title: Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality.
abstract: Immunosuppression after measles is known to predispose people to opportunistic infections for a period of several weeks to months. Using population-level data, we show that measles has a more prolonged effect on host resistance, extending over 2 to 3 years. We find that nonmeasles infectious disease mortality in high-income countries is tightly coupled to measles incidence at this lag, in both the pre- and post-vaccine eras. We conclude that long-term immunologic sequelae of measles drive interannual fluctuations in nonmeasles deaths. This is consistent with recent experimental work that attributes the immunosuppressive effects of measles to depletion of B and T lymphocytes. Our data provide an explanation for the long-term benefits of measles vaccination in preventing all-cause infectious disease. By preventing measles-associated immune memory loss, vaccination protects polymicrobial herd immunity.
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA. Medical Scientist Training Program, School of Medicine, Emory University, Atlanta, GA, USA. michael.j.mina@gmail.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mina
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA. Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
authors.forename: C Jessica E
authors.initials: CJ
authors.lastname: Metcalf
authors.affiliation: Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Rik L
authors.initials: RL
authors.lastname: de Swart
authors.affiliation: Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: A D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA. Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Grenfell
mesh_terms: D001402:B-Lymphocytes / Q000276:immunology; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007156:Immunologic Memory; D056747:Immunomodulation; D015994:Incidence; D008212:Lymphocyte Depletion; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000276:immunology* / Q000517:prevention & control; D008458:Measles Vaccine / Q000008:administration & dosage / Q000276:immunology*; D009894:Opportunistic Infections / Q000276:immunology / Q000401:mortality* / Q000517:prevention & control*; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014611:Vaccination; D014852:Wales / Q000453:epidemiology
chemical_list: D008458:Measles Vaccine