Relationship of measles vaccination with anaemia and malaria in western Kenya

Authors

  • Meghna R. Desai,

    1. Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
    2. Kenya Medical Research Institute, Center for Vector Biology and Control Research, Kisumu, Kenya
    3. Department of Infectious Diseases, Tropical Medicine and AIDS, University of Amsterdam, The Netherlands
    Search for more papers by this author
  • Timothy H. Holtz,

    1. Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
    Search for more papers by this author
  • Rita Helfand,

    1. Division of Viral and Rickettsial Diseases, Atlanta, GA, USA
    Search for more papers by this author
  • Dianne J. Terlouw,

    1. Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
    2. Kenya Medical Research Institute, Center for Vector Biology and Control Research, Kisumu, Kenya
    3. Department of Infectious Diseases, Tropical Medicine and AIDS, University of Amsterdam, The Netherlands
    Search for more papers by this author
  • Kathleen A. Wannemuehler,

    1. Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
    Search for more papers by this author
  • Simon K. Kariuki,

    1. Kenya Medical Research Institute, Center for Vector Biology and Control Research, Kisumu, Kenya
    Search for more papers by this author
  • Ya Ping Shi,

    1. Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
    2. Kenya Medical Research Institute, Center for Vector Biology and Control Research, Kisumu, Kenya
    Search for more papers by this author
  • Bernard L. Nahlen,

    1. Roll Back Malaria, World Health Organization, Geneva, Switzerland
    Search for more papers by this author
  • Feiko O. Ter Kuile

    1. Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
    2. Kenya Medical Research Institute, Center for Vector Biology and Control Research, Kisumu, Kenya
    3. Department of Infectious Diseases, Tropical Medicine and AIDS, University of Amsterdam, The Netherlands
    Search for more papers by this author

Authors
Meghna R. Desai (corresponding author), Kathleen A. Wannemuehler and Ya Ping Shi, Centers for Disease Control and Prevention, National Centers for Infectious Disease, Division of Parasitic Diseases, Malaria Branch, 4770 Buford Hwy N.E., MS F-22, Atlanta 30341, GA, USA. Tel.: +1 770 488 7166; Fax: +1 770 488 4206; E-mail: mdesai@.cdc.gov; kpw9@cdc.gov; yps@cdc.gov
Timothy Holtz, International Research and Programs Branch, Division of Tuberculosis Elimination, NCHSTP, CDC, 1600 Clifton Road, MS E-10, Atlanta 30333, GA, USA. Tel.: +1 404 639 5218; Fax: +1 404 639 1566; E-mail: tholtz@cdc.gov
Rita Helfand, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-34, Atlanta 30333, GA, USA. Tel.: +1 404 639 2447; Fax: +1 404 639 4960; E-mail: rhelfand@cdc.gov
Simon K. Katiuki, Kenya Medical Research Institute, Center for Vector Biology and Control Research, P.O. Box 1578, Kisumu, Kenya. Tel.: +254 35 22902; Fax: +254 35 22981; E-mail: skariuki@kisian.mimcom.net
Feiko O. Ter Kuile and Dianne J. Terlouw, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. Tel: +44 (0) 151 705 3287; Fax: +44 (0) 151 705 3329; E-mail: terkuile@liv.ac.uk; d.j.terlouw@liv.ac.uk
Bernard L. Nahlen, Roll Back Malaria, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland. Tel.: +41 22 791 2869; Fax: +41 22 791 4824; E-mail: nahlenb@who.int

Summary

Objective  Mild viral illness, including that following immunization with live attenuated measles virus (LAMV), has been associated with transient decreases in haemoglobin (Hb) and cellular immune response that may persist for several weeks. In areas of intense malaria transmission, such as western Kenya, infants experience a progressive drop in Hb until age 9–10 months and one-third may have Hb < 8 g/dl. These children may be at risk of developing severe anaemia with further haematological insult. The objective of this paper was to determine if immunization with LAMV was associated with increased risk of transient anaemia and malaria infection.

Methods  Data from previous cross-sectional surveys (n = 5970) and one cohort study (n = 546) conducted among pre-school children were analyzed retrospectively.

Results  Measles vaccination coverage between 12 and 23 months of age ranged from 44.8% to 62.7%. Hb concentrations in children aged 6–23 months with documented measles immunization within the previous 14 or 30 days (n = 103) were similar to those with no history of measles immunization in the previous 90 days (n = 996); mean differences [95% confidence interval (CI)] by 30 days were: in cross-sectional surveys, −0.49 g/dl (−1.12, 0.14); in the cohort study, −0.032 g/dl (−0.52, 0.46). Similarly, the risk of malaria parasitemia or severe to moderate anaemia did not differ.

Conclusion  These data do not suggest that the transient decrease in Hb and cellular immune response after immunization with LAMV results in clinically significant changes in the risk of subsequent severe to moderate anaemia or malaria in young children living in malaria-endemic regions.

Ancillary