Calidad percibida por los usuarios de Fisioterapia en Atención Primaria / Patient's perception of quality for Physical Therapy in Primary Health Care

Objetivo: Conocer las experiencias y percepciones sobre la atención asistencial que reciben los pacientes con cervicalgia, que acuden a unidades de fisioterapia públicas, pertenecientes a la Región de Murcia, España.Material y método: Estudio cualitativo mediante la técnica de grupos focales. Se realizó en tres unidades de fisioterapia a nivel de atención primaria, en donde se llevó a cabo un grupo focal en cada una de ellas. Las sesiones fueron grabadas en cinta magnetofónica y posteriormente transcritas. El análisis de cada grupo fue realizado de forma independiente por tres miembros del equipo y, posteriormente se realizó el acuerdo de la información definitiva. Resultados: La organización fue la dimensión más identificada (19 %), en concreto la organización de los horarios de atención, los problemas derivados de la desproporción entre demanda de consulta y número de fisioterapeutas, y la simultaneidad de tareas asistenciales y no asistenciales. El trato es la dimensión menos identificada (3 % del total). Entre los centros existe similitud en la distribución de las afirmaciones por cada dimensión, excepto en la dimensión "tiempo de espera" (que en el centro "A" corresponde al doble de afirmaciones que en el resto de centros), accesibilidad (menor en el centro "C"), e intimidad (también mayor en el centro "A"). Conclusiones: La metodología de grupos focales, ofrece una perspectiva más amplia de aquellos aspectos identificados por los pacientes, para mejorar la calidad asistencial en fisioterapia. La información obtenida sobre las áreas más relevantes, puede servir en la elaboración de un cuestionario tipo informe del usuario que permita evaluar de forma valida, la frecuencia de problemas de calidad percibida, sobre el servicio asistencial que reciben

Objective: To know the experiences and perceptions on the attention that the patients with neck pain receive in the physical therapy units, in Murcia. Material and method: A qualitative investigation carried out using focal groups in three physiotherapy units at level of primary care where was carried out a focal group in each one of them. The sessions were recorded and transcribed for analysis. The analysis of each group was carried out, first independently by three members of the team and then jointly for a consent of the definitive information. Results: The organization was the more identified dimension (19 %), concretely the organization of the schedules of attention, the derived problems of the disproportion among consultation demand and physiotherapists number, and the simultaneity of tasks (assistance and not assistance). The treat is the less identified dimension (3 % of the total). Among the centers similarity exists in the distribution of the statements for each dimension, except in the dimension waiting time (that in the center "A" it corresponds to double statements that in the rest of centers), accessibility (smaller in the center "C"), and intimacy (also bigger in the center "A"). Conclusions: The methodology of focus groups, offers a wider perspective of those aspects identified by the patients, to improve the quality in physical therapy. The information obtained on the most important areas, it can serve in the elaboration of the patient questionnaire to evaluate with validity, the frequency of problems of perceived quality, about the care service that they receive

[Consistency and validity of the evaluation of the clinical chart]. / Consistencia y validez en la evaluación del expediente clínico.

OBJECTIVE: Assess the degree of external consistency and validity of the EXP CLIN instrument has for measuring the quality information contained in medical charts. MATERIAL AND METHODS: In a transverse comparative study, two hundred and twelve clinical charts were randomly selected belonging to patients seen at a pediatric hospital. The charts were assessed using the EXP-CLIN for phases: 1) internal assessment: by hospital personnel of the pediatric hospital, and, II) external assessment: by personnel from other hospitals. The results were analyzed using the concordance method. RESULTS: The concordance percentages were found to be 76% for medical charts and medical notes related with the process of diagnosis-treatment, as well as the general characteristics of the clinical chart. The concordance percentages average was 88%, supporting the idea that when the EXP-CLIN instrument is applied twice to the same chart, good concordance is obtained between the two measures. CONCLUSIONS: Given that the application of the instrument documented a good level of external consistency, its use is justified for assessing the quality of the information contained in the charts of the patients seen at our unit.

[FARMAC: a program designed for monitoring the prescription of antimicrobials in hospitals]. / FARMAC: programa diseñado para vigilar la prescripción de antimicrobianos en hospitales.

