Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Promotion

First Committee Member

Brady Beecham, MD MPH

Second Committee Member

Aravind Menon, MBBS PhD

Third Committee Member

Armando De Alba, MD MPH

Fourth Committee Member

Fabio Almeida, PhD


Measles is a highly contagious viral disease. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine.

There have been increasing outbreaks of measles to waning immunization. This study sought to evaluate rates of Measles, Mumps and Rubella (MMR) immunization in a Somali population living in Lexington, Nebraska and to evaluate a community health worker intervention to improve immunization rates. NESIIS data for Lexington Regional Health Center (LRHC) was queried to assess MMR trends for all clinic patients between 15 and 72 months both before and after implementation of the community health worker intervention. During the pre-intervention LRHC had an overall initial MMR vaccination rate of 67%. There was a significant lower rate of MMR immunization in the Somali population (29%) compared to the Hispanic population (72%, p<0.0001) and the Non-Somali, Non-Hispanic population (75%, p<0.0001). Interestingly, this vaccine hesitancy was unique to MMR vaccination with rates of varicella vaccination significantly higher at 75% versus 29% for MMR (p<0.0001). During the intervention period LRHC had an overall initial MMR vaccination rate of 37% which was significantly lower than previous. There was a significant increase in rate of MMR immunization in the Somali population (52%) compared to the pre-intervention rate of 29% (p<0.0001). The rate of varicella immunization among the Somali population did not significantly change between the two time periods (p=0.2302). Rates of MMR and varicella immunization significantly decreased in the Hispanic population (MMR 37% p<0.0001, Varicella 61% p<0.0001) and the Other population (MMR 32%, p<0.0001, Varicella 51%, p<0.0001). In conclusion, there is MMR vaccine specific hesitancy within the Somali population in Lexington, Nebraska that puts the community at risk for a measles outbreak. Using a community health worker intervention can help to improve MMR immunization rates within this population.

Available for download on Wednesday, April 22, 2020