Impact and longevity of measles-associated immune suppression: a matched cohort study using data from the THIN general practice database in the UK

Abstract

ObjectiveTo test the hypothesis that measles infection increases the incidence of non-measles infectious diseases over a prolonged period of time.DesignA population-based matched cohort study.Data sourcesThis study examined children aged 1–15 years in The Health Improvement Network UK general practice medical records database. Participants included 2228 patients diagnosed with measles between 1990 and 2014, which were matched on age, sex, general practitioner practice and calendar year with 19 930 children without measles. All controls had received at least one measles vaccination. Children with a history of immune-compromising conditions or with immune-suppressive treatment were excluded.Primary outcome measuresIncidence rate ratio (IRR) of infections, anti-infective prescriptions and all-cause hospitalisations following measles in predetermined periods using multivariate analysis to adjust for confounding variables.ResultsIn children with measles, the incidence rate for non-measles infectious disease was significantly increased in each time period assessed up to 5 years postmeasles: 43% in the first month (IRR: 1.43; 95% CI 1.22 to 1.68), 22% from month one to the first year (IRR: 1.22; 95% CI 1.14 to 1.31), 10% from year 1 to 2.5 years (IRR: 1.10; 95% CI 1.02 to 1.19) and 15% (IRR: 1.15; 95% CI 1.06 to 1.25) in years 2.5 to 5 years of follow-up. Children with measles were more than three times as likely to receive an anti-infective prescription in the first month and 15%–24% more likely between the first month and 5 years. The rate of hospitalisation in children with measles was increased only in the month following diagnosis but not thereafter (IRR: 2.83; 95% CI 1.72 to 4.67).ConclusionFollowing measles, children had increased rates of diagnosed infections, requiring increased prescribing of antimicrobial therapies. This population-based matched cohort study supports the hypothesis that measles has a prolonged impact on host resistance to non-measles infectious diseases.

Studies into the mechanism of measles-associated immune suppression during a measles outbreak in the Netherlands

“…Measles is characterised by fever, cough and a maculopapular skin rash 1 . The disease is associated with a transient immune suppression and increased risk of childhood morbidity and mortality for a period of more than 2 years 2 , 3 , 4 . Paradoxically, measles also induces strong cellular and humoral immune responses that mediate lifelong protection 5 .…”

Clinical characteristics and outcomes of measles outbreak in adults: A multicenter retrospective observational study of 93 hospitalized adults in Greece

“…Measles-induced lymphocytopenia as well as its grade, possibly has a role either as a disease severity biomarker or as a predisposing factor for short- and long-term infectious complications. There is growing evidence that measles infection induces immunosuppression; a recent study in measles-infected children found significantly higher rates of hospitalization (during the first month), of non-measles infections and of antimicrobial prescriptions up to 5 years post-measles, compared to children without measles [ 17 ]. Mina et al showed that measles infection, but not MMR vaccination, reduces the humoral immune memory against numerous viruses in children [ 18 ].…”

Communicating Benefits from Vaccines Beyond Preventing Infectious Diseases

“…A recent study in the Netherlands has confirmed that measles virus infection can reduce pre-existing protective antibodies [ 34 ]. The association of measles infection with increased morbidity and mortality due to non-measles infectious disease has been shown in populations of children from wealthy countries, and this increased mortality rate appears to last for 2–3 years after the infection [ 35 , 36 ].…”