INTRODUCTION: The use of computer programs for monitoring the prescription of antimicrobial agents in hospitals is of paramount importance in the incorporation of electronic databases developed and analyzed by several hospital committees, including the following: infection control; pharmacy; morbidity and mortality; and quality assurance committees, as well as other key areas or departments such as pathology, pharmacy, microbiology, radiology, or hospital administration. OBJECTIVE: To describe the development and use of an "information system" employed for monitoring the prescription of antimicrobial agents in hospitalized patients. MATERIAL AND METHODS: A printed format was developed in order for physicians to ask for authorization for the use of restricted antimicrobial agents (i.e. third-generation cephalosporins and other newly introduced beta lactams, fluoroquinolones, antifungals, antivirals, etc). A computer program, "FARMAC", was designed using the Dbase IV program. FARMAC contemplates the presentation on a screen of a main menu allowing for the use of several options: admissions; antibiotic changes; consultations; discharges; hospital transfers; reports, and distribution. The reports are generated from the menu and appear on the screen or are printed in representative tables and figures. Generally speaking, the system processes information on the use of antimicrobial agents, files information, allows for consultation, of the information and generates reports quickly and efficiently. RESULTS: The presentations were defined on screen, taking into account the space needed in order to avoid an inadequate distribution of the messages, therefore obtaining an optimal image. A database was created defining the necessary fields for storing information with reference to patients and usage patterns of restricted antimicrobial agents. DISCUSSION: The development of an information and surveillance system on the prescription of antibiotics allows for consulting updated information, making the data analysis easier for decision making. Its use will allow for surveying tendencies and usage patterns of controlled and non-controlled antimicrobial agents.

[Secondary costs due to nosocomial infections in 2 pediatric intensive care units]. / Costos secundarios por infecciones nosocomiales en dos unidades pediátricas de cuidados intensivos.

OBJECTIVE: We estimated associated costs to nosocomial infections in two pediatric intensive care units in Mexico City. MATERIAL AND METHODS: A transversal study in the neonatal (NICU) and pediatric (PICU) intensive care units, was done. We reviewed use and cost of diagnostic procedures, medications, and excess of hospital stay. RESULTS: There were 102 infections, 46 in the NICU and 56 in the PICU. The average cost per infection was $11,682 USD and the overall expense was 1,184.71 USD. Infected children had an excess of hospital stay of 9.6 days, 13.7 more laboratory tests and 3.3 more cultures. Hospital stay represented 97% of the overall cost. CONCLUSIONS: This is one of the first estimations of nosocomial infections cost done in Mexico. These results justify the introduction of infection control programs to decrease these complications.

[Nosocomial infections and quality of health care]. / Las infecciones nosocomiales y la calidad de la atención médica.

The main objective of a hospital-acquired infections control program is to decrease the risk of acquisition and the morbidity and costs associated. The organization of a team with technical and humanistic leadership is essential. Every infection control program must also develop strategies that allow: a) identification of the problems, b) to establish the importance of each one, c) to determine their causes, d) to develop solutions and e) the evaluation of the recommended solutions. The development of technical and humanistic abilities by the leader and the members of the team, and the use of the tools mentioned above have produced the only validate and highly effective program of quality improvement in the hospital.

Improved serological response to human diploid cell rabies vaccine when given simultaneously with antirabies hyperimmune globulin.

BACKGROUND: The prevention of rabies in Mexico continues to be an important goal for the health sector. Although the prevalence of this disease continues to fall, between 1990 and 1995 a total of 238 cases were registered (an average of 40 cases annually), with a mean annual incidence of 0.04 cases per 100,000 inhabitants and a mortality of almost 100%, so that it is important to rely on highly effective vaccines with few side effects. The objective of this work was to evaluate seroconversion and tolerance to the human diploid cell antirabies vaccine administered to individuals with a history of exposure to rabies, to compare these results with those reported in the literature for the Fuenzalida vaccine, a rabies vaccine produced in the brain tissue of suckling mice, and to find the role antirabies hyperimmune gamma globulin plays in the concentration of post-vaccination antibody concentrations. METHODS: An analytical transverse study was carried out in 40 children and adults with a history of rabies exposure who were given a complete, five-dose intramuscular schedule of the human diploid cell rabies vaccine. Subjects were followed daily, and local and systemic signs and symptoms were recorded. Two blood samples (at baseline and at the end of the vaccination schedule) were taken and antibody titers against rabies glycoprotein, using the ELISA technique, were measured. RESULTS: Adverse side effects produced by the human diploid cell antirabies vaccine, such as frequency of pain, erythema, itching, and regional adenopathy were fewer than those reported in the literature for the Fuenzalida vaccine (p < 0.05), and of induration and local pain (p < 0.05) in relation to the latter vaccine. All patients seroconverted, producing geometric mean antibody titers of 6.22 IU/mL, an arithmetic mean titer of 9.66 IU/mL with a SD of 9.1 IU/mL. The level of tolerance to the diploid cell vaccine was good and its adverse effects were minimal and fewer than those reported for the Fuenzalida rabies vaccine. Patients receiving the diploid cell vaccine plus antirabies hyperimmune gamma globulin developed higher antibody titers (measured by ELISA test) at the end of the vaccination schedule than those only receiving the vaccine. CONCLUSIONS: These results are important in order to achieve an adequate and opportune level of protection provided by prophylactic vaccines to patients with exposure to rabies.

