Guideline on Special Measles, Rubella

(MR) Immunization Campaign

Heath care Workers

2025

Epidemiology Unit, Ministry of Health

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 Special Measles, Rubella (MR) Immunization Campaign

Measles-Rubella (MR) vaccine will be offered to all eligible individuals during the special
immunization activity.

Eligibility criteria – All healthcare workers in preventive and curative healthcare settings in the
government and private sector.

Organizing Immunization Clinics:

1. Immunization Days and Clinic Locations: Healthcare settings

 The district health team together with hospital administration and the area MOH will
decide whether to conduct immunization clinics at the healthcare setting considering the
practical implications.

 Alternatively, eligible individuals could be referred to MOH office-based immunization

clinics. In such instances, eligible individuals should be referred to these clinics in
groups whenever possible with the list of eligible individuals.

 List of Eligible Individuals- Health Care Institution (Epid/MR/HCW/ Record 1-LEI)

should be made available at the immunization clinic

 Immunization days need to be decided by MOH and hospital administration

collaboratively

2. Clinic Preparation: All clinics should be setup before the immunization event to ensure a
smooth operation.

3. Staff requirements:

 Medical Officer Availability: A medical officer must be present at each clinic. This may
require mobilizing staff from hospitals, central dispensaries, or other MOH offices.
 In addition, each clinic (MOH office, field or onsite) should have adequate staff members
from the following categories:
o Public Health Midwives (PHMM)
o Public Health Nursing Sisters (PHNS)/ Nursing officers or Public Health Inspector
(PHI)
o Supportive staff or volunteer

Staff- Total -5 including vaccinators: Each clinic must have at least 2 trained and competent
vaccinators.

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4. Emergency Preparedness:

 Emergency Tray: An emergency tray with essential medicines (especially adrenaline) and
equipment must be available in adequate quantities at every clinic. The Medical
Officer/PHNS should check and sign off on the emergency tray at the MOH and send it to
the clinic. The Medical Officer /PHNS in charge at the clinic should then recheck and sign
off on it.
 Coordination with nearby hospital/ nearby hospitals should be informed about the special
vaccination campaign in advanced to ensure preparedness to manage possible serious
Adverse Events Following Immunization (AEFI).
 Transport Arrangements: A standby vehicle should be available at all clinics to transport
individuals to a hospital with adequate facilities in the rare event of a serious AEFI.

5. Immunization-Specific Guidelines:

 Pre-vaccination screening:

 All individuals attending immunization clinics must be thoroughly screened by healthcare

workers to identify any contraindications or high-risk conditions and should marked in the
correct column of the Clinic Attendance Registers (Epid/MR/HCW/ Record 2-CAR)
 Individuals suffering from an acute infection or those who have received a live vaccine in
the past four weeks should not receive the MR vaccine. Such individuals can be referred to
the central MOH clinic for vaccination on a later date.
 If high-risk conditions are identified (e.g., severe medical conditions or allergies), these
individuals should be referred to a hospital-based immunization clinic with adequate
facilities.

 Contraindications for MCV

a) Absolute contraindications:

Individuals with following conditions should not be vaccinated with the MR vaccine
- Allergy to a previous MCV dose
- Severe allergy to any previous vaccine
- Those who are severely immunocompromised as a result of congenital disease, HIV infection,
advanced leukaemia or lymphoma, serious malignant disease, or treatment with high-dose
steroids, alkylating agents, or antimetabolites, and individuals who are receiving
immunosuppressive therapeutic radiation.
- Pregnancy should be excluded in all females of childbearing ages through a careful history.
Any pregnant women and women with a Period of Amenorrhoea (POA) who are not on
contraception should not be vaccinated. For clarification of any doubts on possible pregnancy,
should be referred to a VOG prior to vaccination. Women should be advised to avoid pregnancy
for a period of one month after vaccination with MR vaccine.

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 b) Relative contraindications:

- Individuals with following conditions should be vaccinated with precautions in a hospital

immunization clinic
- History of beef/red meat allergy and cow’s milk allergy
- Presence of any contraindications for any other vaccines
- Individuals with allergies to erythromycin, kanamycin, trypsin, or other components of the MR
vaccine

 Consent for vaccination: Verbal consent should be obtained from all eligible individuals.

