THE TRUE BURDEN OF MEASLES: THE ASSOCIATION BETWEEN MEASLES INCIDENCE AND NON-MEASLES INFECTIOUS MORTALITY IN CHILDREN IN BRAZIL, 1980-1995

Abstract

Infectious disease is a major driver of global mortality, particularly in children. Despite the impact of vaccination campaigns, measles remains endemic in much of the developing world and recent outbreaks in the developed world – due in part to the misconception that measles is a benign infection – have raised concern of measles resurgence. In addition to being a primary cause of childhood mortality, measles also causes a profound immunosuppression that predisposes infected individuals to secondary infection, making measles an important underlying cause of non-measles infections as well; however, the extent and etiology of the contribution of measles to all non-measles infectious mortality has not been well-characterized. Here, epidemiological data for 1-9 year olds in Brazil is used to show that measles explains more than 60% of the decrease in childhood infectious mortality observed to coincide with the introduction of nationwide measles vaccination. These results suggest a much greater role for measles vaccination as a driver of reduced childhood mortality – particularly respiratory and diarrheal mortality – than had previously been described, and indicate that measles vaccination should continue to be emphasized in global health today.