[Surveillance and the costs related to the prescription of antimicrobials in a pediatric hospital]. / Vigilancia y costos relacionados con la prescripción de antimicrobianos en un hospital pediátrico.

INTRODUCTION: Important considerations in the selection of an antimicrobial agent include the indications for its prescription, its efficacy, toxicity and cost. However, is has been observed that up to 50% of these prescriptions are inappropriate. OBJECTIVE: To evaluate the utilization patterns and costs of restricted antimicrobial agents requiring authorization of the infectious diseases service for their prescription, in a tertiary care pediatric hospital through the use of a computer software antimicrobial use surveillance program designed by the investigators. MATERIAL AND METHODS: A one-year longitudinal descriptive and prolective survey was conducted in all patients requiring antimicrobial therapy during their hospitalization. Information on the prescription and costs of antimicrobial agents was recorded from both the medical chart and pharmacy registers. RESULTS: A total of 748 patients were prescribed at least one restricted antimicrobial agent, corresponding to 9.6% of the total number of patients hospitalized and 63.4% of the antibiotic expenditures during the study. CONCLUSIONS: Hospital surveillance of antimicrobial prescription is useful for detecting antimicrobial prescription patterns and costs. These types of studies are inexpensive and of easy access when a computerized register is available in the pharmacy.

Malnutrition in childhood lymphoblastic leukemia: a predictor of early mortality during the induction-to-remission phase of the treatment.

BACKGROUND: Previous reports have shown that undernourished children with acute lymphoblastic leukemia (ALL) have a poorer long-term survival as compared with children with normal nourishment status. It has been shown that both the relapse and mortality rates of undernourished children with ALL are higher during the continuation phase of the chemotherapy and are apparently related to a poor tolerance of ablative chemotherapy. No previous articles have analyzed the early mortality rate of these patients. METHODS: We carried out a case-control study, and have studied the effect of severe malnutrition on the mortality of 17 children with ALL during the initial induction-to-remission phase of the treatment. These 17 cases were compared with 76 controls who had survived at least the phases of induction and consolidation. RESULTS: It was found that the chance of dying during the initial phase of the treatment was 2.6 times higher (confidence interval 95%: 0.55-11.89) in undernourished children with ALL than in those children with normal nourishment status. The risk of death increased with the severity of undernourishment (p = 0.04). CONCLUSIONS: These data confirm the prognostic value of malnutrition in children with ALL and suggest that undernourishment may also influence early mortality during the induction-to-remission phase of the treatment.

Cytomegalovirus infection in children: frequency, anatomopathologic characteristics and underlying risk factors in 1618 autopsies.

The aim of this study was to determine the frequency of cytomegalovirus (CMV) infection in children with postmortem study. The records of 1618 autopsies performed during 1980-1989 at the Hospital Infantil de México Federico Gómez were reviewed. Characteristic cytomegalovirus inclusion bodies were identified, in one or several organs, in 47 cases (2.9% of the autopsies). None of these cases was cultured for viruses prior to or at the time of autopsy. Of the 47 cases, 24 (51%) with CMV were younger than 3 months and 38 cases (80%) younger than 12 months of age. In eight cases, the infection was judged as generalized and considered the cause of death. Two of these patients were premature and the infection was most probably intrauterine. The risk factor most frequently identified was secondary immunosuppression. The lung was the most common affected organ, followed by kidney, adrenals, pancreas, liver, brain and salivary glands. In seven cases the inclusion bodies were seen in the brain and in three others periventricular calcifications without inclusion bodies were observed. Although not a rarity in Mexico, CMV infection is not often suspected. Additional studies are needed in order to determine the prevalence of CMV infection in Mexico.

