The state of the world's children.

Correspondence The State of the World's Children Sir, We were interested to read in David Morley's recent annotation 'The State of the World's Children' that in the Gambia there is a 10% mortality in the subsequent nine months after infection with measles, and this compares with only 1% in controls.' Our own interest in the possible predisposition to subsequent death from measles infection was aroused by two deaths within 24 hours from meningococcaemia, which occurred in this hospital earlier this year. Both children were girls aged 2 years, and one had had measles eight weeks before her death and the other six weeks before. Meningococcal infection is an important cause of morbidity and mortality in childhood, causing 2% of all deaths between 1 and 4 years in the United Kingdom. It has been suggested that host factors-for example, familial complement deficiency2-may be operative in some cases of fulminating disease, but in most cases no such factors are recognised and immunosuppression is a well known associate with measles. Niwa et al have recently shown that suppressor T lymphocytes from patients with measles can significantly depress oxygen radical generation by normal polymorphs.3 This effect was shown to last for two months and was more pronounced in patients with secondary bacterial complications. There has been speculation that other viral infections may predispose to infection with Neisseria meningitidis as Young et al reported a simultaneous outbreak of influenza and meningococcal infection in Mississippi where there was a significant association between serologic evidence of influenza and systemic infection with or nasopharyngeal carriage of Neisseria meningitidis.4 The figures from the Gambia would seem to support further the essential inclusion of measles immunisation in any population immunisation programme, and we would be interested in any other instances of fatal meningococcal infection with preceding measles, because although both measles and meningococcal infection are both common in children, particularly in the first years of life, demonstration of a possible association between the two would provide further support for an effort to promote measles immunisation in the United Kingdom.