Aaby P, Coovadia H
Institute of Ethnology and Anthropology, University of Copenhagen, Denmark.
Med Hypotheses. 1985 Oct;18(2):93-112. doi: 10.1016/0306-9877(85)90042-8.
The factors predisposing to severe measles, which accounts for a considerable fraction of the high infant and child mortality in the third world, are re-examined. The conviction that protein-energy-malnutrition (PEM) aggravates measles is challenged by findings of prospective community-based studies. It was found that severe measles was not associated with PEM but frequently accompanied overcrowding in Guinea-Bissau. Secondary cases fared worse than index patients. Among adequately nourished hospitalised African children, immunological and radiological parameters, together with the effects of age and HLA antigens, were closely related to sickness and death in measles. This variation in case fatality rate does not appear to be simply explained by age-dependent host reactions or differences in medical care. The hypothesis which fits most of the observed facts postulates that the transmission of a large inoculum of virus particles to susceptible children is an important cause of severe disease. The implication of this interpretation is that specific measles control, and not only improvements in nutrition, is important in high risk areas for a reduction of measles mortality. It is further suggested that health policy should promote those social changes which limit intense exposure to measles virus.
对导致严重麻疹的因素进行了重新审视，严重麻疹在第三世界婴幼儿高死亡率中占相当大的比例。基于社区的前瞻性研究结果对蛋白质-能量营养不良（PEM）会加重麻疹病情这一观点提出了挑战。研究发现，严重麻疹与PEM无关，但在几内亚比绍，严重麻疹常常伴随着过度拥挤的情况。二代病例的情况比首例患者更糟。在营养状况良好的住院非洲儿童中，免疫和放射学参数，以及年龄和HLA抗原的影响，与麻疹患者的疾病和死亡密切相关。这种病死率的差异似乎不能简单地用年龄依赖性宿主反应或医疗护理差异来解释。符合大多数观察事实的假说是，大量病毒颗粒接种物传播给易感儿童是导致严重疾病的一个重要原因。这一解释的意义在于，在高风险地区，特定的麻疹控制措施，而不仅仅是营养改善，对于降低麻疹死亡率很重要。还进一步表明，卫生政策应促进那些限制麻疹病毒强烈暴露的社会变革。
