Association of Previous Measles Infection With Markers of Acute Infectious Disease Among 9- to 59-Month-Old Children in the Democratic Republic of the Congo

Abstract

BackgroundTransient immunosuppression and increased susceptibility to other infections after measles infection is well known, but recent studies have suggested the occurrence of an “immune amnesia” that could have long-term immunosuppressive effects.MethodsWe examined the association between past measles infection and acute episodes of fever, cough, and diarrhea among 2350 children aged 9 to 59 months whose mothers were selected for interview in the 2013–2014 Democratic Republic of the Congo (DRC) Demographic and Health Survey (DHS). Classification of children who had had measles was completed using maternal recall and measles immunoglobulin G serostatus obtained via dried-blood-spot analysis with a multiplex immunoassay. The association with time since measles infection and fever, cough, and diarrhea outcomes was also examined.ResultsThe odds of fever in the previous 2 weeks were 1.80 (95% confidence interval [CI], 1.25–2.60) among children for whom measles was reported compared to children with no history of measles. Measles vaccination demonstrated a protective association against selected clinical markers of acute infectious diseases.ConclusionOur results suggest that measles might have a long-term effect on selected clinical markers of acute infectious diseases among children aged 9 to 59 months in the DRC. These findings support the immune-amnesia hypothesis suggested by others and underscore the need for continued evaluation and improvement of the DRC’s measles vaccination program.

Response to Comment on “Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality”

“…Previously, we reported evidence for a 2-to 3-year period of "immune-amnesia" (IA) following measles infection (1), in line with experimental data (2,3) and numerous subsequent human studies (4)(5)(6)(7). This result emerged from the relationship between measles incidence and infectious disease mortality and was consistent across three countries, both preand post-vaccination.…”

Disease Progression, Clinical Features, and Risk Factors for Pneumonia in Unvaccinated Children and Adolescents with Measles: A Re-Emerging Disease in Romania

“…Oppositely, in underdeveloped countries such as sub-Saharan countries, it was observed that measles has more severe consequences for children’s health as a result of widespread immunosuppression caused by malnutrition. According to the Demographic and Health Survey conducted in the Democratic Republic of the Congo, 23 percent of children younger than five years old were acutely malnourished, and 43 percent were chronically malnourished [ 29 ]. It has been shown that malnutrition is associated with impaired cell-mediated immunity [ 30 ] and, in underdeveloped regions, with an increased risk of morbidity and mortality in measles patients, or failure of a proper immune response after vaccination.…”

Communicating Benefits from Vaccines Beyond Preventing Infectious Diseases

“…This potential prolonged immune suppression is particularly important in countries such as the Democratic Republic of the Congo (DRC) where malnutrition, associated with dysfunction of cell-mediated immunity, is widespread and may result in increased measles mortality, relative to wealthy countries [ 37 – 39 ]. A study of 2350 children between 9 and 59 months of age in the DRC showed that children with a reported history of measles infection were more likely to have had a fever in the 2 weeks preceding parental interview (OR: 1.80, 95% CI 1.25; 2.60) compared with children who did not have a history of measles [ 40 ]. In the same study, receipt of measles vaccination was protective against recent fever (OR: 0.53, 95% CI 0.38; 0.73), and similar work examining children in the DRC suggests that measles may have a long-term negative impact on pre-existing, vaccine-induced immunity to tetanus [ 41 ].…”