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BMJ. 1995 Aug 19; 311(7003): 481–485.
PMCID: PMC2550544

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


OBJECTIVE--To examine whether the reduction in mortality after standard titre measles immunisation in developing countries can be explained simply by the prevention of acute measles and its long term consequences. DESIGN--An analysis of all studies comparing mortality of unimmunised children and children immunised with standard titre measles vaccine in developing countries. STUDIES--10 cohort and two case-control studies from Bangladesh, Benin, Burundi, Guinea-Bissau, Haiti, Senegal, and Zaire. MAIN OUTCOME MEASURES--Protective efficacy of standard titre measles immunisation against all cause mortality. Extent to which difference in mortality between immunised and unimmunised children could be explained by prevention of measles disease. RESULTS--Protective efficacy against death after measles immunisation ranged from 30% to 86%. Efficacy was highest in the studies with short follow up and when children were immunised in infancy (range 44-100%). Vaccine efficacy against death was much greater than the proportion of deaths attributed to acute measles disease. In four studies from Guinea-Bissau, Senegal, and Burundi vaccine efficacy against death remained almost unchanged when cases of measles were excluded from the analysis. Diphtheria-tetanus-pertussis and polio vaccinations were not associated with reduction in mortality. CONCLUSION--These observations suggest that standard titre measles vaccine may confer a beneficial effect which is unrelated to the specific protection against measles disease.

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  • Aaby P, Knudsen K, Whittle H, Lisse IM, Thaarup J, Poulsen A, Sodemann M, Jakobsen M, Brink L, Gansted U, et al. Long-term survival after Edmonston-Zagreb measles vaccination in Guinea-Bissau: increased female mortality rate. J Pediatr. 1993 Jun;122(6):904–908. [PubMed]
  • Aaby P, Samb B, Simondon F, Knudsen K, Seck AM, Bennett J, Markowitz L, Rhodes P, Whittle H. Sex-specific differences in mortality after high-titre measles immunization in rural Senegal. Bull World Health Organ. 1994;72(5):761–770. [PMC free article] [PubMed]
  • Holt EA, Moulton LH, Siberry GK, Halsey NA. Differential mortality by measles vaccine titer and sex. J Infect Dis. 1993 Nov;168(5):1087–1096. [PubMed]
  • Aaby P, Bukh J, Lisse IM, Smits AJ. Measles vaccination and reduction in child mortality: a community study from Guinea-Bissau. J Infect. 1984 Jan;8(1):13–21. [PubMed]
  • Aaby P, Andersen M, Sodemann M, Jakobsen M, Gomes J, Fernandes M. Reduced childhood mortality after standard measles vaccination at 4-8 months compared with 9-11 months of age. BMJ. 1993 Nov 20;307(6915):1308–1311. [PMC free article] [PubMed]
  • Clemens JD, Stanton BF, Chakraborty J, Chowdhury S, Rao MR, Ali M, Zimicki S, Wojtyniak B. Measles vaccination and childhood mortality in rural Bangladesh. Am J Epidemiol. 1988 Dec;128(6):1330–1339. [PubMed]
  • Aaby P, Bukh J, Lisse IM, Smits AJ, Gomes J, Fernandes MA, Indi F, Soares M. Determinants of measles mortality in a rural area of Guinea-Bissau: crowding, age, and malnutrition. J Trop Pediatr. 1984 Jun;30(3):164–168. [PubMed]
  • Aaby P, Pedersen IR, Knudsen K, da Silva MC, Mordhorst CH, Helm-Petersen NC, Hansen BS, Thårup J, Poulsen A, Sodemann M, et al. Child mortality related to seroconversion or lack of seroconversion after measles vaccination. Pediatr Infect Dis J. 1989 Apr;8(4):197–200. [PubMed]
  • Aaby P, Knudsen K, Jensen TG, Thårup J, Poulsen A, Sodemann M, da Silva MC, Whittle H. Measles incidence, vaccine efficacy, and mortality in two urban African areas with high vaccination coverage. J Infect Dis. 1990 Nov;162(5):1043–1048. [PubMed]
  • Aaby P, Samb B, Simondon F, Knudsen K, Seck AM, Bennett J, Whittle H. Divergent mortality for male and female recipients of low-titer and high-titer measles vaccines in rural Senegal. Am J Epidemiol. 1993 Nov 1;138(9):746–755. [PubMed]
  • Chen RT, Weierbach R, Bisoffi Z, Cutts F, Rhodes P, Ramaroson S, Ntembagara C, Bizimana F. A 'post-honeymoon period' measles outbreak in Muyinga sector, Burundi. Int J Epidemiol. 1994 Feb;23(1):185–193. [PubMed]
  • Holt EA, Boulos R, Halsey NA, Boulos LM, Boulos C. Childhood survival in Haiti: protective effect of measles vaccination. Pediatrics. 1990 Feb;85(2):188–194. [PubMed]
  • Koenig MA, Khan MA, Wojtyniak B, Clemens JD, Chakraborty J, Fauveau V, Phillips JF, Akbar J, Barua US. Impact of measles vaccination on childhood mortality in rural Bangladesh. Bull World Health Organ. 1990;68(4):441–447. [PMC free article] [PubMed]
  • Velema JP, Alihonou EM, Gandaho T, Hounye FH. Childhood mortality among users and non-users of primary health care in a rural west African community. Int J Epidemiol. 1991 Jun;20(2):474–479. [PubMed]
  • Fleiss JL. The statistical basis of meta-analysis. Stat Methods Med Res. 1993;2(2):121–145. [PubMed]
  • Garenne M, Aaby P. Pattern of exposure and measles mortality in Senegal. J Infect Dis. 1990 Jun;161(6):1088–1094. [PubMed]
  • HARTFIELD J, MORLEY D. Efficacy of measles vaccine. J Hyg (Lond) 1963 Mar;61:143–147. [PMC free article] [PubMed]
  • Hull HF, Williams PJ, Oldfield F. Measles mortality and vaccine efficacy in rural West Africa. Lancet. 1983 Apr 30;1(8331):972–975. [PubMed]
  • Griffin DE, Ward BJ, Esolen LM. Pathogenesis of measles virus infection: an hypothesis for altered immune responses. J Infect Dis. 1994 Nov;170 (Suppl 1):S24–S31. [PubMed]
  • Rooth I, Sinani HM, Smedman L, Björkman A. A study on malaria infection during the acute stage of measles infection. J Trop Med Hyg. 1991 Jun;94(3):195–198. [PubMed]
  • Gellin BG, Katz SL. Measles: state of the art and future directions. J Infect Dis. 1994 Nov;170 (Suppl 1):S3–14. [PubMed]

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