[The health worker and counseling about HIV and AIDS]. / El trabajador de salud y la consejería sobre el VIH y SIDA.

By December 1993, more than 17,000 AIDS cases had been reported in Mexico and some estimates indicate approximately 100,000 individuals currently infected with HIV. From the patient's perspective, being HIV positive or having AIDS, places an enormous burden on psychosocial coping mechanisms. Thus, psychosocial support is required for all of these patients. This paper summarizes our educational intervention on counseling techniques and provides information of our demonstration project on the effectiveness of the educational intervention among 89 Mexican health care workers. Overall, these professionals showed improvement in their knowledge and goals of providing counseling. One of the more striking was the discovery of homophobic attitudes among them, particularly those with no previous experience in the care of HIV infected people. This exploratory study allowed us to identify research and educational needs of health care workers. The overwhelming number of estimated cases of HIV infections and the current trends of the epidemic reveal the necessity for training in medical counseling that over 73,000 physicians in Mexico will face in the immediate future.

[Outbreak of respiratory syncytial virus at a neonatal intensive care unit in Mexico City]. / Brote de infección por virus sincicial respiratorio en una Unidad de Cuidados Intensivos Neonatales en la Ciudad de México.

RSV can be spread in hospital wards, being thus responsible for increased morbidity and mortality among infected patients. We describe an RSV outbreak in a Neonatal Intensive Care Unit (NICU). METHODS. As soon as the first RSV cases were detected in the NICU, every patient, as well as the personnel taking care of them, were tested; nasal washes for viral isolation, and nasopharyngeal swabs for viral antigen detection by immunofluorescence, were collected. RESULTS. Twelve patients were hospitalized. RSV was detected in eight, coinfection was observed in three of them. RSV was also detected in three adults. We describe the clinical findings among the RSV infected patients, and the infection control measures that we followed to stop the RSV spread. CONCLUSIONS. Viruses can be responsible for nosocomial infections, being thus mandatory to establish the diagnosis, treatment and infection control measures. In our NICU, the RSV infected patients had mild to moderate disease, there were no deaths attributable to RSV infection. We discuss infection control measures.

[Protection of health personnel against hepatitis B by DNA recombinant vaccine]. / Protección contra hepatitis B en trabajadores de salud con vacuna de DNA recombinante.

Hepatitis B (HVB) is a worldwide spread health problem. It has been assessed that there are more than 300 millions of carriers. HVB has a special concern for health care workers (HCW's) due to the high risk among them of getting the infection in clinic-setting areas. According to some estimation, the risk for hepatitis B among HCW's is 2 to 10 times higher than the risk for general population. The risk is related to the degree of direct contact with blood and body fluids, as well as, with the frequency of traumatic exposure in the work place. The control of this infection is based on the observance of universal precautions and the vaccination, since there is not treatment against this disease. The results of an efficacy-evaluation of DNA recombinant vaccine against hepatitis B are reported; 174 HCW's were studied; three dosages of vaccine were administered (0.1st and 6th month) by I.M. via. In addition, three serum samples were collected at 0, 1st and 9th month after vaccine administration. We did not find carriers of surface antigen of hepatitis B. With regards to seroconverted individuals we observed the following results: there were a satisfactory response to the vaccine in 163 individuals (93.7%); however, 8 (4.6%) persons did not reach titles of protective antibodies and 3 (1.7%) did not show seroconversion at all. Therefore, 11 persons (6.3% of the total) did not result immunized. The secondary reactions to the vaccines were low in frequency and mainly of local presentation. Among the study population we did not find chronic carries of hepatitis B.(ABSTRACT TRUNCATED AT 250 WORDS)

[Overview of HIV infections in pediatric population]. / Panorama de la infección por el virus de la inmunodeficiencia humana en población pediátrica.

A general overview of HIV infection/AIDS in the pediatric population, in Mexico, is provided. The principal categories of transmission in our country are: 45.5% perinatal, 44.0% following transfusion for hemophilia or for other reasons, and less frequently sexual transmission. In the United States and Europe, similar patterns are seen with perinatal transmission being the most important route, at higher percentages than ours. The number of cases of HIV infection in children continues to grow worldwide, primarily reflecting the problem in the adult population.

[Bacterial infections in children with AIDS]. / Infecciones bacterianas en niños con síndrome de inmunodeficiencia adquirida.

