Divergent female-male mortality ratios associated with different routine vaccinations among female-male twin pairs


Aaby, P; Jensen, H; Rodrigues, A; Garly, M.-, L; Benn, CS; Lisse, IM; Simondon, F; (2004) Divergent female-male mortality ratios associated with different routine vaccinations among female-male twin pairs. International journal of epidemiology, 33 (2). pp. 367-73. ISSN 0300-5771 DOI: 10.1093/ije/dyh004

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Abstract

BACKGROUND: Observational studies have suggested that vaccinations have non-specific effects that differ by sex. In the absence of randomized trials, studies of female-male twin pairs would allow us to investigate whether an intervention had sex-specific effects on survival. We therefore examined mortality patterns among female-male twin pairs according to vaccination status. Design We identified female-male twin pairs using the population registers from one urban district and three rural studies from Guinea-Bissau and Senegal and examined the female-male mortality ratio (MR) according to the last vaccine received among pairs in which a death occurred before 18 months of age. As background information, we examined sex- and age-specific mortality patterns in the pre-vaccination era. Subjects In all, 626 female-male twin pairs identified between 1978 and 2000. RESULTS: There was no sex difference in mortality for boys and girls in the pre-vaccination era. In the combined analysis of all studies, the female-male MR was 0.25 (95% CI: 0.05, 0.93) for pairs having received Bacille Calmette-Guerin (BCG) as the last vaccine, 7.33 (95% CI: 2.20, 38.3) for pairs having received diphtheria, tetanus, pertussis (DTP) as the last vaccine, and 0.40 (95% CI: 0.04, 2.44) for pairs having received measles vaccine as the last vaccine. The female-male MR varied significantly for BCG compared with DTP (exact test of homogeneity, P < 0.001) and for DTP compared with measles vaccine (exact test of homogeneity, P = 0.001). CONCLUSION: Non-specific effects of routine vaccinations are likely to be important and influence sex-specific mortality patterns in areas with high mortality. The effects of vaccines need to be considered in the planning of immunization programmes for low-income countries.

Item Type: Article
Keywords: BCG Vaccine, Developing Countries, Diphtheria-Tetanus-Pertussis Vaccine, Female, Guinea-Bissau, Humans, Immunization Schedule, Infant, Infant Mortality, Male, Measles Vaccine, Risk Factors, Rural Health, Senegal, Sex Factors, Urban Health, Vaccination, BCG Vaccine, Developing Countries, Diphtheria-Tetanus-Pertussis Vaccine, Female, Guinea-Bissau, epidemiology, Humans, Immunization Schedule, Infant, Infant Mortality, Male, Measles Vaccine, Risk Factors, Rural Health, statistics & numerical data, Senegal, epidemiology, Sex Factors, Urban Health, statistics & numerical data, Vaccination, statistics & numerical data
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Vaccine Centre
PubMed ID: 15082642
Web of Science ID: 220897100026
URI: http://researchonline.lshtm.ac.uk/id/eprint/10472

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