Measles: Can vaccine be given again after two doses, will older children be eligible?

If a child has already received the measles vaccine, can it be given again? Will there be any problem if it is, asked a guardian sitting in front of the gate of Viqarunnisa Noon School and College in Bashundhara Residential Area. Another worried mother sitting beside her said she had lost her daughter’s vaccination card and was now anxious about whether her daughter had received the measles vaccine.

There is currently a measles outbreak across the country. Media reports mention deaths of young children due to measles and its symptoms. The infection rate is high. In hospitals, anxious parents and relatives can be seen sitting beside children infected with measles. Many of the infected and deceased are under one year of age.

In this situation, the government has launched a measles vaccination campaign. The target age group is 6 to 59 months, meaning up to 5 years old. Alongside concern over measles, parents also have questions about vaccination.

In kindergartens and English-medium schools, children aged 3 to 3.5 years are admitted to playgroup. Government primary schools admit children aged 5 to pre-primary classes. As a result, many school-going children fall within the vaccination coverage. From 5 April, a special vaccination campaign has begun in 30 measles-affected upazilas. From 12 April, vaccination will begin in Dhaka’s two city corporations and in Mymensingh and Barishal city corporations. Nationwide vaccination will begin on 3 May.

To understand awareness in schools and parents’ views, this correspondent visited six schools in the capital last Tuesday and spoke to guardians—some accompanying their children, others their grandchildren.

At the gate of Viqarunnisa Noon School (branch campus) in Bashundhara, Sharmin Akhter and Shipra Sadhak said their children study there. Sharmin Akhter, who had her 4-year-old son with her, said her daughter studies in class three. Both children have received measles vaccines. She lives in Kuril, where vaccination will begin at the urban health center on 12 April. Her son falls within the eligible age group, but she is unsure whether to vaccinate him again. She worries whether an extra dose might cause harm and whether children over 5 can also receive the vaccine.

Similar questions arose from parents at Bangladesh Grammar School and College, Prottay School and College, HURDCO International School, a government primary school in Kuril, and a madrasa in the same area.

At Bangladesh Grammar School and College, administrative officer Amina Sultana said children are admitted to playgroup at 3.5 years. A mother, Jhumur Hasnat, waiting outside, said her 4.5-year-old son studies in nursery, and she is unsure whether another dose is appropriate.

At Kuril Government Primary School, a woman named Jahanara said her grandson (her daughter’s child) studies in class four there. Her daughter lost her garment factory job; her husband is a painter, and they live in Badda. Jahanara keeps her grandson with her and sends him to this school. She asked, “If the measles vaccine has been given once, can it be given again?” She added that the school has not informed her about measles.

There are two measles vaccines: MR-1 (Measles/Rubella) and MR-2. These are given at 9 months and 15 months of age. Public health expert Mushtuq Hossain told Prothom Alo that even if both doses have been given, another dose can be administered without any problem. It will act as a booster dose. The government is vaccinating children aged 6 months to 5 years, but older children can also be vaccinated.

Shipra Sadhak, whose only child studies in class three at Viqarunnisa Noon School, said she is worried about the measles situation. While checking her daughter’s vaccination record, she found the card lost. She is unsure how to confirm whether the vaccine was given.

Regarding the worry of this guardian, Mushtuq Hossain said laboratory tests can determine whether a child has been vaccinated, but it is not necessary. Since a third dose causes no harm and anyone—from children to adults—can take the vaccine, there is no need to worry about previous vaccination status.

He added that since this is a mass campaign, children over 5 are unlikely to receive government vaccines, but they can get vaccinated through private hospitals if they wish.

Measles can affect people of any age, but the younger the child, the higher the risk, because their immunity is weaker and they are more vulnerable.

A guardian from Rampura, Ismat Ara Damini, asked when her 9-month-old child, vaccinated 7 days ago, should receive the next dose. About this, Mushtaq Hossain said at least one month should pass between doses. A child vaccinated at 9 months can receive another dose during this campaign before reaching 15 months.

Professor Abid Hossain Mollah of the Pediatrics Department (Mother and Child) at BIRDEM General Hospital said measles is caused by the measles virus and is highly contagious. Symptoms include high fever, cough, runny nose, red eyes, and after about four days of fever, reddish rashes starting from the face and spreading across the body.