The importance of bacterial infections in children with AIDS was emphasized when they were included within the CDC classification system for children under 13 years of age infected with the HIV. The information available in Mexico on frequency, types of infections and causative agents is scarce. In this study, the frequency and microbiology of bacterial infections in children with AIDS seen at the Hospital Infantil de Mexico Federico Gomez is reported. From September 1985 to December 1991, we found 72 HIV infected children, 6 were classified P0, 6 as asymptomatic (P1) and 60 as symptomatic infections (P2). From this last group, 50 were secondarily infected with bacteria; there was a total of 129 episodes of bacterial infections, averaging 2.5 episodes per patient. Respiratory infections were the most frequent (74.41%), followed by septicemia (10.07%), skin and underlying tissue infections (6.96%) and urinary tract infections (6.17%). Infections of the CNS and deep abscesses were less frequent. Overall mortality rate was 76%, however only in 18 children (36%) was it directly attributed to the bacterial infections. Etiology was documented in 46 episodes (33.65%) of which 30 (65.31%) were gram-negative bacteria and 16 (34.78%) were gram-positive. The best possible methodology must be used for the etiologic diagnosis of bacterial infections in children with AIDS in order to select the most appropriate treatment for severe or recurrent bacterial infections.

[Health care worker relationship with HIV infected patients or AIDS patients]. / El trabajador de la salud y su relación con personas infectadas con el virus de la inmunodeficiencia humana o enfermos con síndrome de inmunodeficiencia adquirida.

The roll of the health care worker (HCW) providing care to HIV-infected patients or living with AIDS has became an important issue in the course of the epidemic, and has impacted the evolution of these patients. Diverse studies have shown that the acceptance of the HCW to care for these patients is related to the degree of education in regards to the subject. There is a positive correlation between knowledge about universal precautions and mechanisms of transmission with the willingness to care for HIV-infected patients. This review shows several studies that have been developed in order to assess the attitudes among HCW's toward HIV-infected patients and the phenomen HIV/AIDS as public health problem. In addition, political issues are discussed in regards to measure protection to HCW as well as HIV-infected patients.

[Medical facilities for women and children infected with HIV]. / Infraestructura de atención y servicio para mujeres y niños infectados por el virus de la inmunodeficiencia humana.

The phenomena HIV infection and acquired immunodeficiency syndrome (AIDS) among women and children is an important concern for underdeveloped and developing countries and has became a Public Health problem. The medical facilities required for care of these patients are special and demand a comprehensive approach and multidisciplinary team-work. In this way, the patients would receive adequate care for their needs. This review includes the antecedents of the HIV infection among women and children. Mechanisms of transmission, and the current model of medical care that exists in some developed countries. Finally, a commentary is made in regards to the importance of continuing medical education of the health-term in order to confront the AIDS epidemic.

[Immunizations in hospitalized and outpatient children: the reduction of lost vaccination opportunities]. / Inmunizaciones en niños hospitalizados y de consulta externa: reducción de las oportunidades perdidas de vacunación.

Among the strategies directed towards the control of preventable illnesses through vaccination, are the "National Days for Vaccination" and the intensive campaigns for country-wide vaccination, which have been taking place in our country during the last few years. An important aspect that must be taken into account is the immunization of children or patients who are hospitalized or those are under medical supervision due to changing chronic pathologies which have is some way interfered with the normal course of the application of the basic scheme of immunizations. The causes which have lead to incomplete vaccination schemes or to unstarted ones have been analyzed in different studies. In many cases, it has been observed that the information available to parents as well as to health workers in inexact. Hospitalization per se does not constitute a contraindication for vaccination, except in certain circumstances where there is some relation to the type of vaccine, as for example that of live attenuated virus or the existence of an underlying disease, like neoplasms and congenital or acquired immunodeficiency, which should be individually studied to evaluate the application of the vaccine depending on each individual case.

