Measles vaccination in the presence or absence of maternal measles antibody: impact on child survival.
BACKGROUND
Measles vaccine (MV) has a greater effect on child survival when administered in early infancy, when maternal antibody may still be present.


METHODS
To test whether MV has a greater effect on overall survival if given in the presence of maternal measles antibody, we reanalyzed data from 2 previously published randomized trials of a 2-dose schedule with MV given at 4-6 months and at 9 months of age. In both trials antibody levels had been measured before early measles vaccination.


RESULTS
In trial I (1993-1995), the mortality rate was 0.0 per 1000 person-years among children vaccinated with MV in the presence of maternal antibody and 32.3 per 1000 person-years without maternal antibody (mortality rate ratio [MRR], 0.0; 95% confidence interval [CI], 0-.52). In trial II (2003-2007), the mortality rate was 4.2 per 1000 person-years among children vaccinated in presence of maternal measles antibody and 14.5 per 1000 person-years without measles antibody (MRR, 0.29; 95% CI, .09-.91). Possible confounding factors did not explain the difference. In a combined analysis, children who had measles antibody detected when they received their first dose of MV at 4-6 months of age had lower mortality than children with no maternal antibody, the MRR being 0.22 (95% CI, .07-.64) between 4-6 months and 5 years.


CONCLUSIONS
Child mortality in low-income countries may be reduced by vaccinating against measles in the presence of maternal antibody, using a 2-dose schedule with the first dose at 4-6 months (earlier than currently recommended) and a booster dose at 9-12 months of age.


BACKGROUND
NCT00168558.
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen.
Peter
P
Aaby
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
Cesário L
CL
Martins
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
May-Lill
ML
Garly
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen.
Andreas
A
Andersen
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
Ane B
AB
Fisker
Institute of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Denmark.
Mogens H
MH
Claesson
Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen.
Henrik
H
Ravn
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
Amabelia
A
Rodrigues
London School of Hygiene and Tropical Medicine, United Kingdom.
Hilton C
HC
Whittle
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen.
Christine S
CS
Benn
D000914:Antibodies, Viral / Q000097:blood*; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006801:Humans; D007112:Immunity, Maternally-Acquired; D007223:Infant; D008297:Male; D008457:Measles / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage / Q000276:immunology*; D016019:Survival Analysis; D014611:Vaccination / Q000379:methods*
D000914:Antibodies, Viral; D008458:Measles Vaccine
2-dose measles vaccination; age of measles vaccination; maternal measles antibodies; nonspecific beneficial effects of measles vaccine