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Delayed excess mortality after exposure to measles during the first six months of life
1Inst. of Anthropology, U. of Copenhagen, Denmark.
Insights
Children exposed to measles before six months old faced significantly higher mortality risks later in life, especially those with uneducated mothers. Measles exposure impacts long-term child survival, with diarrhea deaths being common among exposed children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Measles infection in early childhood can have long-term health implications.
- Understanding the mortality risks associated with measles exposure is crucial for public health interventions.
Purpose of the Study:
- To investigate the long-term mortality risk in children exposed to measles before six months of age.
- To identify factors influencing mortality among measles-exposed children in Guinea-Bissau.
Main Methods:
- A cohort study was conducted in an urban area of Guinea-Bissau.
- Cox regression models were used to analyze mortality risks and background factors.
- Mortality rates were compared between children exposed to measles and unexposed controls.
Main Results:
- Children exposed to measles before six months had a 34% mortality risk versus 11% in controls.
- Maternal education was the only significant background factor affecting mortality.
- Mortality was significantly higher in exposed children across multiple age intervals, particularly for those with uneducated mothers (5.7 times higher).
- Diarrhea was a common cause of death among exposed children.
Conclusions:
- Early-life measles exposure is associated with significantly increased long-term mortality in children.
- The impact of measles exposure on mortality is exacerbated in populations with lower maternal education.
- These findings underscore the importance of measles control programs and considering long-term health consequences of early infectious exposures.
Abstract:
In an urban area of Guinea-Bissau, 71 children exposed to measles before age 6 months had a mortality risk of 34% (95% confidence interval (Cl) 24-47) between 6 and 60 months of age. The mortality risk for the 205 other children of the same birth cohort who had not been exposed to or developed measles was 11% (95% Cl 9-15), a significant difference compared with exposed children. With a version of the Cox regression model, maternal education was found to be the only background factor with a significant effect on mortality. When background factors were controlled for, the mortality of children exposed to measles was significantly higher than that of controls in each of the age intervals 6-11, 12-23, and 24-35 months. For the large subgroup of children of mothers without any formal education, exposed children had 5.7 times (95% Cl 2.7-12.0) higher mortality than did the control children in the age interval 6-35 months. Diarrhea deaths were particularly common among exposed children. Of 22 children who had been exposed before age 6 months during a subsequent epidemic and had a blood test taken, there was a significantly higher mortality risk (27%) between 6 months and 5 years than in the 26 controls who had a blood test (0%). Children who had elevated antibody titers to measles after exposure had a particularly high mortality compared with controls. These results suggest that later childhood mortality may be related to infectious experiences during the first months of life. The possible long-term health consequences of exposure to measles virus should be considered when assessing the value of measles control programs.