Measles Vaccine
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TIKRIT UNIVERSITY COLLEGE OF MEDICINE Community project 2 year 1st group 2007 nd
The Epidemiological Coverage Rate Of The Measles Vaccine Among Children Under Five Years Of Age Attending TTH
Supervisor: Dr. Nashwan Ni’met
Done by: Ali Mohammed (Chairman) Ali Khair Al-Din (Presenter) Marwa Mahmood (Reporter) Omar Musa’id Safana Tahir Zahra’a Mahmood Zahra’a Ahmed Lamya’a Ahmed Vian Husain Hiba Muthanna
CONTENTS
Subject:
Page number:
Abbreviations
2
Abstract
3
Acknowledgement
4
Introduction
5
Subjects and methods
7
Results
8
Discussion
13
Conclusion
15
Recommendations
16
References
17
Appendix
18
1
ABBREVIATIONS
• EPI:
Expanded Program immunization
on
• IMoH:
Iraqi Ministry of Health
• MMR:
Measles, Mumps, Rubella
• TTH:
Tikrit Teaching Hospital
• UNICEF:
United Nations Children’s Fund
• WHO:
World Health Organization
2
ABSTRACT The epidemiological coverage rate of the measles vaccine was calculated among children under 5 years of age attending Tikrit teaching hospital during the period from the 1st of April to the 1st of May 2007. Of the 100 children surveyed, there were 38 children (20 males and 18 females) who failed to receive the vaccination which means a percentage of 38%. The causes of the un-immunization were negligence (15%), ignorance (8%), security issue -parents didn’t trust the vaccine(8%), residence -living at distant places- (3%) and disease of the child (3%).
3
ACKNOWLEDGMENT
We would like to thank Dr. Nesreen M. Ibraheem for her kind help and for her being so scientific Special thanks to all the parents who helped us in the questionnaire Best wishes to them
4
INTRODUCTION It is the right of every child to be immunized and the duty of every parent to ensure this. Measles vaccine: Measles remains a leading cause of death among young children, despite the availability of a safe and effective vaccine for the past 40 years. An estimated 345 000 people, the majority of them children, died from measles in 2005 (the latest year for which figures are available).1 Active immunization has been proved to be the more effective technique for long term immunity. Measles Virus Vaccine, Live, Attenuated (Dried) is prepared in avian leucosis-free chick embryo fibroblast cultures from the Edmondston Strain of attenuated measles virus. This vaccine is indicated for the active immunization of children against measles (rubeola). It does not protect against German measles (rubella). This vaccine is recommended routinely for all children at, or as soon as practicable after, their first birthday. If a goal of measles elimination is adopted, a second dose of measles vaccine is required. It is given at 4 to 6 years of age. The minimum interval between the 2 doses should be at least 1 month. The measles vaccine is contra-indicated in cases of any acute illness, including febrile illness. It is also contra-indicated in cases of allergic reaction to any component of Measles Virus Vaccine. Adverse Reactions: Local erythema and/or swelling around the site of injection are not uncommon and regional lymphadenopathy may occur rarely. Fever or mild rash, or both, may occur 5 to 12 days after administration. Dosage and Administration: One dose of 0.5 mL of Measles Virus Vaccine, Live, Attenuated (Dried) S.C., in Iraq at 9 months of age, or as soon as possible thereafter. If a goal of measles elimination is adopted, a second dose of 0.5 mL Measles Virus 5
Vaccine is required, in Iraq it is given with MMR vaccine at 15 months of age.2 Measles disease: The un-immunized persons are most people at risk. First sign of infection is usually high fever which begins approximately 10 to 12 days after exposure and lasts one to seven days. During the initial stage, the patient may develop coryza (runny nose), cough, red and watery eyes and small white spots inside the cheeks. After several days, a rash develops, usually on the face and upper neck. Over a period of about three days, the rash proceeds downward, eventually reaching the hands and feet. The disease can be transmitted by an infected individual from four days prior to the onset of the rash to four days after the onset. The most serious complications include blindness, encephalitis (a dangerous infection of the brain causing inflammation), severe diarrhoea (possibly leading to dehydration), ear infections and severe respiratory infections such as pneumonia, which is the most common cause of death associated with measles. Treatment by general nutritional support and the treatment of dehydration with oral rehydration solution are necessary. Giving vitamin A at the time of diagnosis can help prevent eye damage and blindness.
