Socioeconomic confounding may also play a role
When discussing the hypothesis that standard dose Schwartz measles
vaccine reduces mortality from conditions other than measles(1) Shann
refers to the observations that while measles causes only10% of child
mortality 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
When I worked at Murgwanza Hospital in Tanzania from 1984-1991
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 health care
programme gained momentum following 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 not immunised against measles when this was available
were more likely to be poorly nourished and less likely to be brought for
early medical care if they had life threatening illnesses such as malaria
It is true that a study in Benin (4,2) failed to
show that DTP and polio vaccination was associated with reduced mortality
from other conditions . However, this study was only relevant to a narrow
age band until the children were given measles vaccination.
suggest that measles immunisation could be an indicator that parents in
developing countries are trying to give their children optimum care.
Therefore the improved mortality is not necessarily due to the vaccine
Accident & Emergency Consultant
North Tees General Hospital
Stockton on Tees
1 Shann F. A little bit of measles does you good. BMJ 1999;319:4-5.
2 Aaby P, Samb B, SimondonF, Coll Seck AM, KnudsenK, Whittle H. Non-
specific beneficial effect of measles immunisation : analysis of mortality
studies from developing countries BMJ 1995;311 481-5.
3 SambB, AaabyP, Whittle H, Coll Seck AM, Simondon F. Decline in measles
case fatality ratio after the introduction of measles immunisation in
rural Senegal. Am J Epidemiol 1997;145:51-7.
4 Velema JP, Alihonou EM, Gandaho T, Hounye FH Childhood mortality among
users and non-users of primary health care in a rural West African
community. Int J Epidemiol 1991;20,474-9.
Competing interests: No competing interests