Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, Washington.
School of Public Health, University of Liberia, Monrovia, Liberia.
Am J Trop Med Hyg. 2022 Sep 12;107(4):863-872. doi: 10.4269/ajtmh.21-1083. Print 2022 Oct 12.
The bidirectional interaction between undernutrition and infection can be devastating to child health. Nutritional deficiencies impair immunity and increase susceptibility to infection. Simultaneously, infections compound undernutrition by increasing metabolic demand and impairing nutrient absorption. Treatment of acute malnutrition (wasting) can reverse some of its deleterious effects and reduce susceptibility to infectious diseases. Nutrition-specific approaches may be packaged with other interventions, including immunization, to support overall child health. To understand how mass nutritional supplementation, treatment of wasting, and vaccination affect the dynamics of a vaccine-preventable infection, we developed a population-level, compartmental model of measles transmission stratified by age and nutrition status. We simulated a range of scenarios to assess the potential reductions in measles infection and mortality associated with targeted therapeutic feeding for children who are wasted and with a mass supplementation intervention. Nutrition interventions were assumed to increase engagement with the health sector, leading to increased vaccination rates. We found that the combination of wasting treatment and mass supplementation coverage followed by an increase in vaccination coverage of non-wasted children from a baseline of 75% to 85%, leads to 34% to 57% and 65% to 77% reduction in measles infection and mortality and 56% to 60% reduction in overall mortality among wasted children, compared with the wasting treatment alone. Our work highlights the synergistic benefits that may be achieved by leveraging mass nutritional supplementation as a touch point with the health system to increase rates of vaccination and improve child survival beyond what would be expected from the additive benefits of each intervention.
营养不良和感染之间的双向相互作用可能对儿童健康造成毁灭性影响。营养缺乏会损害免疫力，增加感染的易感性。同时，感染会通过增加代谢需求和损害营养吸收来加剧营养不良。急性营养不良（消瘦）的治疗可以逆转其一些有害影响，并降低对传染病的易感性。营养特定方法可以与其他干预措施（包括免疫接种）相结合，以支持儿童整体健康。为了了解群体营养补充、消瘦治疗和疫苗接种如何影响可预防疫苗感染的动态，我们开发了一个基于年龄和营养状况分层的麻疹传播的人群水平、隔室模型。我们模拟了一系列场景，以评估针对消瘦儿童的有针对性的治疗性喂养和大规模补充干预措施与目标治疗性喂养和大规模补充干预措施相关的麻疹感染和死亡率的潜在降低。假设营养干预措施会增加对卫生部门的参与，从而提高疫苗接种率。我们发现，消瘦治疗和大规模补充覆盖率的结合，随后将非消瘦儿童的疫苗接种覆盖率从 75%提高到 85%，可将麻疹感染和死亡率降低 34%至 57%和 65%至 77%，并将消瘦儿童的总死亡率降低 56%至 60%，而消瘦治疗单独治疗的情况下。我们的工作强调了通过利用大规模营养补充作为与卫生系统的接触点来提高疫苗接种率并改善儿童生存状况的协同效益，这可能超出每个干预措施的附加效益所预期的效果。