Aim: To find the measles vaccine coverage rate among children under 5 years of age in Tikrit Teaching Hospital. Objectives: 1. Identify the proportion of children (under 5 years) immunized by measles vaccine. 2. Clarify the possible complications after immunization with measles vaccine. 3. Identify the frequency, type and time of vaccination against measles. 4. Determine the children who are affected with measles disease. 6
SUBJECTS AND METHODS The study was a cross-sectional type conducted in TTH from the 1st of April to the 1st of May 2007 to assess the epidemiological coverage rate of the measles vaccine among children under 5 years of age. The selection of the children was conducted by simple random sampling. The sample size was 100 children, among them there were 52 children living in rural areas and 48 children living in urban areas. Collection of the data was by a previously prepared questionnaire (a copy of which is included in the appendix) which included some general questions about the age, name, gender, address and residence of the child, with special questions about the measles disease, vaccine, time and frequency of vaccination. The questionnaires were filled by the group members after asking the child’s parents about them.
7
RESULTS From the total 100 children surveyed, there were only 62% of them who were vaccinated with the measles vaccine, the percentage in rural areas was 63.5% while in urban areas it was 60.5%, this is shown in table (1). Table (1): The relation between the residence and the immunization status with the measles vaccine. Residence Immunized Unimmunized Total Urban
29(60.5%)
19(39.5%)
48
Rural
33(63.5%)
19(36.5%)
52
Total
62(62%)
38(38%)
100
The causes of the un-immunization were negligence (15%), ignorance (8%), security issue -parents didn’t trust the vaccine(8%), residence -living at distant places- (3%) and disease of the child (3%), this is shown in table (2). Table (2): Causes of unimmunization in relation to residence. Cause
Urban
Rural
Total
Negligence
7(46.5%)
8(53.5%)
15
Ignorance
2(25%)
6(75%)
8
Others
10(66%)
5(34%)
15
Total
19(50%)
19(50%)
38
8
From the vaccinated 62 children, 30 were males and 32 were females, while the un-vaccinated 38 children were divided as 20 males and 18 females, this is shown in table (3). Table (3): The relation between gender and immunization status of the child. Gender
Immunized Unimmunized
Total
Males
30(48.4%)
20(52.6%)
50
Females
32(51.6%)
18(47.4%)
50
Total
62
38
100
From these 50 females, 19 were living in urban areas and 31 were living in rural areas, while from the 50 males surveyed, 29 were living in urban areas and 21 were living in rural areas, this is shown in the following master table(4), Figure(1). Table (4): The relation between gender and immunization status with the residence of the child. Urban
Rural
Gender Immunized Unimmunized Immunized Unimmunized Males
15(52%)
14(74%)
15(45%)
6(32%)
Females
14(48%)
5(26%)
18(55%)
13(68%)
Total
29
19
33
19
9
From the 62 immunized children, 33 children suffered complications of the vaccine including 14 males and 19 females, while the other 29 children didn’t have the complications including 16 males and 13 females, this is shown in table (5). Table (5): Relation between gender and complications of the measles vaccine. Gender
Complications
Not
Total
Males
14(42.5%)
16(55%)
30
Females
19(57.5%)
13(45%)
32
Total
33(100%)
29(100%)
62
From these complications the most important was fever accounting for (78%) of the cases with other causes shown in table(6), figure(2). Table (6): Important complications of the measles vaccine in relation to gender of the child. Type of complication
Males
Females
Total
Fever
11
15
26(78%)
Loss of appetite
2
0
2(6%)
Others
1
4
5(16%)
Total
14
19
33
10
Most of the children who were vaccinated with measles vaccine were also vaccinated with MMR vaccine (71%). The reverse is also true in that most of the children who were not vaccinated with measles vaccine also didn’t receive an MMR vaccine (84%), this is shown in table (7). Table (7): The relation between immunization with measles and MMR vaccines. Measles vaccine MMR vaccine
Total Immunized
Immunized
44(71%)
Unimmunized
18(29%)
Total
Unimmunized
M:20 F:24 M:10 F:8
62(100%)
M:3 F:3 M:17 32(84%) F:15 6(16%)
38(100%)
50 50 100
From the 62 children who were vaccinated with measles vaccine, only 13 children (21%) had received another dose of vaccination, while from the 50 children vaccinated with MMR vaccine, 11 children (22%) had repeated the vaccination, this is shown in table(8).
