Sex-differential and non-specific effects of routine vaccinations in a rural area with low vaccination coverage: an observational study from Senegal

被引:30
作者
Aaby, Peter [1 ,3 ]
Nielsen, Jens [2 ]
Benn, Christine S. [2 ]
Trape, Jean-Francois [1 ]
机构
[1] Inst Rech Dev, Lab Paludol Epidemiol & Zool Afrotrop, Dakar, Senegal
[2] Statens Serum Inst, Res Ctr Vitamins & Vaccines CVIVA, DK-2300 Copenhagen, Denmark
[3] Bandim Hlth Project, Indepth Network, Bissau, Guinea Bissau
基金
新加坡国家研究基金会;
关键词
BCG; DTP; Measles vaccine; Non-specific effects of vaccines; Sequence of vaccinations; Sex-differential effects; DIPHTHERIA-TETANUS-PERTUSSIS; BIRTH-WEIGHT CHILDREN; FEMALE-MALE MORTALITY; BCG VACCINATION; GUINEA-BISSAU; SURVIVAL; IMMUNIZATIONS; VACCINES; COHORT; TRIAL;
D O I
10.1093/trstmh/tru186
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: We examined the potential sex-differential and non-specific effects of bacille Calmette-Gu,rin (BCG), diphtheria-tetanus-pertussis (DTP) and measles vaccine (MV) in a rural area of Senegal. Methods: The 4133 children born in the area between 1996 and 1999 were included in the study. Vaccinations were provided at three health centres. Vaccine information was collected through 3-monthly home visits. The survival analysis compared the effects of BCG and DTP according to the following sequence of vaccinations: BCG-first, BCG+DTP1-first, or DTP1-first. We compared DTP and MV between 9 and 24 months of age, as 9 months is the minimum age for MV. Results: At 12 months the vaccination coverage was 44%, 46% and 9%, respectively, for BCG, DTP1 and MV. Most children received BCG+DTP1-first and this combination was associated with a significantly lower mortality rate ratio (MRR) of 0.69 (0.53-0.89) compared with unvaccinated children. There was no benefit for children receiving BCG-first or DTP1-first. The female-male MRR was 0.79 (0.64-0.96) among unvaccinated children, but was significantly inversed with 1.45 (1.00-2.10) for children receiving DTP vaccination (test of homogeneity, p=0.006). Children who had received DTP simultaneously with MV or DTP after MV had significantly higher mortality (MRR=2.59 [1.32-5.07]) compared with children having MV-only as their most recent vaccination. After 9 months, the female-male MRR was 0.61 (0.31-1.19) for measles-vaccinated children but remained 1.54 (1.03-2.31) for DTP-vaccinated children who had not received MV (p=0.01). Conclusions: The sequence of routine vaccinations is important for the overall impact on child survival and these vaccines are associated with sex-differential effects.
引用
收藏
页码:77 / 84
页数:8
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