PIP: Mexico's control strategy for immunopreventable diseases calls for universal vaccination of children. In addition to the National Vaccination Days begun in the 1980s, vaccines are bought to homes and schools by health promoters, physicians, and nurses. Recently attention has been directed to the need to vaccinate children in hospitals and clinics in order to achieve better vaccination coverage. Hospitalization in itself does not constitute a contraindication to vaccination, and for some children illness is the only reason for visiting a health service and the only opportunity for vaccination. According to the Public Health Service, a minor illness such as an upper respiratory infection with fever does not contraindicate vaccination. The Federico Gomez Children's Hospital in Mexico City has initiated a program to vaccinate children in both its inpatient and outpatient services. A program to inform health personnel of the need to vaccinate, talks for parents of patients, an evaluation of the immunization status of each patient presenting for outpatient consultation or hospitalizations, and a greater availability of vaccines were the main program measures. Vaccination was authorized on discharge of each patient, including patients with infections who had been afebrile for 24 hours. A survey of vaccination coverage was conducted from September 19 to October 9, 1991 in the pediatric inpatient and outpatient services. The vaccination card, other written record, or a verbal report of vaccination was requested for each child. The completeness of vaccination was assessed for each child in accordance with age. Another survey was conducted to assess the incidence of contraindications to vaccination for hospitalized children. The average number of doses of vaccines administered per month increased from 150 before the program began to 600 after it was underway. 5832 of the 1027 pediatric patients seen in the inpatient and outpatient services were judged completely vaccinated for their age levels. 18% of the children observed had not received any vaccinations. Only 44.8% of the children had vaccination cards. 10.6% of hospitalized patients had a contraindication to vaccination. Among these 57 patients, 27 were immunosuppressed, 14 had convulsions, 12 had cancer, and 4 had lymphoenia.

[Nosocomial measles: a proposal for its control in hospitals]. / Sarampión nosocomial: propuestas para su control en hospitales.

The transmission of measles in medical settings has become increasingly recognized. Due to the lack of information on nosocomial measles in Mexico we performed a 14 year retrospective study at the Hospital Infantil de México Federico Gómez. The objectives of our study were: a) to determine the frequency of the disease in our hospital; b) to determine the association between nutritional status and risk of acquiring nosocomial measles and c) to establish the relationship between nutritional status and complications in morbidity and mortality due to nosocomial measles. Eighty nine children with nosocomial measles were identified. We observed that patients with severe malnutrition had a greater risk of acquiring nosocomial measles developing complication and dying. The most frequent complication was pneumonia.

[Complications in children with measles]. / Complicaciones en niños con sarampión.

Ongoing immunization campaigns have significantly reduced the incidence of measles. To evaluate the efficacy of vaccination policies, however, it is necessary to analyze disease indicators of mortality and of morbidity such as medical complications and sequelae. We reviewed the hospital experience at Hospital Infantil de Mexico regarding children with measles who necessitated hospitalization between January 1976 and December 1989. During this 14 year period, 176 patients with measles were hospitalized; the majority of the cases corresponded to the period between 1985 and 1989. Fifty five percent of the cases corresponded to children under one year of age. Of those older than 12 months, 81% lacked an immunization history. Eighty percent were from Mexico city or from the neighboring state of Mexico. The mayor complications included: respiratory tract infections such as pneumonia (50.8%), diarrhea (18.2%), and less frequent: laringotracheitis, otitis media, myocarditis and pyodermitis. More than 70% were significantly (grade II or III) malnourished. Twenty three patients died, for a mortality of 13%. The factors more likely related to measles mortality were; age less than two years, undernutrition, and more than two medical complications associated. This report emphasizes that medical complications and mortality are more likely to occur in very young unimmunized, malnourished children.

[Guidelines for vaccination against measles in children]. / Lineamientos para la vacunación contra el sarampión en niños.

After the introduction of massive immunization campaigns in Mexico, started in 1973, the measles mortality rate has been reduced in children under five years of age from 2.8% in 1989 to a level of 1.6% in 1985. Two epidemics occurred in 1985 and 1989 with 19,460 and 20,076 reported cases respectively. In the first quarter of 1990 a total of 22,906 cases were reported. The age distribution has been: patients greater than 1 year 26.3%; 1-4 years 24.8%; 5-14 years 35.5% and greater than 15 years 18.2%. The vaccination coverage, between 1987 and 1988, ranges from 34% to 75% in outbreaks studies and in the National Health Survey. The vaccine efficacy in those outbreaks has been estimated from 63% to 89%. The epidemics have been primary related to low vaccination coverage during the last 15 years. The conglomeration of a cumulative number of non vaccinated persons could explain the distribution of cases in all age groups. The strategy based on two doses as has been recommended in the US, is useful in programs addressed to eradicate measles, but the low resources and limited access to health services in rural communities of Mexico have made these control measures in feasible. The measles control in Mexico, must be based in vaccinate each child at the first anniversary, this strategy could be enough to take off the measles epidemics.