Abstract

PIP: The effects of measles immunization on diarrhea morbidity and mortality are reviewed using data from field studies and theoretical calculations. 2 types of measles-associated diarrhea are distinguished: with-measles diarrhea, which starts between 1 week prerash-onset and 4 weeks postrash-onset, and postmeasles diarrhea, which starts 4-26 weeks postrash-onset. The etiology of these measles-associated diarrheas 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 of between 45-90% can avert 44-64% of measles cases, 0.6-3.8% of diarrhea episodes, and 6-26% of diarrhea deaths among children under age 5. The cost of measles immunization is in the range of US$2-15 (1982 prices)/child vaccinated. The impact of measles immunization on diarrhea 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 diarrhea, and to determine the cost-effectiveness of measles immunizations as an intervention to reduce diarrhea mortality.