Randomized Trials Comparing Inactivated Vaccine After Medium or High Titer Measles Vaccine with Standard Titer Measles Vaccine After Inactivated Vaccine: A Meta-Analysis.


Aaby, P; Ravn, H; Benn, CS; Rodrigues, A; Samb, B; Ibrahim, SA; Libman, MD; Whittle, HC; (2016) Randomized Trials Comparing Inactivated Vaccine After Medium or High Titer Measles Vaccine with Standard Titer Measles Vaccine After Inactivated Vaccine: A Meta-Analysis. The Pediatric infectious disease journal. ISSN 0891-3668 DOI: 10.1097/INF.0000000000001300

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Abstract

: Observational studies have suggested that girls have higher mortality if their most recent immunization is an inactivated vaccine rather than a live vaccine. We therefore reanalyzed five randomized trials of early measles vaccine (MV) in which it was possible to compare an inactivated vaccines (after medium or high titer MV) and a live standard titer MV (after an initial inactivated vaccine).<br/> : The trials were conducted in Sudan, Senegal, The Gambia and Guinea-Bissau. The intervention group received live medium or high titer MV from 4-5 months, and then an inactivated vaccine from 9-10 months of age; the control children received inactivated vaccine/placebo from 4-5 months, and standard titer MV from 9-10 months of age. We compared mortality from 9 months until end of study at 3-5 years of age for children who received inactivated vaccine (after medium or high titer MV) and standard titer MV (after inactivated vaccine), respectively. The original data sets were analyzed using a Cox proportional hazards model stratified by trial.<br/> : The mortality rate ratio (MRR) was 1.38 (95% CI: 1.05-1.83) after an inactivated vaccine (after medium or high titer MV) compared with a standard titer MV (after inactivated vaccine). Girls had a MRR of 1.89 (1.27-2.80) whereas there was no effect for boys, the sex-differential effect being significant (p=0.02). Excluding measles cases did not alter these conclusions, the MRR after inactivated vaccines (after medium or high titer MV) being 1.40 (1.06-1.86) higher overall and 1.92 (1.29-2.86) for girls. Control for variations in national immunization schedules for other vaccines did not modify these results.<br/> : After 9 months of age, all children had been immunized against measles, and mortality in girls was higher when they had received inactivated vaccines (after medium or high titer MV) rather than live standard titer MV (after an inactivated vaccine).<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 27434829
Web of Science ID: 388216200018
URI: http://researchonline.lshtm.ac.uk/id/eprint/2659778

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