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Conclusion
WHO recommends that vaccination against measles normally be undertaken
at the age of 9 months (11); however, It was considered that measles
epidemics have occurred every 2 to 5 years in developing countries
such as Turkey (Table 1). In this respect, during a measles epidemic,
if a large proportion of cases occur in children below nine months
(i.e., the attack rate for children <9 months is high), the age
of measles immunization should be temporarily lowered to 6 months.
Because of the lesser efficacy of the vaccine at this age, these children
must be re-immunized as soon as possible after 9 months (11-13).
In Turkey, medical facilities are concentrated in the cities and larger
towns, leaving most rural areas without adequate access to medical
care. This situation is especially acute in eastern Anatolia, where
medical care is generally available only in the provincial capitals
(14).
In Turkey, 30.509 measles cases were reported in 2001 and 66.1% (n=20,154)
of them were seen between March and June (Figure 1). The children
were mostly in the 5-9 years age group (37.1%, n=11329) (Figure 2).
These datas reveal that morbidity rate of 132 per 100 000 population
and mortality rate of 18 per million population in 1970 decreased
gradually by the years and reach to 45 per 100000 population and 0.13
per million population, respectively, in 2001 (Table 1), because of
improving the protective health services and adding measles to routine
vaccination schedule (10).
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The recent measles outbreak in
Turkey was reported from rural of Sirnak Province in southeast of
Turkey (15). This outbreak began in January, 2001 in two settlements
(Cizre and Idil counties of Sirnak province) nearby each other therefore
intensive comings and goings seen between them. In Cizre, the index
case applied to village clinic in 03 January 2001 while in Idil the
first application was seen in 23 January. The peak application levels
were observed at March and April in Cizre and at May in Idil. The
course of the outbreak might have been effected from the personnels
whose occupational places change frequently or from the exessive amount
of health personnels working as temporarily. It is important that
according to primary care clinic records, 7.4% of the suffered patients
(n=39) were 0 to 9 months old children who hadn't been vaccinated
yet (15). This ratio is in accordance with the findings of Ertem et
al. (16) who determined that 6.7% of the sufferers were below 9 months
at the measles outbreak occured and 26.7% of the measles cases were
vaccinated children in the center of Diyarbakir, Southeast of Turkey
in 1996.
 
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