title: Increased female-male mortality ratio associated with inactivated polio and diphtheria-tetanus-pertussis vaccines: Observations from vaccination trials in Guinea-Bissau.
abstract: BACKGROUND
  The 2-fold increase in female mortality after high-titer measles vaccine may have occurred because many children received diphtheria-tetanus-pertussis (DTP) vaccine or inactivated polio vaccine (IPV) after high-titer measles vaccine.
  
  
  OBJECTIVE
  We examined whether DTP vaccine and IPV were associated with increased female mortality when they were the most recent vaccine administered to children who had not received measles vaccine.
  
  
  METHODS
  IPV was used as a control vaccine in 4 randomized trials of early measles vaccination (MV) with enrollment at 4-6 months of age conducted in Guinea-Bissau. Many children had not received all 3 DTP vaccinations before enrollment, and therefore received DTP after IPV or MV. We examined whether DTP vaccination status at enrollment affected the female-male mortality ratio.
  
  
  METHODS
  9544 children enrolled in 4 trials.
  
  
  METHODS
  The female-male mortality ratio in different vaccine groups.
  
  
  RESULTS
  Females had a higher mortality rate than males among children randomized to receive IPV (mortality rate ratio [MR] 1.52, 95% CI 1.02-2.28), but females had a similar mortality rate to males among children randomized to receive MV (MR 1.01, 0.69-1.46) and among children in the IPV group after they had received MV at 9 months of age or later (MR 0.88, 0.68-1.14). Children who had not received a third dose of DTP before enrollment (and were likely to receive DTP after MV or IPV) tended to have a higher mortality than children who had received all 3 doses of DTP (MR 1.30, 0.97-1.73). This effect was seen only among girls (MR 1.61, 1.08-2.40) and not among boys (MR 1.02, 0.67-1.54). Girls had a lower mortality when MV was the most recent vaccine received rather than DTP or IPV (MR 0.49, 0.28-0.87).
  
  
  CONCLUSIONS
  Randomization to IPV was associated with higher female than male mortality. However, the increased female mortality might result from additional doses of DTP received after enrollment and before measles vaccination.
authors.affiliation: Projecto de Saúde de Bandim, Indepth Network, Bissau, Guinea-Bissau. P.aaby@bandim.org
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.forename: May-Lill
authors.initials: ML
authors.lastname: Garly
authors.forename: Jens
authors.initials: J
authors.lastname: Nielsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Ravn
authors.forename: Cesario
authors.initials: C
authors.lastname: Martins
authors.forename: Carlitos
authors.initials: C
authors.lastname: Balé
authors.forename: Amabelia
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Christine Stabell
authors.initials: CS
authors.lastname: Benn
authors.forename: Ida Maria
authors.initials: IM
authors.lastname: Lisse
mesh_terms: D046688:Child Mortality; D002675:Child, Preschool; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D008458:Measles Vaccine / Q000009:adverse effects / Q000276:immunology; D011054:Poliovirus Vaccine, Inactivated / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D012727:Sex Characteristics
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine; D011054:Poliovirus Vaccine, Inactivated