Anthropometric, cognitive, and schooling benefits of measles vaccination: Longitudinal cohort analysis in Ethiopia, India, and Vietnam
Arindam Nandi, Anita Shet, Jere R. Behrman, Maureen M. Black, David E. Bloom, Ramanan Laxminarayan
Abstract
Objective
To estimate the associations between measles vaccination and child anthropometry, cognition, and schooling outcomes in Ethiopia, India, and Vietnam.
Methods
Longitudinal survey data from Young Lives were used to compare outcomes at ages 7–8 and 11–12 years between children who reported receipt or non-receipt of measles vaccine at 6–18 months-of-life (n = ∼2000/country). Z-scores of height-for-age (HAZ), BMI-for-age (BMIZ), weight-for-age (WAZ), Peabody Picture Vocabulary Test (PPVT), early grade reading assessment (EGRA), language and mathematics tests, and attained schooling grade were examined. Propensity score matching was used to control for systematic differences between measles-vaccinated and measles-unvaccinated children.
Findings
Using age- and country-matched measles-unvaccinated children as comparisons, measles-vaccinated children had better anthropometrics, cognition, and schooling. Measles-vaccinated children had 0.1 higher HAZ in India and 0.2 higher BMIZ and WAZ in Vietnam at age 7–8 years, and 0.2 higher BMIZ at age 11–12 years in Vietnam. At ages 7–8 years, they scored 4.5 and 2.9 percentage points (pp) more on PPVT and mathematics, and 2.3 points more on EGRA in Ethiopia, 2.5 points more on EGRA in India, and 2.6 pp, 4 pp, and 2.7 points more respectively on PPVT, mathematics, and EGRA in Vietnam. At ages 11–12 years, they scored 3 pp more on English and PPVT in India, and 1.7 pp more on PPVT in Vietnam. They also attained 0.2–0.3 additional schooling grades across all ages and countries.
Conclusion
Our findings suggest that measles vaccination may have benefits on cognitive gains and school-grade attainment that can have broad educational and economic consequences which extend beyond early childhood.
Read paper
Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens
Michael J. Mina, Stephen J. Elledge et al.
Abstract
Measles virus is directly responsible for more than 100,000 deaths yearly. Epidemiological studies have associated measles with increased morbidity and mortality for years after infection, but the reasons why are poorly understood. Measles virus infects immune cells, causing acute immune suppression. To identify and quantify long-term effects of measles on the immune system, we used VirScan, an assay that tracks antibodies to thousands of pathogen epitopes in blood. We studied 77 unvaccinated children before and 2 months after natural measles virus infection. Measles caused elimination of 11 to 73% of the antibody repertoire across individuals. Recovery of antibodies was detected after natural reexposure to pathogens. Notably, these immune system effects were not observed in infants vaccinated against MMR (measles, mumps, and rubella), but were confirmed in measles-infected macaques. The reduction in humoral immune memory after measles infection generates potential vulnerability to future infections, underscoring the need for widespread vaccination.
Read paper
Indirect costs of adult pneumococcal disease and productivity-based rate of return to PCV13 vaccination for older adults and elderly diabetics in Denmark
J.P. Sevilla, Andrew Stawasz, Daria Burnes, Peter Bo Poulsen, Reiko Sato, David E. Bloom
Abstract
Objectives
To assess vaccines, HTAs should consider their broader socioeconomic effects, including those on market and nonmarket productivity (indirect costs, ICs). They should also consider decision criteria beyond cost-effectiveness that incorporate such effects, like social rates of return (RoR). We develop a method for measuring vaccination’s productivity benefits and social RoR and apply it to the case of PCV13 in older Danish adults.
Methods
We measure ICs from death and disability per treatment episode of inpatient community-acquired pneumonia (ICAP), outpatient CAP (OCAP), bacteremia, and meningitis in Danes aged 50–85. Losses include market and nonmarket work (housework, caregiving, and volunteering time valued at the unskilled wage), and span the duration of disability or, with death, the rest of life with background mortality risks. We calculate a RoR to PCV13 Adult in terms of averted direct costs (DCs) and ICs, allowing for herd effects and serotype replacement from child vaccination. We perform separate calculations for diabetics aged 65–85. We use data from EuroStat, Statistics Denmark, Danish prices/charges, and the published literature.
Results
ICs per episode exceed per capita GDP (PCGDP) for ICAP, approach PCGDP for bacteremia, exceed five times PCGDP for meningitis, and exceed 20 times DCs for OCAP. ICs consist largely of nonmarket productivity—specifically housework—lost to death. The RoR to PCV13 in the general older adult population is 149% and is driven by averted ICAP-related costs. In elderly diabetics, ICs per episode are higher and the RoR a stunning 1,191%. Main results are robust in sensitivity analyses.
Conclusions
The ICs of pneumococcal disease are considerable, even among older retired adults. The RoR to PCV13 in Danish older adults is high, especially for elderly diabetics, and compares very favorably with that of highly-regarded development interventions. Failing to account for productivity in valuing vaccination can result in considerable undervaluation.
Read paper