title: 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.
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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  A change in sequence of vaccinations, rather than HTMV itself, may have been the cause of increased female mortality in these trials.
authors.affiliation: Projecto de Saúde de Bandim, Danish Epidemiology Science Centre, Apartado 861, Bissau, Guinea-Bissau. psb@mail.gtelecom.gw <psb@mail.gtelecom.gw>
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.forename: Henrik
authors.initials: H
authors.lastname: Jensen
authors.forename: Badara
authors.initials: B
authors.lastname: Samb
authors.forename: Badara
authors.initials: B
authors.lastname: Cisse
authors.forename: Morten
authors.initials: M
authors.lastname: Sodemann
authors.forename: Marianne
authors.initials: M
authors.lastname: Jakobsen
authors.forename: Anja
authors.initials: A
authors.lastname: Poulsen
authors.forename: Amabelia
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Ida Maria
authors.initials: IM
authors.lastname: Lisse
authors.forename: Francois
authors.initials: F
authors.lastname: Simondon
authors.forename: Hilton
authors.initials: H
authors.lastname: Whittle
mesh_terms: D002423:Cause of Death; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage*; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D008457:Measles / Q000401:mortality* / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage*; D011054:Poliovirus Vaccine, Inactivated / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012675:Senegal / Q000453:epidemiology; D012737:Sex Factors; D012744:Sex Ratio
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine; D011054:Poliovirus Vaccine, Inactivated