Factors Affecting the Implementation of Measles Immunization

1. Mother education
Education is the process of changing attitudes and code of conduct a person or group of people in a mature business people through teaching and training efforts. (Alwi H, 2001).

The role of a mother to the immunization program is essential. Hence an understanding of this program is essential for these circles. Understanding of the mother or maternal knowledge of immunization is strongly influenced by the level of maternal education.

The higher level of education or knowledge of someone getting needed health care centers as a place to seek treatment for themselves and their families. Based on several studies concluded that the higher level of education a mother the more likely to immunize their infants. (Slamet, 2002, p.45).

Education can be categorized low levels of initial education if the first nine years of schooling up to secondary education (junior high). Categorized higher education where secondary education (high school) education program that includes diploma, undergraduate, masters, doctors and specialists was held college. (Http://Wikipedia.org online.com / Date Accessed May 26, 2010).

2. Number of children
Children are People who were born (Descendants) / belongs to a family group. (Alwi H, 2001).
The amount is the amount (number or something that is gathered into one). (Ministry of National Education, 2002.hal 11).

So the Son is the number of offspring in one family. (Ministry of National Education, 2002, p.11).
Number of children in single-family lots will result in reduced attention and affection that is received, especially if the distance is too close to children in families with less economic and social conditions, the number of children will result in much less than affection and attention in children, is also a primary need such as food, and housing and child health conditions are not met (Notoatmodjo, 2003, p.. 56).

Results showed that most mothers who carry out child labor by the number of at least 3 people (79.7%) which indicates that the mother has applied a small family norm as a happy and prosperous one form of health development programs in order to improve the welfare of the community. High number of children will have an impact on the incidence of various health problems for both mother and baby is born like the state of health of children primarily immunized children (http://.blog.spot.com/ Accessed on 24 April 2010).

3. Age infant
Age is one characteristic trait of a very major. Age infants that age infants are calculated from birth up to receive measles immunization. (Http://Syehaceh. Wordpress. Com / Accessed on 25 April 2010).
WHO recommends immunization at age 9 months for routine immunization programs in developing countries. In areas with risk of mortality of infants aged less than 9 months of a very high recommended the administration of two doses of measles vaccine at age 6 and 9 months. In developed countries, which have a risk of contracting measles at an early age is much lower, given measles vaccine at age 12-15 months, when all children have lost maternal antibody so that an optimal immune response can be achieved (Wahab, 2002, p.60 - 61).
Actually measles immunization can be given before the baby was 9 months, for example, at the age between 6-7 months when the passive immunity acquired from the mother began to disappear. But then he should get a one-time injection was repeated after 15 months (Markum, 2002, p.28).

4. Mother Age
Age is one characteristic trait of the primary parent. Age has a relationship with the level of exposure, the magnitude of risk and resistance properties. Different experiences of health problems / diseases and decision makers are influenced by the age of the individual. (Notoatmodjo, 2003, p. 40).
From research it was found that maternal age-related knowledge and their attitude towards immunization. This study found that the main factors associated with measles immunization is the maternal age. Namely maternal age maternal age, calculated from birth until the time of the study. (Http://Syehaceh. Wordpres.com / DiaksesTanggal 25 April 2010).

5. Socioeconomic status
Socioeconomic levels proved highly influential on health problems in a family. In families with a good socioeconomic level, will automatically get a good well-being as well. Nutritional status will increase Because nutritional quality obtained. Because the primary needs are met then any health problems get attention in the family. (Sulistyawati, 2009, hal.104).

The presence of the spread of different health problems based on socioeconomic status in general is influenced by two things: because there are differences in economic capability in preventing disease or health services and because there are differences of life and behavior of living sikaf owned. Various variables are very closely related to socioeconomic status that is characteristic. Socioeconomic status is closely connected with the work / type, family income, region, place of residence / geographic, living habits and so forth. Socioeconomic status is also closely associated with psychological factors in society. (Http://Syehaceh. Wordpress. Com / Accessed on 25 April 2010).

