SEVERE MEASLES - A REAPPRAISAL OF THE ROLE OF NUTRITION, OVERCROWDING AND VIRUS DOSE
SEVERE MEASLES - A REAPPRAISAL OF THE ROLE OF NUTRITION, OVERCROWDING AND VIRUS DOSE
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DOI：
10.1016/0306-9877(85)90042-8
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发表时间：
1985-01-01
影响因子：
4.7
通讯作者：
COOVADIA, H
中科院分区：
文献类型：
--
作者：
AABY, P;COOVADIA, H
诱发严重麻疹的因素，这占了相当大的一部分，在第三世界的高婴儿和儿童死亡率，重新审查。基于社区的前瞻性研究结果对蛋白质-能量-营养不良（PEM）导致麻疹的信念提出了挑战。结果发现，严重的麻疹与PEM无关，但在几内亚比绍经常伴随着过度拥挤。继发性病例的表现比索引患者差。在营养充足的住院非洲儿童中，免疫学和放射学参数以及年龄和HLA抗原的影响与麻疹的患病和死亡密切相关。病例死亡率的这种变化似乎不能简单地用年龄依赖性宿主反应或医疗护理的差异来解释。符合大多数观察到的事实的假说假定，大量接种的病毒颗粒传播给易感儿童是严重疾病的重要原因。这一解释的含义是，在高危地区，对降低麻疹死亡率来说，具体的麻疹控制，而不仅仅是改善营养，是很重要的。它进一步建议，卫生政策应促进这些限制强烈暴露于麻疹病毒的社会变革。
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 hospitalized 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.