Differences in female-male mortality after high-titre measles vaccine and association with subsequent vaccination with diphtheria-tetanus-pertussis and inactivated poliovirus: reanalysis of West African studies


Aaby, P; Jensen, H; Samb, B; Cisse, B; Sodemann, M; Jakobsen, M; Poulsen, A; Rodrigues, A; Lisse, IM; Simondon, F; Whittle, H; (2003) Differences in female-male mortality after high-titre measles vaccine and association with subsequent vaccination with diphtheria-tetanus-pertussis and inactivated poliovirus: reanalysis of West African studies. Lancet, 361 (9376). pp. 2183-2188. ISSN 0140-6736 DOI: 10.1016/S0140-6736(03)13771-3

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Abstract

BACKGROUND: Females given high-titre measles vaccine (HTMV) have high mortality; diphtheria-tetanus-pertussis (DTP) vaccination might be associated with increased female mortality. We aimed to assess whether DTP or inactivated poliovirus (IPV) administered after HTMV was associated with increased female-male mortality ratio. METHODS: In three trials from West Africa, 2000 children were randomised to HTMV or control vaccine at 4-5 months of age; a second vaccination was given at age 9-10 months (standard measles vaccine). Children in high-titre groups were given IPV or DTP-IPV. Another 944 children received HTMV as routine vaccination in Senegal. FINDINGS: When we compared high-titre and control groups, no difference in mortality between the first and the second vaccination was noted. After the second vaccination, the female-male mortality ratio was 1.84 (95% CI 1.19-2.84) in children in the high-titre groups who received DTP-IPV or IPV, and 0.59 (0.34-1.04) in controls who received standard measles vaccine (p=0.007). Children who received HTMV but no additional DTP-IPV or IPV had a female-male mortality ratio of 0.83 (0.41-1.67). This ratio was 2.22 (1.04-4.71) for children who received DTP-IPV after routine HTMV and 1.00 (0.68-1.47) for those who did not. When we combined the results from all trials, the female-male mortality ratio was 1.93 (1.33-2.81) for those who received DTP or IPV after HTMV, and 0.96 (0.69-1.34) for those who did not (p=0.006). INTERPRETATION: A change in sequence of vaccinations, rather than HTMV itself, may have been the cause of increased female mortality in these trials.

Item Type: Article
Keywords: Cause of Death, Diphtheria-Tetanus-Pertussis Vaccine, Female, Gambia, Guinea-Bissau, Humans, Immunization Schedule, Infant, Male, Measles, Measles Vaccine, Poliovirus Vaccine, Inactivated, Randomized Controlled Trials, Research Design, Senegal, Sex Factors, Sex Ratio, Cause of Death, Diphtheria-Tetanus-Pertussis Vaccine, administration & dosage, Female, Gambia, epidemiology, Guinea-Bissau, epidemiology, Humans, Immunization Schedule, Infant, Male, Measles, mortality, prevention & control, Measles Vaccine, administration & dosage, Poliovirus Vaccine, Inactivated, administration & dosage, Randomized Controlled Trials, Research Design, Senegal, epidemiology, Sex Factors, Sex Ratio
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Vaccine Centre
PubMed ID: 12842371
Web of Science ID: 183815600010
URI: http://researchonline.lshtm.ac.uk/id/eprint/10469

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