- For those above the age of 18 years each individual should consent to receive a dose of MR
vaccine
- The consent received should marked in the correct column of the Clinic Attendance Registers
(Epid/MR/HCW/ Record 2-CAR)

 Vaccine Administration:

 Dosage:
MR Vaccine: A single dose of 0.5 ml will be administered via the subcutaneous route,
preferably into the outer upper arm on the left side (deltoid region).
 Interval between an MR and other live vaccines : There must be a minimum interval of
4 weeks between the administration of MR vaccines and any other live vaccines (BCG,
chicken pox, Rotavirus, Yellow fever) per the guidelines of the Immunization Handbook
(Epidemiology Unit, 2012).

 Post-Vaccination Observation:
After receiving the vaccine, each individual must be observed for a minimum of 20 minutes
to monitor for any potential Adverse Events Following Immunization (AEFI).

 Vaccine Safety Management:

Cold Chain Maintenance:

 Storage Conditions: MR vaccines must be stored between 2°C and 8°C. During the
immunization session, reconstituted vaccines should be kept on a foam pad to maintain the
cold chain and protected from direct sunlight.
 Vaccine Expiry: Reconstituted vaccines must be discarded after 6 hours since opening or
at the end of the clinic session, whichever comes first.

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6. Clinic Records and Returns: Data Compilation and Submission:

 Before arranging the clinics for the Healthcare Workers ICNO/MO public health should get list
of eligible individuals using Epid/MR/HCW/Record 1-LEI and send or submit online summery
return using Epid/MR/HCW/Return of record 1-LEI by June 16th 2025.
 Clinic registration should be done using Epid/MR/HCW/Record 2 CAR-in clinics conducted
for health care workers
 Vaccination clinic tally sheets used to mark and crosscheck number of doses Epid/MR/Record
3-TS.
 At the end of each clinic day, all data should be compiled and submitted to the Epidemiology
Unit through the Regional Epidemiologist (RE) using the provided formats or upload to the
online platform Epid/MR/HCW/Return of Record 2-CAR.

 Clinic form Submission:

o Form 1 (Epid/MR/HCW/Form 1) should be prepared in three (3) copies.

1. One copy should be sent to the MOH
2. 2nd copy should be sent to the head of the healthcare institution.
3. 3rd copy should be kept at the vaccination centre itself

o With the receipt of form 1 (Epid/MR/HCW/Form 1), MOH should be prepared form 2
(Epid/MR/HCW/Form 2) and sent to the regional epidemiologist

o Finally, form 3 (Epid/MR/HCW/Form 3) should be sent to the Epidemiology unit by

Regional epidemiologist.

Table 1. Records/Returns/Forms

Epid/MR/HCW/ Record 1-LEI Record 1- List of Eligible Individuals (HCW)

Epid/MR/HCW/Return of Record 1-LEI
Return of record 1-Summery return of LEI

Epid/MR/HCW/ Record 2-CAR Record 2-Clinic Attendance Register HCW

Epid/MR/Record 3-TS Record 3: Vaccination clinic tally sheet -MR
Epid/MR/HCW/Return of Record 2-
Return of record 2-Summery return of CAR-HCW
CAR
Form 1-Clinic Return from the Healthcare Institution
Epid/MR/HCW/Form 1
to MOH
Form 2-MOH Office Return to Regional
Epid/MR/HCW/Form 2
Epidemiologist
Form 3- Vaccine Return of MR Doses for Health Care
Epid/MR/HCW/Form 3 Workers from Regional Epidemiologists to
Epidemiology Unit

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Documentation of vaccinations:

 Routine Immunization Record: For those with a Child Health Development Record
(CHDR), details of the catch-up dose, details must be documented in the immunization
section, including the vaccine type (MR), batch number, and date of administration under
the routine immunization section.
 Vaccination Cards: Individuals without a CHDR or who receive an additional dose (SIA),
should be entered in the special vaccination card with all relevant details (vaccine type, batch
number, date), which must be signed and stamped by the MOH. Recipients should be
advised to keep this card safe for future reference.