The virus enters through the respiratory tract and temporarily weakens the immune system. It significantly reduces vitamin A levels in the body. Complications often include pneumonia and severe diarrhea.

According to this physician, the virus spreads instantly through coughing and sneezing. If a child has fever and rashes, whether measles or not, medical advice should be sought. A child with rashes should be kept isolated for at least five days from the onset.

Mushtuq Hossain blamed negligence in the government’s vaccination program for the current situation. The last mass measles campaign was in 2020, and a partial one in 2021. The goal of such campaigns is to cover children who missed vaccination.

The expert further said that after the operational plan (OP) expired in 2024, delays by the Ministry of Finance over whether the government would purchase measles vaccines with its own funding or procure them from UNICEF by paying a service charge meant that vaccines were not purchased. As a result, the number of children who did not receive the measles vaccine increased abnormally. Coverage of the two doses also did not reach the target (95 per cent). Consequently, children’s immunity against measles has declined.

Young children have been more easily infected with measles due to malnutrition. Last year, the vitamin A capsule campaign did not take place. Mushtuq Hossain also commented that vaccines are now being procured from UNICEF by declaring an emergency health situation.

He said that measles is not fatal in itself. However, due to malnutrition, children infected with measles are developing pneumonia, and many are dying from pneumonia. These deaths should not be considered as deaths from measles symptoms, but rather as deaths caused by measles.

He further said that, although delayed, the government has launched a mass vaccination campaign as an emergency health response. This will reduce the number of measles infections, but it may take another month for infections to decline. It may take about two months for measles-related deaths to decrease.

According to Mushtuq Hossain, awareness campaigns should be increased nationwide to prevent measles.

Unlike dengue prevention campaigns—where parents received messages and official information—no similar initiative exists for measles so far.

The principal of Prottay Ideal School and College, Shamima Ara Siddiqui, told Prothom Alo that the school reopened a few days ago after the Eid holidays. So far, no such messages have been sent to parents. However, the school always advises that children should not be sent to school if they have fever or cold.

Shamima Ara Siddiqui believes that if awareness messages about measles are to be given to parents, it would be better if they come through government instructions. She said her school has about 400 students from playgroup to class ten. Children aged 3 to 3.5 years are admitted to playgroup. The number of 5-year-old children in her school is around 150.

Outside Bangladesh Grammar School and College, Jyoti Chakraborty was waiting for her child studying in kindergarten. Next to her was Rabija Begum, the grandmother of another student in the same class. They said they had not received any separate message from the school regarding measles.

Jyoti Chakraborty said that since younger children under one year of age are being more affected by measles, there may be no school-based awareness activities. However, parents are remaining alert in their own way. She said she once worked as a medical assistant but left her job due to her child. She is very conscious about vaccination. After the measles outbreak was reported, she checked her child’s vaccination card and confirmed that both measles doses had been given.

On the way into HURDCO International School (English medium), two guardians—Umme Habiba and Munni Akhter—were seen. Both of their children study in playgroup. They said that although they had not received any written instructions from the school, they themselves are aware of measles.

Senior administrative officer of the institution, Farzana Nasrin, said they had not received any government instruction for measles awareness campaigns. Although they did not send any written message to parents, they advised them to be cautious about measles on the day of result publication last Saturday.

Farzana Nasrin added that Hardco International School had been used as a venue under government instructions during Covid vaccination, and more recently for HPV (cervical cancer prevention) and typhoid vaccination campaigns. The institution has around 2,000 students from playgroup to A level, of whom more than 400 are aged between 3.5 and 7 years.

At the Mahadu Talimil Banat Madrasa in Kuratoli Bazaar, a mother whose daughter studies in class one said while returning home that they had not been informed anything about measles or vaccination by the madrasa. Her daughter has already received the measles vaccine.

Head teacher of Kuril Government Primary School, Shafiqul Islam, told Prothom Alo that although no messages were sent to parents, students are being informed about measles in class and made aware.

Assistant teacher of the school, Jahidul Islam, said that the urban health centre called on Monday and informed them that the school will be used as a vaccination venue on 12 April.

Public health expert Mushtaq Hossain has emphasised making the measles mass vaccination campaign a regular programme. Describing the measles situation as an “epidemic,” he said that measles services must be expanded to district-level hospitals.

Patients with measles should be treated separately, and careful attention must be given so that treatment of critically ill patients with other diseases is not disrupted, he added.