Impact and longevity of measles-associated immune suppression: a matched cohort study using data from the THIN general practice database in the UK

• Published in: BMJ open Vol. 8; no. 11; p. e021465
• Main Authors: Gadroen, Kartini, Dodd, Caitlin N, Masclee, Gwen M C, de Ridder, Maria A J, Weibel, Daniel, Mina, Michael J, Grenfell, Bryan T, Sturkenboom, Miriam C J M, van de Vijver, David A M C, de Swart, Rik L
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-11-2018; BMJ Publishing Group
• Subjects: Adolescent; Age; Anti-Infective Agents - therapeutic use; Case-Control Studies; Child; Child, Preschool; Codes; Cohort analysis; Communicable Diseases - epidemiology; Databases, Factual; Demographics; Dendritic cells; Digital archives; Drug dosages; Feasibility studies; Female; Hospitalization - statistics & numerical data; Humans; Immunologic Memory; Immunosuppression; Incidence; Infant; Infections; Infectious Diseases; Laboratories; Longitudinal Studies; Lymphocytes; Male; Measles; Measles - epidemiology; Measles - immunology; Measles Vaccine; Mortality; Mumps; Population; Prescriptions; Risk Assessment; Statistics, Nonparametric; Time Factors; United Kingdom - epidemiology; Vaccination - statistics & numerical data; Vaccines; Viruses; United Kingdom; United Kingdom > UK; England; Wales; immune suppression; measles
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-021465

ObjectiveTo test the hypothesis that measles infection increases the incidence of non-measles infectious diseases over a prolonged period of time.DesignA population-based matched cohort study.Data sourcesThis 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 measuresIncidence 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.ResultsIn 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).ConclusionFollowing 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.