RT Journal Article
SR Electronic
T1 Impact and longevity of measles-associated immune suppression: a matched cohort study using data from the THIN general practice database in the UK
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e021465
DO 10.1136/bmjopen-2017-021465
VO 8
IS 11
A1 Kartini Gadroen
A1 Caitlin N Dodd
A1 Gwen M C Masclee
A1 Maria A J de Ridder
A1 Daniel Weibel
A1 Michael J Mina
A1 Bryan T Grenfell
A1 Miriam C J M Sturkenboom
A1 David A M C van de Vijver
A1 Rik L de Swart
YR 2018
UL http://bmjopen.bmj.com/content/8/11/e021465.abstract
AB 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.