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.
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.
Aaby
Peter
P
Projecto de Saúde de Bandim, Danish Epidemiology Science Centre, Apartado 861, Bissau, Guinea-Bissau. psb@mail.gtelecom.gw <psb@mail.gtelecom.gw>
Jensen
Henrik
H
Samb
Badara
B
Cisse
Badara
B
Sodemann
Morten
M
Jakobsen
Marianne
M
Poulsen
Anja
A
Rodrigues
Amabelia
A
Lisse
Ida Maria
IM
Simondon
Francois
F
Whittle
Hilton
H
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
D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine; D011054:Poliovirus Vaccine, Inactivated