11
Table (8): Frequency of vaccination with measles and MMR vaccine. Measles vaccine
MMR vaccine
Repeated
Not
Repeated
Not
Males
4
26
3
17
Females
9
23
8
22
13(21%)
49(79%)
11(22%)
39(78%)
Total 62(100%)
50(100%)
From the 100 children surveyed, 17 of them had the measles disease, 11 of them were not vaccinated with the measles vaccine and 6 were vaccinated, this is shown in table (9). Table(9): The measles cases in relation to their immunization status. Diseased
Vaccinated
Not
Total
Males
4
8
12
Females
2
3
5
Total
6(35%)
11(65%)
17(100%)
12
DISCUSSION In 1990, Iraq started an (EPI) in which the measles and MMR vaccines were scheduled. But by late March 2003, public health officials thought that routine childhood vaccinations were unavailable at the majority of public health clinics. In mid-May, with assistance from CPA and the (UNICEF), the (IMoH) sent teams to assess the damage that hampered the efforts of the (EPI). During May 17--22, six teams traveled to all of Iraq's 18 governorates and visited major vaccine-storage sites and some primary health-care centers. Each team visited three to four governorates and used a standard form to collect information on clinic staff availability, remaining vaccine supplies at the major storage sites, and the status of cold-chain equipment. Karkh and Rusafa, the two districts comprising the governorate of Baghdad, were assessed separately because of the size of their populations and the number of public health facilities. At the time of the survey, 893 (61%) PHCCs in Iraq had equipment and staff sufficient to provide vaccinations daily. On the basis of the amount of equipment known to have existed immediately before the war, the assessment found that 532 (33%) of the 1,628 refrigerators, 18 (46%) of the 39 cold rooms, and 81 (13%) of the 642 generators needed to provide electricity to some equipment were damaged.3 This is an important finding demonstrating the effects of invasion on vaccination programs in Iraq. One million children have no immunity to measles - more than enough to spark a dangerous outbreak in which many children could die or be left with lasting disabilities.4 In this study the measles vaccine coverage rate among children attending TTH was 62%, arranged as 60.5% in urban areas and 63.5% in rural areas (table1), while in another study conducted in Guinea in 1995, measles-vaccination coverage in the
13
urban area was 83.8% among children under 5 years old, with only 55% for children living in rural areas.5 As shown in table(2) the causes of the un-immunization were negligence (15%), ignorance (8%), security issue -parents didn’t trust the vaccine-(8%), residence -living at distant places- (3%) and disease of the child (3%). From the 62 children vaccinated with measles vaccine, 33 children suffered from the complications of the vaccine including 57.5% females with 42.5% males (table5), and this was the same finding in another study conducted in Egypt in 2001, that the girls are more likely to develop complications of this vaccine.6 From the 17 cases of measles, 11 were not vaccinated with the measles vaccine and 6 were vaccinated with it (table9), which demonstrates that this vaccine had a good effectiveness.
