title: A randomized trial of a standard dose of Edmonston-Zagreb measles vaccine given at 4.5 months of age: effect on total hospital admissions.
abstract: Observational studies and trials from low-income countries indicate that measles vaccine has beneficial nonspecific effects, protecting against non-measles-related mortality. It is not known whether measles vaccine protects against hospital admissions. Between 2003 and 2007, 6417 children who had received the third dose of diphtheria, tetanus, and pertussis vaccine were randomly assigned to receive measles vaccine at 4.5 months or no measles vaccine; all children were offered measles vaccine at 9 months of age. Using hospital admission data from the national pediatric ward in Bissau, Guinea-Bissau, we compared admission rates between enrollment and the 9-month vaccination in Cox models, providing admission hazard rate ratios (HRRs) for measles vaccine versus no measles vaccine. All analyses were conducted stratified by sex and reception of neonatal vitamin A supplementation (NVAS). Before enrollment the 2 groups had similar admission rates. Following enrollment, the measles vaccine group had an admission HRR of 0.70 (95% confidence interval [CI], .52-.95), with a ratio of 0.53 (95% CI, .32-.86) for girls and 0.86 (95% CI, .58-1.26) for boys. For children who had not received NVAS, the admission HRR was 0.53 (95% CI, .34-.84), with an effect of 0.30 (95% CI, .13-.70) for girls and 0.73 (95% CI, .42-1.28) for boys (P = .08, interaction test). The reduction in admissions was separately significant for measles infection (admission HRR, 0 [95% CI, 0-.24]) and respiratory infections (admission HRR, 0.37 [95% CI, .16-.89]). Early measles vaccine may have major benefits for infant morbidity patterns and healthcare costs. Clinical trials registration NCT00168558.
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
authors.forename: Cesario L
authors.initials: CL
authors.lastname: Martins
authors.forename: Christine S
authors.initials: CS
authors.lastname: Benn
authors.forename: Andreas
authors.initials: A
authors.lastname: Andersen
authors.forename: Carlito
authors.initials: C
authors.lastname: Balé
authors.forename: Frederik
authors.initials: F
authors.lastname: Schaltz-Buchholzer
authors.forename: Vu An
authors.initials: VA
authors.lastname: Do
authors.forename: Amabelia
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.forename: Henrik
authors.initials: H
authors.lastname: Ravn
authors.forename: Hilton
authors.initials: H
authors.lastname: Whittle
authors.forename: May-Lill
authors.initials: ML
authors.lastname: Garly
mesh_terms: D019587:Dietary Supplements; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage / Q000276:immunology*; D012307:Risk Factors; D012737:Sex Factors; D014801:Vitamin A / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D008458:Measles Vaccine; D014801:Vitamin A
keywords: Edmonston-Zagreb; hospital admissions; measles infection; measles vaccination; morbidity reduction; nonspecific effects of vaccine