The results showed that the factors that influence dropout or incomplete immunization status of infants among the distance factor is home to the place of immunization service. Mom will seek health care that is closest to his home due to considerations other activities that must be resolved is forced to be postponed. (Http://Syehaceh. Wordpress.com / Accessed on 25 April 2010).

Overview About the Measles Immunization

1. Definition
a. Measles immunization is given to receive immunization against measles immunity actively (Markum, 2002, p.26).
b. Immunization against measles is the act of giving measles vaccine to children which aims to establish immunity against measles (Hidayat, 2005, hal104).

2. Measles Vaccine
Measles vaccines containing live measles virus which has been attenuated. Measles vaccine circulating in Indonesia can be obtained in the form of dry packaged singly or in combination with a dry pack mumps vaccine / goitre (mumps) and rubella (German measles). In the United States last package is known as the MMR vaccine Measles-Mumps-Rubella Vaccine. (Markum, 2002, p.26)

In developing countries, measles immunization is recommended given early with the intention of providing immunity as early as possible, prior to exposure to natural measles virus infection. Early immunization apparently hit by the innate immune anti originating from the mother (maternal antibodies), it can inhibit the formation of a substance the body immune to measles in children, so that repeat immunization was given 4-6 months later. Then to Indonesia vaccines campak.diberikan start child was 9 months. (Http://syehaceh.wordpress.com/Diakses On 25 April 2010).
Measles vaccine should be refrigerated at the appropriate temperature (2-8 0C) due to sunlight or heat can kill the virus measles vaccine. When the virus died before it is injected, the vaccine is not able to induce an immune response (Wahab, 2002, p.60).

3. Measles immunization
WHO recommends immunization at age 9 months for routine immunization programs in developing countries. In areas with risk of mortality of infants aged less than 9 months of a very high recommended the administration of two doses of measles vaccine at age 6 and 9 months. In those countries, which have a risk of contracting measles at an early age is much lower, given measles vaccine at age 12-15 months, when all children have lost maternal antibody so that an optimal immune response can be achieved (Wahab, 2002, p.60 - 61 ).
Timing of immunization against measles at age 9 -12 months. How to measles immunization subcutaneously with a dose of 0.5 ml. (Hidayat, 2005, hal.104).
Actually measles immunization can be given before the baby was 9 months, for example, at the age of 6-7 months when the passive immunity acquired from the mother began to disappear. But then he should get a one-time injection was repeated after 15 months. (Markum, 2002, p.. 28)

4. Immunity and Immunization Reactions
Power protection measles immunization is very high, namely 96-99%. According to the study, acquired immunity is lifelong, as the staying with immunity acquired when children infected with measles naturally (Markum, 2002, p.. 29)
Immunizations that are common reactions include high fever (temperature over 39.4 º C), which occurs 8-10 days after vaccination and lasts for about 24-48 hours (approximately 2% incidence) and skin rash for about 1-2 days 2 incidence % (Wahab, 2000, p.61).

5. Side Effects and Contra Indications
Side effects are very rare, possibly a mild seizures can occur and are not dangerous on day 10-12 after injection. Moreover, it can occur in the form of brain inflammation or ansefalopati ansefalitis within 30 days after immunization. But it happened very rarely, namely 1 in a million shot. This figure is much lower than the incidence of brain inflammation due to natural measles disease of 1 in 250 cases. Thus the risk for the occurrence of brain inflammation caused by natural infection 2500 times greater than the result of immunization. (Markum, 2002, hal.29).

According to WHO, contra indications only applies to terminally ill children, suffering from tuberculosis (tuberculosa) without treatment, or who suffer from severe malnutrition in degrees. Measles vaccination should also not be given to children suffering from malignant disease or is in the treatment of malignant disease. Since not enough scientific information gathering, measles immunization should be deferred in pregnant women. In children who have suffered seizures, measles immunization can be given as usual, provided with medical supervision (Markum, 2002, hal.30).

Immunization Program Objectives

Immunization program goal is to reduce mortality and morbidity caused by diseases - diseases that can be prevented by immunization (PD3I). So to achieve this has been a lot of things done by the government through policies, strategies and activities through the funding of domestic and foreign aid (MOH, 2007, p.1).

