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Impact and longevity of measles-associated immune suppression: a matched cohort study using data from the THIN
Kartini Gadroen1, Caitlin N Dodd1, Gwen M C Masclee1
1Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.
Insights
Measles infection significantly increases the risk of other infectious diseases in children for up to five years. This prolonged impact on immune resistance necessitates careful monitoring and management post-measles.
Area of Science:
- Immunology
- Infectious Diseases
- Public Health
Background:
- Measles is a highly contagious viral illness.
- The long-term effects of measles on host immune defense are not fully understood.
- Previous studies suggest potential immune suppression following measles infection.
Purpose of the Study:
- To investigate if measles infection leads to an increased incidence of non-measles infectious diseases over an extended period.
- To quantify the duration and magnitude of measles' impact on host resistance.
Main Methods:
- A population-based matched cohort study utilizing UK general practice medical records.
- Inclusion of 2,228 children diagnosed with measles (1990-2014) matched with 19,930 unvaccinated controls.
- Analysis of infection incidence, anti-infective prescriptions, and hospitalizations using multivariate models.
Main Results:
- Children with measles showed significantly higher rates of non-measles infections up to 5 years post-infection.
- Increased anti-infective prescriptions were observed in measles patients, particularly within the first month.
- Hospitalization rates were elevated only in the first month after measles diagnosis.
Conclusions:
- Measles infection has a prolonged detrimental effect on children's immune resistance to other infections.
- The findings support the hypothesis of a sustained impact of measles on host defense mechanisms.
- Increased antimicrobial prescribing highlights the clinical burden of secondary infections post-measles.
Objective:
To test the hypothesis that measles infection increases the incidence of non-measles infectious diseases over a prolonged period of time.
Design:
A population-based matched cohort study.
Data Sources:
This 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 Measures:
Incidence 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.
Results:
In 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).
Conclusion:
Following 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.
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