UCLA

Measles is a highly contagious viral disease, and infection can result in severe symptoms, complications, and both acute and prolonged immunologic effects. The Democratic Republic of the Congo (DRC) is a resource poor and measles endemic country. Limited health care services, poor nutrition, and high levels of infectious disease, as found in the DRC, make host immune function of crucial public health importance. In addition to assessing vaccination coverage and seroprotective antibody levels, identifying and quantifying the immunologic impact of measles vaccination and disease on child health outcomes can provide valuable recommendations for public health policy and practice. The overall aim of this dissertation is twofold. First, this dissertation seeks to describe measles vaccination coverage and seroprotective levels of measles antibody in DRC and examine factors that may contribute to the large proportion of children with inadequate immunity. Second, it aims to assess associations of both measles vaccination and disease with markers of infectious disease (acute fever, cough, and diarrhea outcomes). Chapter 1 is a brief overview of measles vaccination and disease pathogenesis. Chapter 2 examines predictors of measles vaccination coverage in the DRC and describes characteristics of children who are least reached by routine measles immunization efforts. Chapter 3 utilizes a causal mediation model to quantify the impact of measles vaccination on acute fever, cough, and diarrhea outcomes. Chapter 4 describes measles antibody seroprevalence among vaccinated and unvaccinated children and identifies trends in inadequate immunization. Finally, Chapter 5 explores the immunologic impact of measles on child health outcomes by examining the association of previous measles infection with acute fever, cough, and diarrhea episodes.