Increased long term mortality associated with rash after early measles vaccination in rural Senegal

Objectives, To examine whether clinical symptoms, including rash, were more common after measles immunization compared with placebo and to study the a ssociation between postvaccination symptoms and later mortality. Design. Examination of side effects in the 3 weeks after immunization in a trial of high titer and standard titer measles vaccines. Patients. Two hundred twenty-four children randomly selected to be included in the surveillance for diarrhea, fever and rash. Results, There was no difference in fever and diarrhea between recipients o f high titer vaccines and recipients of placebo. However, high titer recipi ents tended to have more measles-like rashes than placebo recipients [relat ive risk, 2.12 (range, 0.90 to 5.03)]. Among recipients of high titer vacci nes, children who presented a rash had higher mortality in the following 5 to 7 years than those who did not develop rash [mortality rate ratio, 3.85 (range, 1.52 to 9.79)]. High titer recipients without a rash had the same m ortality as children in the placebo group who were given standard doses of measles vaccine at 10 months of age [mortality rate, 0.76 (range, 0.35 to 1 .62)]. Conclusions. These observations suggest that in this particular study, rash after high titer measles vaccine may identify children who received a part icularly high dose of vaccine or children with more severe and persistent p ostvaccination immunosuppression. Whether high titer vaccine is more likely than standard titer measles vaccine to provoke such reaction is not known, given that we did not compare side effects after different titers of measl es vaccine. Future trials of live measles vaccine should monitor the develo pment of rash.