7. AEFI Reporting:

 AEFI Identification:
Any AEFI identified during the clinic should marked in the correct column of the Clinic
Attendance Registers (Epid/MR/HCW/Record 2 CAR) and compiled into the respective
Clinic Summery (Epid/MR/HCW/Return of Record 2 CAR)
 Routine Reporting: All AEFI must be reported and investigated as per the "Guidelines
on reporting and investigation of AEFI" (Epid/75/2012).

Role of RDHS in Special MR Immunization Campaign

1. Facilitate, coordinate, monitor, and evaluate all the activities related to the special
immunization activity within the district.
2. Ensure smooth implementation of all the immunization activities in the district according
to the instructions issued by the Epidemiology Unit.
3. Ensure the availability of a medical officer at all immunization clinics on immunization days
by mobilizing staff from other health institutions in the district.
4. Ensure the availability of an adequate number of trained and competent health staff to all
immunization clinics by mobilizing staff from other health institutions in the district.
5. Ensure sufficient transport facilities are available on immunization days for the efficient and
timely distribution of vaccines and other logistics to the clinic centres.

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Role of Regional Epidemiologist/MO-Epidemiology in Special MR
Immunization activity- Health care workers

1. Coordination of all the activities related to the special MR immunization activity within the
district.
2. Conduct district-level training programs for MOOH and hospital staff.
3. Coordinate and supervise trainings for MOH office staff at MOH level.
4. Estimation of required vaccine stocks and other logistics for the district.
5. Closely monitoring of requisition of MR vaccine & other logistics at the MOH level.
6. Ensuring proper vaccine storage and cold chain maintenance at all levels in the district.
7. Close supervision of the supply chain to ensure timely distribution of vaccines, AD syringes,
and other logistics within the district.
8. Close monitoring and supervision of all special immunization-related activities and MR
immunization coverage during special immunization days.
9. Compilation and reporting district-level MR special immunization performance to the
Epidemiology unit Epid/MR/HCW/Form 3 for health care workers
10. Overseeing logistic arrangements at the district and MOH level.

Role of MOH in Special MR Immunization campaign

1. Identify occupational and educational settings in consultation with the RE/MO-

Epidemiology for the special MR immunization activities.
2. Identify immunization clinic centers along with designated staff and ensure logistic facilities
for their smooth functioning.
3. Identify the eligible population and estimate required MR vaccine stocks & other logistic
needs for the MOH area.
4. Train MOH staff on the special MR immunization activities.
5. Guide all MOH staff to reach maximum vaccination coverage in the target age group.
6. Encourage non-health staff in the area to mobilize all target individuals to the clinics to
achieve maximum coverage.
7. All possible efforts towards local advocacy to ensure the success of the special
immunization campaign.
8. If volunteer support is expected, ensure they are properly trained on documentation and
registration procedures.
9. Plan to ensure the timely availability of sufficient vaccines, proper storage, cold chain
maintenance, an adequate supply of vaccine carriers with frozen cool packs, required
formats, and all other logistics for the successful implementation of the special MR
immunization activities.
10. Preparing a transportation plan with an appropriate network to ensure timely delivery of the
vaccine to the clinics and a plan for the collection of vaccines and returns after the clinics.

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 11. At the end of each clinic day, the completed clinic return from all clinics should be received
by the MOH.
12. At the end of the special immunization campaign period compile data in 2 copies of the
MOH clinic return, send with one copy to the Regional Epidemiologist and keep one copy
as an office copy.

Role of heads of Hospitals

 When Immunization clinics for HCWs are conducted at the hospitals

1. Collaborate with area MOH and the district team to setup immunization clinics and
organize other logistics.
2. Supervise preparatory activities and clinic activities on the day of immunization.
3. Ensure proper record keeping and data management activities.

 When immunization clinics are conducted outside the hospitals

1. Support district-level health authorities to carry out Special MR Immunization activities

by providing additional health personnel, transport facilities etc whenever possible.
2. Ensure the prompt and efficient services for any individuals with AEFI from the Special
MR Immunization clinics
3. Timely notification of all reported AEFI to the relevant authorities.

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