14
CONCLUSION 1. The measles vaccine coverage rate is very low (62%). 2. There was no significant difference between rural and urban areas in this percentage (63.5% and 60.5% respectively). 3. From the important causes of unimmunization was ignorance, negligence and the security issue which is becoming an important subject since the invasion in 2003. 4. Females are more prone to complications due to immunization with the measles vaccine than males. 5. There was a low rate of revaccination with both the measles and the MMR vaccines.
15
RECOMMENDATIONS
Here are some advices from our group members:
To parents: 1. To ensure the children vaccination by bringing them to the hospital in time. 2. To organize a table for the vaccination program of their children.
To IMoH:
1. To ensure the continuous and regular supply of the measles and MMR vaccine. 2. To supply all the hospitals and PHCCs with the vaccines. 3. To organize large campaigns for the vaccinations. 4. To intensify the training and educational sessions for the health care workers.
16
REFERENCES
1. Melinda Henry. Vaccines and Biologicals. WHO, department of immunization, Geneva, 2002.
2. Connaught. Measles Virus Vaccine. UNICEF, USA.
3. SA Ni'ma, MB CHB-MSC, AAK Imad, MB CHB-MSC. MMWR Magazine Vaccination Services in Postwar Iraq, May 2003. USA.
4. IRIN. Middle East online, UNICEF, 2007.
5. Morten Sodemann, Henrik Jensen, Amabelia Rodrigues, Tomé Cá, and Peter Aaby . BANDIM DSS, GUINEA-BISSAU, Canada,1999.
6. WHO. Egypt report of immunization coverage, WHO, Geneva, 2001.
17
APPENDIX Figure(1): The relation between gender and immunization status with the residence of the child.
55
68
45 Rural immunized
Urban unimmunized
32 Rural unimmunized
74
48 52
100% 80% 60% 40% 20% 0%
Urban immunized
26
Males
Females
Figure(2): Important complications of the measles vaccine in relation to gender of the child.
80 60 Pe rce ntage 40 20 0
78 16 Others
6 Loss of appetite
S1 Fever
Type of complications
18
The Epidemiological Coverage Rate Of The Measles Vaccine Among Children Under Five Years Of Age Attending TTH
Supervisor: Dr. Nashwan Ni’met
Done by: Ali Mohammed (Chairman) Ali Khair Al-Din (Presenter) Marwa Mahmood (Reporter) Omar Musa’id Safana Tahir Zahra’a Mahmood Zahra’a Ahmed Lamya’a Ahmed Vian Husain Hiba Muthanna
CONTENTS
Subject:
Page number:
Abbreviations
2
Abstract
3
Acknowledgement
4
Introduction
5
Subjects and methods
7
Results
8
Discussion
13
Conclusion
15
Recommendations
16
References
17
Appendix
18
1
ABBREVIATIONS
• EPI:
Expanded Program immunization
on
• IMoH:
Iraqi Ministry of Health
• MMR:
Measles, Mumps, Rubella
• TTH:
Tikrit Teaching Hospital
• UNICEF:
United Nations Children’s Fund
• WHO:
World Health Organization
2
ABSTRACT The epidemiological coverage rate of the measles vaccine was calculated among children under 5 years of age attending Tikrit teaching hospital during the period from the 1st of April to the 1st of May 2007. Of the 100 children surveyed, there were 38 children (20 males and 18 females) who failed to receive the vaccination which means a percentage of 38%. The causes of the un-immunization were negligence (15%), ignorance (8%), security issue -parents didn’t trust the vaccine(8%), residence -living at distant places- (3%) and disease of the child (3%).
