Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
J Infect. 2017 Jun;74 Suppl 1:S10-S17. doi: 10.1016/S0163-4453(17)30185-8.
The measles virus is among the most transmissible viruses known to infect humans. Prior to measles vaccination programs, measles infected over 95% of all children and was responsible for over 4 million deaths each year. Measles vaccination programs have been among the greatest public health achievements reducing, eliminating endemic measles in the whole of the Americas and across much of the globe. Where measles vaccines are introduced, unexpectedly large reductions in all-cause childhood mortality have been observed. These gains appear to derive in part from direct heterologous benefits of measles vaccines that enhance innate and adaptive immune responses. Additionally, by preventing measles infections, vaccination prevents measles-associated short- and long-term immunomodulating effects. Before vaccination, these invisible hallmarks of measles infections increased vulnerability to non-measles infections in nearly all children for weeks, months, or years following acute infections. By depleting measles incidence, vaccination has had important indirect benefits to reduce non-measles mortality. Delineating the relative importance of these two modes of survival benefits following measles vaccine introduction is of critical public health importance. While both support continued unwavering global commitments to measles vaccination programs until measles eradication is complete, direct heterologous benefits of measles vaccination further support continued commitment to measles vaccination programs indefinitely. We discuss what is known about direct and indirect nonspecific measles vaccine benefits, and their implications for continued measles vaccination programs.
麻疹病毒是已知感染人类最具传染性的病毒之一。在麻疹疫苗接种计划之前，麻疹感染了超过 95%的所有儿童，每年导致超过 400 万人死亡。麻疹疫苗接种计划是最伟大的公共卫生成就之一，在整个美洲和全球大部分地区减少和消除了地方性麻疹。在引入麻疹疫苗的地方，人们观察到所有原因导致的儿童死亡率意外大幅下降。这些收益似乎部分来自麻疹疫苗的直接异源效益，增强了先天和适应性免疫反应。此外，通过预防麻疹感染，疫苗接种可预防麻疹相关的短期和长期免疫调节作用。在接种疫苗之前，这些麻疹感染的无形特征会使几乎所有儿童在急性感染后的数周、数月或数年内对非麻疹感染的易感性增加。通过减少麻疹发病率，疫苗接种对降低非麻疹死亡率有重要的间接益处。阐明麻疹疫苗接种后这两种生存益处模式的相对重要性，对公共卫生至关重要。虽然两者都支持继续坚定不移地致力于全球麻疹疫苗接种计划，直到完全消灭麻疹，但麻疹疫苗接种的直接异源效益进一步支持无限期继续承诺开展麻疹疫苗接种计划。我们讨论了已知的麻疹疫苗直接和间接非特异性益处，及其对继续开展麻疹疫苗接种计划的影响。
