الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Measles is a universal disease and it is reported from all over the world. Measles is a major health problem for the children in all countries the severity of measles is higher in Africa than that reported in North Europe and America. . Before the introduction of measles vaccination in -1963, the disease was very unfrequent among adults and among the children below 6 months because of the inherited maternql antibodies. Many references related the severity of measles among poor communities to the socio-economic status of the families. Before vaccination era measles epidemics occured every other year and that was related to the natural increase by birth of the susceptible. -, There is close relation between the weather condition and the spread of meas les infection and epidemics occur when the optimum temperature and humidity prevail. The variations ln the severity of measles was related to the nutritional and the general health status of the susceptibles. In Egypt, morbidity data about measles is lacking and the notification of measles is only mode for the hospitalized cases. No cases of measles were reported from private clinics and hospitals and the reported cases represent a small fraction of the act ua 1 cases of measles in Egypt. Secondary infection during the course of the disease . is responsible for the most common and serious complicat ions of measles which include otitis media, broncho pneumonia encephalitis and gastroenteritis. These complications are the main causes of death in measles. Mortalities of ’meas les are recorded and published by central agency for public mobilisation and statistics a CAPMAS. The reported meas les mortali ties is far below the factual mortality of measles in Egypt because a major part of measles mortalities are related to the complication of measles rather than to measles itself and the international code for classif ication of causes of deaths and diseases (I.C.C.D.) is not usually followed in such cases. After several trials to produce potent and reliable vaccine against measles. Cole and Conseil showed ~n 1916 that the serum of a child who just recovered from an attack of measles could protect another susceptible child. In 1963, measles vaccines we~e first introduced in U.S.A. The types of measles vaccines used are the live attenuated virus vaccines and its efficacy is higher than 95 it is either introduced (intradermaly) alone or in combination with rubella and mumps virus (M.R.M.). The optimum age for measles vaccination is for children between 12-15 months age when the maternal . antibodies is used to be at its lowest leve 1, measles vaccination was first introduced in the national irrUnunization program in Egyptian 1976, and it is compulsory for all susceptible children after the age of 9 months. The aim of the study was to study the trends of measles morbidity and mortality i.t;l Egypt and the effect of the introduction of compulsory measles vaccination on such trend. The materials used in the study are the morbidity and mortality data produced anq published by Ministry of Health and the central -agency for public mobilization and statistics (CAPMAS). The statistical analysis of the collected data was performed by the investigator and by the computer center of the high institute of public health. The statistical analysis methods included estimating the different components of movements which are present in the time series these components included the trend value present in the time series by using the regression equation and the least square method. The seasonal index of measles morbidity and mortality was computed using the percentage average method other population, morbidity and mortality indices and rates were used during the study. Graphical presentation of the results was used to demonst rate the cxclic pattern and the linear trend of meas les morbidity and mortality in the urban and rural areas of Egypt throughout 1960-1985. Vaccination against measles was first introduced in Egypt in 1963, but it was introduced into the national immunization program in 1976 by ministerial decree to vaccine all children at age of 9 months. The introduction of measles vaccination had greatly red uced the number of reported cases of measles in the whole world including Egypt. The data obtained through the study revealed that the introduction of measles vaccination in Egypt in 1976, had produced the follow~ng effects: 1- The intensity of the disease was much reduced since 1976, when the average number of reported cases of measles had been reduced by 57 less than that reported before the introduction of measles vaccines. 2- The computed linear trend of measles morbidity report ing throughout 1960-1985, indicated negative trend in the urban and rural areas of Egypt where B = 438.6 and -12.6 respectively. 3- The reported hospital measles deaths and the case fatality rate of measles had been reduced and the computed trend was negative in Egypt b value estimated for reported deaths -41.4 and -10.3 and that estimated for case fatality rate = -0.3 and -0.6 in the urban and rural areas respectively. 4- The reported total measles mortalities recorded by CAPMAS was reduced and the average number of reporting after measles vaccine introduction was 42.4 less than that estimated before 1976. 5- The reduction of measles morbidity and mortality was more apparant in the urban areas of Egypt and the effect of measles vaccine introduction was not equally felt in the urban and rural areas of Egypt. where the reported measles cases was reduced by 64 and 3.5 respectively. 6- The characteristic biannual pattern of measles become irregular with fluctuation during some years. 7- The age incidence of measles have been changed and the age trend was negative before vaccines introduction (b = -0.09) and it was positive after vaccines intro duction where b = +0.21 this mean that after meas les vaccine introduction the diseases tend to affect older children. . 8- No evidence of any difference in the effect and be haviour of the disease among both sexes after the introduction of measles vaccinat~on. 9- The seasonal indices of measles reporting along the year showed marked changes when the peak seasonal . index had been shifted from 6th epidemic period during prevaccination era to the 4th epidemic period during post vaccination era but this could not be attributed only to measles vaccines introduction. 10- The fluctuation and the irregular pattern of measles after measles vaccine.s introduction was observed in the U.S.A. and U.R.R.S. and it was related there to failure in the cold-chain and the administration of the vaccines at less than 12 months age children and for severly malnourished children. 11- Measles infant mortalities had been greatly reduced after measles vaccines introduction when it ranged between 25.3 to 34.4 of total measles mortalities while it was 72 before measles vaccines introduction. 12- The average number of infant measles deaths before measles vaccines introduction was 481.4while after vaccination era it was 156.3 per year (a value which is one third of that estimated before vaccines intro . duct ion) . 13 - Comput ing the trend values of measles infant death throughout 1964-1981, indicated negative trend where b = -45.5, the trend value of measles infant mortality rate was negative where b = -4.8. 14- Computing the seasonal indices of infant measles deaths showed that the maximum seasonal index occurs during pre and post-vaccination periods but the intensity of infant measles mortality was less after introducing measles vaccines in Egypt. Summary of Conclusions and Recommendation: - We may conclude the following: 1- Measles is still the most important childhood infect ious disease. 2- The introduction of measles vaccines reduces greatly the number of reported measles cases and deaths. 3- The age incidence of measles had been increased. 4- The available vaccines are reliable if properly stored and given. Recommendations: The investigator may recommend the following: . 1- Training of the doctors and medical students on the correct methods of writing the death certificate. 2- The implementation of 1958, infectious disease not ification low. 3- Enlighten the population that vaccination against measles is a successful method of measles prevention. 4- Training of the health team in the rural areas about the best methods of storing and introducing the vaccines. 5- Measles vaccination campaign every few years besides the ongoing vaccination program. 6- Trials of new vaccines which could be given to younger infants and with stand the failure of the cold chain.