3
ACKNOWLEDGMENT
We would like to thank Dr. Nesreen M. Ibraheem for her kind help and for her being so scientific Special thanks to all the parents who helped us in the questionnaire Best wishes to them
4
INTRODUCTION It is the right of every child to be immunized and the duty of every parent to ensure this. Measles vaccine: Measles remains a leading cause of death among young children, despite the availability of a safe and effective vaccine for the past 40 years. An estimated 345 000 people, the majority of them children, died from measles in 2005 (the latest year for which figures are available).1 Active immunization has been proved to be the more effective technique for long term immunity. Measles Virus Vaccine, Live, Attenuated (Dried) is prepared in avian leucosis-free chick embryo fibroblast cultures from the Edmondston Strain of attenuated measles virus. This vaccine is indicated for the active immunization of children against measles (rubeola). It does not protect against German measles (rubella). This vaccine is recommended routinely for all children at, or as soon as practicable after, their first birthday. If a goal of measles elimination is adopted, a second dose of measles vaccine is required. It is given at 4 to 6 years of age. The minimum interval between the 2 doses should be at least 1 month. The measles vaccine is contra-indicated in cases of any acute illness, including febrile illness. It is also contra-indicated in cases of allergic reaction to any component of Measles Virus Vaccine. Adverse Reactions: Local erythema and/or swelling around the site of injection are not uncommon and regional lymphadenopathy may occur rarely. Fever or mild rash, or both, may occur 5 to 12 days after administration. Dosage and Administration: One dose of 0.5 mL of Measles Virus Vaccine, Live, Attenuated (Dried) S.C., in Iraq at 9 months of age, or as soon as possible thereafter. If a goal of measles elimination is adopted, a second dose of 0.5 mL Measles Virus 5
Vaccine is required, in Iraq it is given with MMR vaccine at 15 months of age.2 Measles disease: The un-immunized persons are most people at risk. First sign of infection is usually high fever which begins approximately 10 to 12 days after exposure and lasts one to seven days. During the initial stage, the patient may develop coryza (runny nose), cough, red and watery eyes and small white spots inside the cheeks. After several days, a rash develops, usually on the face and upper neck. Over a period of about three days, the rash proceeds downward, eventually reaching the hands and feet. The disease can be transmitted by an infected individual from four days prior to the onset of the rash to four days after the onset. The most serious complications include blindness, encephalitis (a dangerous infection of the brain causing inflammation), severe diarrhoea (possibly leading to dehydration), ear infections and severe respiratory infections such as pneumonia, which is the most common cause of death associated with measles. Treatment by general nutritional support and the treatment of dehydration with oral rehydration solution are necessary. Giving vitamin A at the time of diagnosis can help prevent eye damage and blindness.
Aim: To find the measles vaccine coverage rate among children under 5 years of age in Tikrit Teaching Hospital. Objectives: 1. Identify the proportion of children (under 5 years) immunized by measles vaccine. 2. Clarify the possible complications after immunization with measles vaccine. 3. Identify the frequency, type and time of vaccination against measles. 4. Determine the children who are affected with measles disease. 6
SUBJECTS AND METHODS The study was a cross-sectional type conducted in TTH from the 1st of April to the 1st of May 2007 to assess the epidemiological coverage rate of the measles vaccine among children under 5 years of age. The selection of the children was conducted by simple random sampling. The sample size was 100 children, among them there were 52 children living in rural areas and 48 children living in urban areas. Collection of the data was by a previously prepared questionnaire (a copy of which is included in the appendix) which included some general questions about the age, name, gender, address and residence of the child, with special questions about the measles disease, vaccine, time and frequency of vaccination. The questionnaires were filled by the group members after asking the child’s parents about them.