According to the MOH (2001) The goal of immunization is to prevent illness and death of infants and children - children that is caused by epidemics that often arise. The Indonesian government strongly encourages the implementation of immunization programs as a way to reduce morbidity and mortality in infants, toddlers / children - pre-school children. (Http://syehaceh.wordpres. Com / Accessed on 25 April 2010).

Type of immunization, vaccines and usefulness

a. Immunization is divided into two:
1) Active Immunization
Active immunization is immune from any person's body that is actively forming agent anti-bodies. Active immunization is divided in two:
a) Active immunization of natural
Active immunization is the natural immune system that automatically obtained after recovering from an illness.
b) artificial active immunization
Artificial active immunization is obtained immunity from vaccinations given to protection from a disease (IGN Ranuh, et al, 2005, p.23).
2) Passive immunization
Passive immunization is immune to a person who acquired immune substances obtained from the outside. Passive immunization is divided in two:

a) Passive immunization of natural
Passive immunization is a natural antibody from any person's inherited by the mother who is a direct biological parents while in the womb.
b) Passive immunization of artificial
Artificial passive immunization is obtained because the immune serum injections to prevent certain diseases (IGN Ranuh, 2005, p.24).
b. Kind - kind of vaccine development program entry immunization (PPI) and its usefulness:
1) BCG (Bacillus Calmatte Guerin)
BCG vaccine is made from the bacterium tuberculosis (TB) who have been living in weaken. (MOH, 2009, p. 29).
The purpose of this vaccine to create immunity that is active against tuberculosis. (MOH, 2005, p. 5).
2) DPT (Dipteri Pertussis Tetanus)
Vaccine DPT vaccine called "Triple" which consists of:
a) diphtheria vaccine: diphtheria bacteria that has been attenuated.
b) pertussis vaccine: pertussis bacterium that has been attenuated
c) tetanus vaccine: tetanus bacteria that have been weakened.
DPT vaccine goal is to provide the same active immunity against diphtheria, whooping cough and tetanus. (MOH, 2005, p. 6).
3) Polio
Recognized two types of polio vaccine dead vaccine (Salk) and live vaccine that has been in the weaken (Sabin). (MOH, 2009, p. 29).
The purpose of this immunization is to prevent paralysis in infants and toddlers wilt. (MOH, 2005, p. 9).
4) Measles
Measles virus measles-containing vaccine that has been weaken. (MOH 2009, p. 29).
The purpose of this vaccine to provide immunity against measles. (MOH, 2005, p.10).
5) Hepatitis B (HB)
HB vaccine derived from virus in weaken. (MOH 2009, p. 29).
The purpose of HB vaccine is to give immunity to the infant and toddler jaundice. (MOH, 2005, p.11).

Understanding of the immunization program

The immunization program is an activity aimed at an area that requires quick handling to prevent the occurrence of outbreaks (Extraordinary Events). (MOH 2009, page.2).

In Indonesia, the immunization program has been started since the 19th century to eradicate smallpox in Java. Indonesia's last case of smallpox was discovered in 1972 and in 1974 Indonesia was officially declared smallpox-free country. 1977 to the year 1980 was introduced immunization BCG, DPT and TT respectively to give immunity to the diseases of children tuberculosis, diphtheria, pertussis and tetanus neonatorum. In 1981 and 1982 respectively was introduced antigen polio and measles which started in 55 districts and sub-districts known as the Development of Immunization (PPI). (MOH, 2005, p.. 27).

In 1987 the immunization program was first introduced PWS (Local Area Monitoring) as a tool monitor coverage. PWS actually very useful for monitoring the trend of achieving coverage of the program within a certain period and can take immediate corrective action and follow-up. By utilizing the PWS and its follow-up in late 1990 by the National UCI can be achieved early, then followed UCI propensi and district level the following year (MOH, 2007, p.58).

The immunization program is a program that is very effective and efficient and proven by its success eradicate smallpox in the world. In order to target the national and global commitment to achieve eredikasi, elimination, and reduction of Cosmos, the disease can be prevented by immunization (PD3I) can be achieved, immunization activities need to be improved and maintained both the quantity and quality (MOH, 2007, p.58).