Assessing the Effects of Measles Virus Infections on Childhood Infectious Disease Mortality in Brazil

Siyang Xia, Cricket C. Gullickson, Jessica C.E. Metcalf, Bryan T. Grenfell, Michael J. Mina

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background. Measles virus infection induces acute immunosuppression for weeks following infection, and also impairs preexisting immunological memory, resulting in “immune amnesia” that can last for years. Both mechanisms predispose the host to severe outcomes of subsequent infections. Therefore, measles dynamics could potentially affect the epidemiology of other infectious diseases. Methods. To examine this hypothesis, we analyzed the annual mortality rates of children aged 1–9 years in Brazil from 1980 to 1995. We calculated the correlation between nonmeasles infectious disease mortality rates and measles mortality rates using linear and negative-binomial models, with 3 methods to control the confounding effects of time. We also estimated the duration of measles-induced immunomodulation. Results. The mortality rates of nonmeasles infectious diseases and measles virus infection were highly correlated. This positive correlation remained significant after removing the time trends. We found no evidence of long-term measles immunomodulation beyond 1 year. Conclusions. These results support that measles virus infection could increase the mortality of other infectious diseases. The short lag identified for measles effects (<1 year) implies that acute immunosuppression was potentially driving this effect in Brazil. Overall, our study indicates disproportionate contributions of measles to childhood infectious disease mortality, highlighting the importance of measles vaccination.

Original languageEnglish (US)
Pages (from-to)133-140
Number of pages8
JournalJournal of Infectious Diseases
Issue number1
StatePublished - Jan 1 2023

All Science Journal Classification (ASJC) codes

  • General Medicine


  • Brazil
  • childhood infectious disease mortality
  • correlation analysis
  • immunomodulation
  • measles virus infection


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