7
RESULTS From the total 100 children surveyed, there were only 62% of them who were vaccinated with the measles vaccine, the percentage in rural areas was 63.5% while in urban areas it was 60.5%, this is shown in table (1). Table (1): The relation between the residence and the immunization status with the measles vaccine. Residence Immunized Unimmunized Total Urban
29(60.5%)
19(39.5%)
48
Rural
33(63.5%)
19(36.5%)
52
Total
62(62%)
38(38%)
100
The causes of the un-immunization were negligence (15%), ignorance (8%), security issue -parents didn’t trust the vaccine(8%), residence -living at distant places- (3%) and disease of the child (3%), this is shown in table (2). Table (2): Causes of unimmunization in relation to residence. Cause
Urban
Rural
Total
Negligence
7(46.5%)
8(53.5%)
15
Ignorance
2(25%)
6(75%)
8
Others
10(66%)
5(34%)
15
Total
19(50%)
19(50%)
38
8
From the vaccinated 62 children, 30 were males and 32 were females, while the un-vaccinated 38 children were divided as 20 males and 18 females, this is shown in table (3). Table (3): The relation between gender and immunization status of the child. Gender
Immunized Unimmunized
Total
Males
30(48.4%)
20(52.6%)
50
Females
32(51.6%)
18(47.4%)
50
Total
62
38
100
From these 50 females, 19 were living in urban areas and 31 were living in rural areas, while from the 50 males surveyed, 29 were living in urban areas and 21 were living in rural areas, this is shown in the following master table(4), Figure(1). Table (4): The relation between gender and immunization status with the residence of the child. Urban
Rural
Gender Immunized Unimmunized Immunized Unimmunized Males
15(52%)
14(74%)
15(45%)
6(32%)
Females
14(48%)
5(26%)
18(55%)
13(68%)
Total
29
19
33
19
9
From the 62 immunized children, 33 children suffered complications of the vaccine including 14 males and 19 females, while the other 29 children didn’t have the complications including 16 males and 13 females, this is shown in table (5). Table (5): Relation between gender and complications of the measles vaccine. Gender
Complications
Not
Total
Males
14(42.5%)
16(55%)
30
Females
19(57.5%)
13(45%)
32
Total
33(100%)
29(100%)
62
From these complications the most important was fever accounting for (78%) of the cases with other causes shown in table(6), figure(2). Table (6): Important complications of the measles vaccine in relation to gender of the child. Type of complication
Males
Females
Total
Fever
11
15
26(78%)
Loss of appetite
2
0
2(6%)
Others
1
4
5(16%)
Total
14
19
33
10
Most of the children who were vaccinated with measles vaccine were also vaccinated with MMR vaccine (71%). The reverse is also true in that most of the children who were not vaccinated with measles vaccine also didn’t receive an MMR vaccine (84%), this is shown in table (7). Table (7): The relation between immunization with measles and MMR vaccines. Measles vaccine MMR vaccine
Total Immunized
Immunized
44(71%)
Unimmunized
18(29%)
Total
Unimmunized
M:20 F:24 M:10 F:8
62(100%)
M:3 F:3 M:17 32(84%) F:15 6(16%)
38(100%)
50 50 100
From the 62 children who were vaccinated with measles vaccine, only 13 children (21%) had received another dose of vaccination, while from the 50 children vaccinated with MMR vaccine, 11 children (22%) had repeated the vaccination, this is shown in table(8).
