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 on

immunization

• 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%).

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 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

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 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 lymph-
adenopathy 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.

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 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.

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 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

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 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

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 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 Unimmunized
M:20 M:3
Immunized 44(71%) 6(16%) 50
F:24 F:3
M:10 M:17
Unimmunized 18(29%) 32(84%) 50
F:8 F:15
Total 62(100%) 38(100%) 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).

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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%)

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 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.

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 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.

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 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.

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 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.

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 APPENDIX
Figure(1): The relation between gender and immunization status
with the residence of the child.

100%
26
55 48 80%
68 60%
74 40%
45 52 20%
32
0%
unimmunized

immunized

unimmunized

immunized
Urban
Rural

Urban
Rural

Males Females

Figure(2): Important complications of the measles vaccine in

relation to gender of the child.

80
60
Pe rce ntage 40 78
20
16 6 S1
0
Others Loss of Fever
appetite
Type of complications

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