In a 2014 review of the non-specific effects of measles vaccines, among others, the WHO Strategic Advisory Group of Experts indicated that some studies of measles vaccine were suggestive (but not conclusive) of a beneficial effect of measles vaccine on overall mortality beyond the expected direct effect of the vaccine against measles. In particular, randomized control trials of children in Guinea- Bissau which looked at mortality up to the age of 9 months showed a low number of deaths post administration of the 3 doses of the measles vaccine over the study follow up period. Another trial in Nigeria also showed similar results.
Measles
In some cases, girls may reap greater health benefits from some vaccinations than boys
Across multiple studies reviewed, the effect of measles vaccine appears to be more beneficial to girls combating all-cause mortality when differences between vaccine effect in boys and girls was assessed.
Conflict can impact health systems, compromising disease elimination goals
Conflict in the Eastern Mediterranean Region impacted health infrastructure and compromised the success of the region’s measles elimination goal. At the same time that rates of migration and displacement skyrocketed, the number of measles cases in the region doubled, from 10,072 cases in 2010 to 20,898 in 2015.
Immunization activities in countries of conflict are achieved through global partners support
During the humanitarian crisis in the Syrian Arab Republic, the constant support from WHO, UNICEF, and local NGOs resulted in immunizations against VPDs reaching over 90% of children.
Sustaining immunization activities during conflict can be achieved through programmatic support from global partners
During the conflict in Yemen, efforts spearheaded by WHO, with coordination among partners and effective use of resources, especially GAVI, resulted in continued high pentavalent vaccine coverage decreasing only 3% from 2010 to 2015. Yemen also remained polio-free through 2015 and smoothly introduced two new vaccines (MR and IPV).
Conflict and migration can lead to disease outbreaks in previously controlled diseases
Large measles outbreaks occurred in Lebanon and Jordan, following an influx of Syrian refuges migrating to escape conflict. In Lebanon, the measles incidence increased 200-fold in one year following high migration. There were 2.1 measles cases per million population in Lebanon in 2012; this increased to 411 cases per million in 2013.
Measles infection suppresses the immune system for up to 3 years after infection
In a study of data from England & Wales, Denmark, and the US, it was shown that measles infection suppresses the immune system for up to 3 years after infection, increasing the risk of death due to other childhood infections during that time. This means that prevention of measles significantly impacts overall health during critical childhood years.
Measles vaccination has a greater impact on reducing mortality in female children
A review of measles vaccination data found that female children experience substantially higher mortality risks from measles relative to male children and greater reductions in mortality with vaccination. In essence, vaccinating female children against measles provides them with the same survival chances as unvaccinated male children.
Vaccination against measles may also decrease overall child mortality, especially among children in lower castes
An analysis of children aged 12-59 months in rural India showed that children who were not vaccinated against measles vaccine in infancy had a three times higher likelihood of death, with unvaccinated children from lower caste households having the highest risk of mortality (odds ratio, 8.9). However, the results also revealed a nonspecific reducing effect of the vaccine on the overall child mortality in this region. This indicates that vaccination against measles can benefit the overall population, especially those in lower castes who have not received the vaccine in infancy. Thus, making them the group that would receive the highest benefit.
A women’s empowerment program was associated with higher rates of immunization among children
An impact evaluation for a women’s empowerment program in India found that the children of mothers who participated the empowerment program were significantly more likely to be vaccinated against DTP, measles, and tuberculosis than children of mothers not involved in the program. This study also found that the women’s empowerment program had positive spillover effects: In villages where the program occurred, children of mothers not in the program (non-participants) were 9 to 32% more likely to be immunized against measles than in villages where the program did not occur (controls). Overall, measles vaccine coverage was nearly 25% higher in the program villages compared to the control villages.