11
Table (8): Frequency of vaccination with measles and MMR vaccine. Measles vaccine
MMR vaccine
Repeated
Not
Repeated
Not
Males
4
26
3
17
Females
9
23
8
22
13(21%)
49(79%)
11(22%)
39(78%)
Total 62(100%)
50(100%)
From the 100 children surveyed, 17 of them had the measles disease, 11 of them were not vaccinated with the measles vaccine and 6 were vaccinated, this is shown in table (9). Table(9): The measles cases in relation to their immunization status. Diseased
Vaccinated
Not
Total
Males
4
8
12
Females
2
3
5
Total
6(35%)
11(65%)
17(100%)
12
DISCUSSION In 1990, Iraq started an (EPI) in which the measles and MMR vaccines were scheduled. But by late March 2003, public health officials thought that routine childhood vaccinations were unavailable at the majority of public health clinics. In mid-May, with assistance from CPA and the (UNICEF), the (IMoH) sent teams to assess the damage that hampered the efforts of the (EPI). During May 17--22, six teams traveled to all of Iraq's 18 governorates and visited major vaccine-storage sites and some primary health-care centers. Each team visited three to four governorates and used a standard form to collect information on clinic staff availability, remaining vaccine supplies at the major storage sites, and the status of cold-chain equipment. Karkh and Rusafa, the two districts comprising the governorate of Baghdad, were assessed separately because of the size of their populations and the number of public health facilities. At the time of the survey, 893 (61%) PHCCs in Iraq had equipment and staff sufficient to provide vaccinations daily. On the basis of the amount of equipment known to have existed immediately before the war, the assessment found that 532 (33%) of the 1,628 refrigerators, 18 (46%) of the 39 cold rooms, and 81 (13%) of the 642 generators needed to provide electricity to some equipment were damaged.3 This is an important finding demonstrating the effects of invasion on vaccination programs in Iraq. One million children have no immunity to measles - more than enough to spark a dangerous outbreak in which many children could die or be left with lasting disabilities.4 In this study the measles vaccine coverage rate among children attending TTH was 62%, arranged as 60.5% in urban areas and 63.5% in rural areas (table1), while in another study conducted in Guinea in 1995, measles-vaccination coverage in the
13
urban area was 83.8% among children under 5 years old, with only 55% for children living in rural areas.5 As shown in table(2) the causes of the un-immunization were negligence (15%), ignorance (8%), security issue -parents didn’t trust the vaccine-(8%), residence -living at distant places- (3%) and disease of the child (3%). From the 62 children vaccinated with measles vaccine, 33 children suffered from the complications of the vaccine including 57.5% females with 42.5% males (table5), and this was the same finding in another study conducted in Egypt in 2001, that the girls are more likely to develop complications of this vaccine.6 From the 17 cases of measles, 11 were not vaccinated with the measles vaccine and 6 were vaccinated with it (table9), which demonstrates that this vaccine had a good effectiveness.
14
CONCLUSION 1. The measles vaccine coverage rate is very low (62%). 2. There was no significant difference between rural and urban areas in this percentage (63.5% and 60.5% respectively). 3. From the important causes of unimmunization was ignorance, negligence and the security issue which is becoming an important subject since the invasion in 2003. 4. Females are more prone to complications due to immunization with the measles vaccine than males. 5. There was a low rate of revaccination with both the measles and the MMR vaccines.
15
RECOMMENDATIONS
Here are some advices from our group members:
To parents: 1. To ensure the children vaccination by bringing them to the hospital in time. 2. To organize a table for the vaccination program of their children.
To IMoH:
1. To ensure the continuous and regular supply of the measles and MMR vaccine. 2. To supply all the hospitals and PHCCs with the vaccines. 3. To organize large campaigns for the vaccinations. 4. To intensify the training and educational sessions for the health care workers.
16
REFERENCES
1. Melinda Henry. Vaccines and Biologicals. WHO, department of immunization, Geneva, 2002.
2. Connaught. Measles Virus Vaccine. UNICEF, USA.
3. SA Ni'ma, MB CHB-MSC, AAK Imad, MB CHB-MSC. MMWR Magazine Vaccination Services in Postwar Iraq, May 2003. USA.
4. IRIN. Middle East online, UNICEF, 2007.
5. Morten Sodemann, Henrik Jensen, Amabelia Rodrigues, Tomé Cá, and Peter Aaby . BANDIM DSS, GUINEA-BISSAU, Canada,1999.
6. WHO. Egypt report of immunization coverage, WHO, Geneva, 2001.
17
APPENDIX Figure(1): The relation between gender and immunization status with the residence of the child.
55
68
45 Rural immunized
Urban unimmunized
32 Rural unimmunized
74
48 52
100% 80% 60% 40% 20% 0%
Urban immunized
26
Males
Females
Figure(2): Important complications of the measles vaccine in relation to gender of the child.
80 60 Pe rce ntage 40 20 0
78 16 Others
6 Loss of appetite
S1 Fever
Type of complications
18
