Measles Vaccination and Childhood Mortality in Rural Bangladesh1

Abstract

To ascertain whether measles vaccination was associated with reduced mortality rates in rural Bangladeshi children, the authors conducted a case-control study in four contiguous areas, two of which had participated in an intensive measles vaccination program which began in the spring of 1982. Cases were 536 children who had died in the four-area region at the age of 10-60 months between April 1982 and December 1984. Two age- and sex-matched controls were selected from the four-area region for each case; each control had survived at least through the date of death of the matched case. Measles vaccination was associated with a 36% (95% confidence interval 21%-48%) proportionate reduction in the overall rate of death and a 57% (95% confidence interval 43%-67%) reduction in the rate of deaths directly attributed to measles or ascribed to diarrhea, respiratory illness, or malnutrition. The association of measles vaccination and reduced mortality remained unchanged after the authors restricted controls to children who had survived at least one year after the deaths of their matched cases. Moreover, children vaccinated in 1982 exhibited a sustained reduction in the rate of death in 1983 and 1984. The authors concluded that measles vaccination was associated with a pronounced and sustained reduction in the rate of death among children in this study.

Non-specific beneficial effect of measles immunisation: analysis of mortality studies from developing countries

“…It has therefore been speculated that the prevention of delayed deaths from measles could explain the reduction 6. This could be tested by comparing mortality of unimmunised and immunised children after the exclusion of all cases of measles.…”

“…Recent studies indicate that vaccines may have important non-specific effects as girls receiving high titre measles vaccines were found to have reduced long term survival compared with recipients of standard titre vaccines 1 2 3. On the other hand, studies of standard titre measles vaccine have reported a greater than expected reduction in mortality in areas with high mortality 4 5 6. As these observations suggest that measles immunisation may have a non-specific, beneficial effect5 we reviewed mortality studies of unvaccinated and vaccinated children and examined whether the reduction in mortality after measles immunisation is due only to the specific prevention of acute measles disease and its long term consequences.…”

Does increased access increase equality? Gender and child health investments in India

“…If getting vaccinated decreases mortality in the developing world (as we know that it does -see, among a huge additional literature - Aaby et al, 2002;Clemens et al, 1988;Koenig et al, 1990) then any changes in vaccination are likely to map fairly directly into changes in mortality. 17 However, this link is not necessarily sufficient.…”

Morbilliviruses and human disease

“…The situation is very different in developing countries. There, measles can have very high mortality rates (5-10%) and severe morbidity is associated with the infection [9,10]. The causes of these differences in clinical outcome between the developed and the developing world are not well understood.…”