title: Non-specific and sex-differential effects of vaccinations on child survival in rural western India.
abstract: BACKGROUND
  Studies from Africa have suggested marked non-specific effects (NSEs) of routine vaccinations with effects on child survival. There have been few studies from Asia. We re-analyzed a study from Maharashtra, India, which had collected information on vaccinations during infancy and survival until 5 years of age.
  
  
  METHODS
  4138 children born between 1987 and 1989 were visited at home every three months to collect information on nutritional status and vaccinations. Since nutritional status was a determinant of time to vaccinations, we adjusted for nutritional status in the analyzes of the association between vaccinations and mortality.
  
  
  METHODS
  45 contiguous villages in Shirur Administrative Block in Pune District.
  
  
  METHODS
  Mortality rate ratios (MRR) for different vaccination status groups.
  
  
  RESULTS
  The study area has male preferential treatment, but the female-male mortality ratio varied between age groups with different pre-dominant vaccines; it was high in the age group in which diphtheria-tetanus-pertussis (DTP) vaccine predominates and low in the age group in which measles vaccine (MV) is given. Children who followed the WHO recommended schedule of first BCG and then DTP vaccination were vaccinated earlier than other children (p<0.01). Two-thirds of the children had received BCG and DTP out-of-sequence, i.e. BCG and DTP simultaneously or BCG after DTP. Children who received BCG and DTP simultaneously or BCG as most recent vaccination had significantly lower mortality than children having DTP as the most recent vaccination, the mortality rate ratio being 0.15 (0.03-0.70).
  
  
  CONCLUSIONS
  BCG out-of-sequence may be associated with lower mortality than DTP as the most recent vaccination. Given the public health implications, this possibility should be tested in randomized trials. Excess female mortality may also be related to vaccination policy.
authors.affiliation: Vadu Rural Health Program, KEM Hospital Research Centre, Rasta Peth, Pune 411011, India.
authors.forename: Siddhivinayak
authors.initials: S
authors.lastname: Hirve
authors.forename: Ashish
authors.initials: A
authors.lastname: Bavdekar
authors.forename: Sanjay
authors.initials: S
authors.lastname: Juvekar
authors.forename: Christine S
authors.initials: CS
authors.lastname: Benn
authors.forename: Jens
authors.initials: J
authors.lastname: Nielsen
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
mesh_terms: D001500:BCG Vaccine / Q000008:administration & dosage*; D002675:Child, Preschool; D003141:Communicable Diseases / Q000401:mortality*; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012424:Rural Population; D012737:Sex Factors; D016019:Survival Analysis; D014611:Vaccination / Q000379:methods*
chemical_list: D001500:BCG Vaccine; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines