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Trop Med Int Health. 2012 Dec;17(12):1492-505. doi: 10.1111/j.1365-3156.2012.03093.x. Epub 2012 Sep 24.

Non-specific effects of diphtheria-tetanus-pertussis and measles vaccinations? An analysis of surveillance data from Navrongo, Ghana.

Author information

  • 1Navrongo Health Research Centre, Navrongo, Ghana  Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark  London School of Hygiene and Tropical Medicine, London, UK  Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.

Abstract

OBJECTIVES:

Studies from low-income countries have suggested that routine vaccinations may have non-specific effects on child mortality; measles vaccine (MV) is associated with lower mortality and diphtheria-tetanus-pertussis (DTP) with relatively higher mortality. We used data from Navrongo, Ghana, to examine the impact of vaccinations on child mortality.

METHODS:

Vaccination status was assessed at the initiation of a trial of vitamin A supplementation and after 12 and 24 months of follow-up. Within the placebo group, we compared the mortality over the first 4 months and the full 2 years of follow-up for different vaccination status groups with different likelihoods of additional vaccinations during follow-up. The frequency of additional vaccinations was assessed among children whose vaccination card was seen at 12 and 24 months of follow-up.

RESULTS:

Among children with a vaccination card, more than 75% received missing DTP or MV during the first 12 months of follow-up, whereas only 25% received these vaccines among children with no vaccination card at enrollment. Children without a card at enrollment had a significant threefold higher mortality over the 2-year follow-up period than those fully vaccinated. The small group of children with DTP3-4 but no MV at enrollment had lower mortality than children without a card and had the same mortality as fully vaccinated children. In contrast, children with 1-2 DTP doses but no MV had a higher mortality during the first 4 months than children without a card [MRR = 1.65 (0.95, 2.87)]; compared with the fully vaccinated children, they had significantly higher mortality after 4 months [MRR = 2.38 (1.07, 5.30)] and after 2 years [MRR = 2.41 (1.41, 4.15)]. Children with 0-2 DTP doses at enrollment had higher mortality after 4 months (MRR = 1.67 (0.82, 3.43) and after 2 years [MRR = 1.85 (1.16, 2.95)] than children who had all three doses of DTP at enrollment.

CONCLUSIONS:

As hypothesised, DTP vaccination was associated with higher child mortality than measles vaccination. To optimise vaccination policies, routine vaccinations need to be evaluated in randomised trials measuring the impact on survival.

© 2012 Blackwell Publishing Ltd.

KEYWORDS:

difteria‐tétano‐pertusis; diphtheria‐tetanus‐pertussis; diphtérie‐tétanos‐coqueluche; efectos no específicos; effets non spécifiques; measles; mortalidad; mortality; mortalité; non‐specific effects; rougeole; sarampión; vaccines; vaccins; vacunas

PMID:
23006334
[PubMed - indexed for MEDLINE]
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