dose of vaccine as part of the national programme will help break the chain of virus.

“Even after having been vaccinated for MMR, your child could still be the carrier of the virus. The child may not suffer because of having vaccinated in the past, but it can still transmit the virus. In order to prevent the transmission and break the chain, participating the campaign would help,” she says.

However, she cautions that parents should avoid MR vaccination if the child has been given vaccinated for MMR in last one or two months or if the child is suffering from any viral infection.

‘Vaccination optional’

No information is available on the clinical and field trials of the MR vaccine, being supplied by Serum Institute of India. MR vaccine is believed to have less side effects, though there are chances of anaphylaxis (allergic reaction) to MR vaccination.

“It happens only to one in three million children. No such case has been reported in the state so far,” Renuka says. In order to observe whether the children are allergic to the vaccine, they are made to sit for half an hour after administering the vaccine. Any symptom of allergy could be traced within half an hour.

On the cases of several parents refusing to vaccinate their children, Renuka says the department has no intention to force parents to vaccinate their kids. “We can only request them, but can not make it compulsory. It’s absolutely their choice,” she told Citizen Matters.

Dr Mahesh Kumar, RCHO Bengaluru Urban, says the other option for parents who do not wish to vaccinate their child in schools, is to approach the private practitioner or family physician and ask the doctor to administer MR vaccine to the child as part of the campaign.

“We have made provision for private practitioners/paediatricians to place a request with the local government medical officer specifying the vaccine dosage required, based on the number of children to be vaccinated in their clinic or hospital. We will supply them the vaccine depending on their request on a specific date during one of the campaign days and later we will collect the vaccine administered report from the doctors,” he said. This way the parents who avoid vaccinating their children in schools can still be a part of the campaign, if they want.

How to decide whether to vaccinate or not?

Ask yourself these questions:

  • Has your child been given initial and booster doses of MMR vaccine already?
  • Has your child suffered from any viral or bactierial infection in last 20 days?
  • Has your child already had episodes of measles and rubella?
  • Do you believe natural immunity is better than vaccination?
  • Does your child have any known cases of allergy to measles vaccine?
  • Do you believe government should not intervene in personal medical choices?

If your answer to any of the questions is yes, you don’t have to participate in the MR mass vaccination drive.

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  1. Chidambaran Subramanian says:

    Its good to see an article here that does not go overboard praising vaccines. You are right that the parents should have the final say in healthcare choices for their children.

  2. naresh says:

    This is the first post on this website I do not agree with..How does the author get to the conclusion at the bottom from everything above in the article? I believe the author is not qualified to draw up the list of questions to not get vaccinated. Even if the list above were to come from a qualified source, the common man on the street is no where qualified to answer those questions.

    Questions like “Do you believe natural immunity is better than vaccination?” are ridiculous since there is solid science that vaccines do work and help save thousands of lives. Does this organization support people skipping other vaccines because the “natural way” is better?

    “Do you believe government should not intervene in personal medical choices?” .. such questions are good for politicians during rallies and not to be used in reality. As mentioned before, the average person is in no way equipped to answer such questions.

  3. Vaidya R says:

    Since when did vaccination become the issue that it is now, with people questioning their need.
    Even up to the 90s, you had a list of vaccine shots that needed to be given and you got them done. I don’t remember people questioning the need for them. Yes, there are a lot more vaccines these days, like for MMR and chicken pox, which weren’t there earlier, or maybe considered necessary.
    Is this what happens when you have too much information, from too many sides?

  4. Shree D N says:

    Having followed the issue for a while now, I would say yes, information started reaching people courtesy internet. To be fair to both the sides, there are people in Bangalore who contracted polio due to vaccine-derived virus (a few closely associated with us), people working on this issue, children who got paralysed/ disabled after vaccine shots etc – the cases we know of first hand.
    These cases were earlier not visible as no one gave a platform to these people – the Internet changed it. But of course, vaccine itself is a shot of virus, and can affect children with low immunity – so no one should be surprised at it.
    Measles is a manageable disease, but 3% of child deaths in India happen to due to Measles, so the govt is trying to help by giving an extra shot. But Since MMR is a common mandatory vaccine in the vaccine schedules, most urban parents/ people with access to medical facilities would have gone for it, and don’t find the need to go for it again.

  5. naresh says:

    I did a google search of keywords including bangalore/karnataka and polio and found that the last reported case of polio in Bangalore was about a decade ago and too was in a child travelling from North India.

    According to the World Health Organization.. ” Since 2000, more than 10 billion doses of OPV have been administered to nearly 3 billion children worldwide. As a result, more than 13 million cases of polio have been prevented, and the disease has been reduced by more than 99%. During that time, 24 cVDPV outbreaks occurred in 21 countries, resulting in fewer than 760 VDPV cases.

    The small risk of cVDPVs pales in significance to the tremendous public health benefits associated with OPV. Every year, hundreds of thousands of cases due to wild polio virus are prevented. Well over 10 million cases have been averted since large-scale administration of OPV began 20 years ago.”

    Total of 760 cases in 21 countries in 20 years after billions of doses of vaccine… I would take those odds any day.

  6. Shailesh Mistry says:

    MMR vaccine is one of the leading cause of autism among kids. There has been considerable debate on this with the CDC in US. Also, there is a documentary VAXXED which based on this.

  7. Concerned says:

    Shailesh, please do not spread these false statistics. This is not true and has been refuted by many including the CDC. The false claims has lead to many cases of mumps outbreak in parts of California; interesting enough, in the affluent neighborhoods.

    Parents should make an educated choice, but please do make sure you are educating yourself on the right facts. There is always a risk benefit to vaccines. In the vast majority of cases, the benefits far out weigh the risks. However, you should consult with your doctor to see if your child is at risk more than others.

  8. Srinivasa SA says:

    ‘@Concerned, @naresh, I see there is lot of news on this autism and vaccination relationship. CDC itself, I understand, recently didn’t deny it.

  9. T.rajitha says:

    My child now she is 16months now she has vaccinated with MR vaccine and in 9 months MMR vaccine has been taken does it affects my child

  10. Kumudini says:

    Measles, also known as rubeola, is a highly infectious disease. Itโ€™s caused by a virus, and can be prevented by effective vaccination. The adult form is more severe than when children acquire it, and the infected adults would end up feeling way worse.
    Most people get better within 2 weeks. But measles can sometimes cause dangerous problems, such as lung infection (pneumonia) or brain swelling (encephalitis). In rare cases, it can even cause seizures or meningitis.

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