Jackson Bianca D, Black Robert E
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
BMC Public Health. 2017 Nov 7;17(Suppl 4):783. doi: 10.1186/s12889-017-4745-2.
Measles vaccination effectiveness studies showed dramatic decreases in all-cause mortality in excess of what would be expected from the prevention of measles disease alone. This invited speculation that measles infection may increase the risk of diarrhea morbidity and mortality subsequent to the acute phase of the disease. The aim of the present systematic review is to summarize the existing evidence in the publically available literature pertaining to the putative causal link between measles and diarrhea in the period 4-26 weeks following measles rash onset.
We searched the PubMed, Embase, Open Grey and Grey Literature Report databases for relevant literature using broad search terms. Prospective, retrospective and case-control studies in low- and middle-income countries involving children under five wherein relevant evidence were presented were included. Data were extracted from the articles and summarized.
Fifty abstracts retrieved through the database searches met the initial screening criteria. Twelve additional documents were identified by review of the references of the documents found in the initial searches. Six documents representing five unique studies that presented evidence relevant to the research question were found. Four of the included studies took place in Bangladesh. One of the included studies took place in Sudan. Some measles vaccine effectiveness studies show lower diarrhea morbidity and mortality among the vaccinated. However, children who received vaccine may have differed in important ways from children who did not, such as health service utilization. Additionally, cohort studies following unvaccinated children showed no difference in diarrhea morbidity and mortality between cases and controls more than 4 weeks after measles rash onset. One study showed some evidence that severe measles may predispose children to gastroenteritis, but was not able to show a corresponding increase in the risk of diarrhea mortality.
The available evidence suggests that the risk of measles-associated diarrhea mortality is largely limited to the 5-week period 1 week prior to and 4 weeks after measles rash onset, and that there is no increased risk of diarrhea mortality in the longer-term caused by measles.
麻疹疫苗接种效果研究表明，全因死亡率显著下降，降幅超过仅预防麻疹疾病所预期的水平。这引发了一种推测，即麻疹感染可能会增加疾病急性期后腹泻发病和死亡的风险。本系统评价的目的是总结公开文献中有关麻疹出疹后4 - 26周内麻疹与腹泻之间假定因果关系的现有证据。
我们使用广泛的检索词在PubMed、Embase、Open Grey和灰色文献报告数据库中搜索相关文献。纳入低收入和中等收入国家涉及五岁以下儿童且提供了相关证据的前瞻性、回顾性和病例对照研究。从文章中提取数据并进行总结。
通过数据库检索获得的50篇摘要符合初步筛选标准。通过查阅初始检索中找到的文献的参考文献，又识别出12篇文献。发现了6篇文献，代表5项独特的研究，这些研究提供了与研究问题相关的证据。其中4项纳入研究在孟加拉国进行。1项纳入研究在苏丹进行。一些麻疹疫苗接种效果研究表明，接种疫苗者的腹泻发病率和死亡率较低。然而，接种疫苗的儿童可能在一些重要方面与未接种疫苗的儿童不同，例如卫生服务利用情况。此外，对未接种疫苗儿童的队列研究表明，麻疹出疹后4周以上，病例组和对照组的腹泻发病率和死亡率没有差异。一项研究显示有一些证据表明严重麻疹可能使儿童易患肠胃炎，但未能显示腹泻死亡率相应增加。
现有证据表明，麻疹相关腹泻死亡风险主要限于麻疹出疹前1周和出疹后4周的5周期间，麻疹不会导致长期腹泻死亡风险增加。
