Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
             
• Before use, the vaccine is reconstituted with sterile diluent.
• The most effective compromise is immunization as close to the age of
9 months as possible.
• The age can be lowered to 6 months if there is measles outbreak in the 
community. 
Dr
. Abdulsalam Al-Akel 
46
Measles Vaccination Schedule
• For infants immunized between 6 months and 9 months of age, a second dose 
should be administered as soon as possible after the child reaches the age of 9 
months 
• This should be provided at least 4 weeks have elapsed since the last dose.
• In countries where the incidence of measles has declined, the age of
immunization is being raised to 12 months
• This is to avoid the blocking effect of persistent trans-placentally acquired
antibody.
Dr
. Abdulsalam Al-Akel 
47
Measles Vaccination Schedule
• Minimum interval from dose 1 to 2 is:
• 4 weeks for MMR 
• 3 months for MMRV (although a 4-week interval is valid)
• Separate MMR and VAR vaccines preferred for dose 1 in ages 12 
through 47 months
• MMRV preferred for dose 2 and dose 1 at age 48 months or older
Dr
. Abdulsalam Al-Akel 
48
Measles Vaccination
ADMINISTRATION:
• The reconstituted vaccine is generally injected subcutaneously
• It is also effective when administered intramuscularly.
Contraindication
• People with a history of an anaphylactic reaction to neomycin, gelatin or
other components of the vaccine should not be vaccinated.
Dr
. Abdulsalam Al-Akel 
49
Contraindication of Measles Vaccine
• Measles
vaccine
is
contraindicated
in
persons
who
are
severely
immunocompromised due to:
•
congenital disease
•
severe HIV infection
•
advanced leukaemia or lymphoma, serious malignant disease
•
treatment with high-dose steroids, alkylating agents or antimetabolites
•
receive immuno-suppressive therapeutic radiation.
Dr
. Abdulsalam Al-Akel 
50
ADVERSE EFFECTS OF VACCINE 
Toxic shock syndrome (TSS)
• It occurs when measles vaccine is contaminated
• It occurs when the same vial is used for more than one session on the same
day or next day.
• The vaccine should not be used after 4 hours of opening the vial.
• TSS is totally preventable and reflects poor quality of immunization
services.
Dr
. Abdulsalam Al-Akel 
51
The symptoms of TSS are typical
• Severe watery diarrhoea
• vomiting and high fever are reported within few hours of measles
vaccination.
• There are usually a cluster of cases as all infants vaccinated from
contaminated vial will be affected.
• This may cause death within 48 hours.
• Case fatality rates are high.
Dr
. Abdulsalam Al-Akel 
52
Thank You so Much for Your 
Attention
Dr
. Abdulsalam Al-Akel 
53


            Quiz: