Interventions for the control of diarrhoeal diseases among young children: Measles immunization

The effects of measles immunization on diarrhoea morbidity and mortality are reviewed using data from field studies and theoretical calculations. Two types of measles associated diarrhoea are distinguished: with-measles diarrhoea, which atarts between 1 week pre-rash onset and 4 weeks post-rash-onset, and post-measles diarrhoea, which starts 4-26 weeks post-rash onset. The etiology of these measles-associated diarrhoeas is unknown, but some evidence points towards a frequently severe and dysenteric form of disease, with Shigella playing a major role. Theoretical calculations indicate that measles immunization, at the age of 9-11 months, with coverage between 45% and 90% can avert 44-64% of measles cases, 0.6-3.8% of diarrhoea episodes, and 6-26% of diarrhoea deaths among children under 5 years of age. The cost of measles immunization is in the range of US$ 2-15 (1982 prices) per child vaccinated. The impact of measles immunization on diarrhoea mortality may be partly additional to the impact of oral rehydration because it averts deaths that are not prevented by oral rehydration. Community research is urgently needed to confirm or reject these theoretical suppositions, to clarify the etiology of measles associated diarrhoea, and to determine the cost-effectiveness of measles immunization as an intervention to reduce diarrhoea mortality.