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Measles vaccination may be marker for other health seeking behaviours

  1. Craig Dalton, director (cdalt@doh.health.nsw.gov.au)
  1. Hunter Public Health Unit, Wallsend 2287, Australia
  2. North Tees General Hospital, Stockton on Tees, Teesside TS19 8PE
  3. Southend Hospital, Westcliff-on-Sea, Essex SS0 0RY
  4. Royal United Hospital, Bath BA1 3NG
  5. Inter-American Development Bank, Washington, DC 20577, USA
  6. Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria 3052, Australia
  7. Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark

    EDITOR —The hypothesis presented by Shann in his editorial that measles immunisation provides non-specific immune stimulation sufficient to decrease mortality from other diseases is interesting.1 However, I don't really believe that the studies have ruled out the more likely explanation that measles immunisation is just a marker for other socioculturally determined health seeking behaviours. The fact that similar effects are not seen for other vaccines does not exclude measles immunisation from being correlated with health seeking behaviours.

    Measles vaccination is different from other vaccinations in its timing, and it is often associated with national campaigns (including in some of the studies Shann references). Are there any data that rule out the confounding effect of sociocultural determinants?

    References

    1. 1.↵
      1. Shann F
      . A little bit of measles does you good. BMJ 1999; 319: 4–5. (3 July.)
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    Socioeconomic confounding may also play a part

    1. David Emerton, accident and emergency consultant
    1. Hunter Public Health Unit, Wallsend 2287, Australia
    2. North Tees General Hospital, Stockton on Tees, Teesside TS19 8PE
    3. Southend Hospital, Westcliff-on-Sea, Essex SS0 0RY
    4. Royal United Hospital, Bath BA1 3NG
    5. Inter-American Development Bank, Washington, DC 20577, USA
    6. Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria 3052, Australia
    7. Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark

      EDITOR—Shann in his editorial on measles1 discusses the hypothesis that standard dose Schwartz measles vaccine reduces mortality from conditions other than measles. He refers to the observation that measles causes only 10% of child mortality whereas the vaccine reduces mortality in developing countries by at least 30%2 and that immunised children who have not had measles have a much lower mortality than unimmunised children who have not had measles.2 3

      When I worked at Murgwanza Hospital in Tanzania from 1984 to 1991 measles vaccination was generally available in the community through the maternal child health programmes. These programmes included an educational component relating to nutrition, prevention of disease, and early treatment of febrile illnesses such as malaria. As the primary healthcare programme gained momentum after the Alma Ata declaration, which aimed for health for all by the year 2000, efforts to improve health awareness intensified. It was distressing that children were not all immunised and that outbreaks of measles still occurred. Often children with measles presented late and had signs of other illnesses. We always assumed that children who were …

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