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首页> 外文期刊>Vaccine >The sequence of vaccinations and increased female mortality after high-titre measles vaccine: Trials from rural Sudan and Kinshasa
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The sequence of vaccinations and increased female mortality after high-titre measles vaccine: Trials from rural Sudan and Kinshasa

机译：高滴度麻疹疫苗接种后的接种顺序和增加的女性死亡率：苏丹农村和金沙萨的试验

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OBJECTIVE: West African studies have hypothesized that increased female mortality after high-titre measles vaccine (HTMV) was due to subsequent diphtheria-tetanus-pertussis (DTP) and inactivated polio vaccine (IPV) vaccinations. We tested two deductions from this hypothesis in HTMV studies from rural Sudan and Kinshasa; first, there should be no excess female mortality for HTMV recipients when DTP was not given after HTMV and second, excess female mortality should only be found among those children who received DTP after HTMV. STUDIES: The Sudanese trial randomised 510 children to Edmonston-Zagreb (EZ) HTMV, Connaught HTMV or a control vaccine (meningococcal). Both the Connaught HTMV and the control group received standard measles vaccine at 9 months. In the Kinshasa study 1023 children received one dose of HTMV at 6 months or two doses at 312 and 912 months of age. FINDINGS: First, the Sudan trial is one of the few randomised studies of measles vaccine; the EZ HTMV group had lower mortality between 5 and 9 months of age than controls, the mortality ratio (MR) being 0.00 (p=0.030). This effect was not due to prevention of measles infection. Second, both studies provided evidence that HTMV per se was associated with low mortality. In a combined analysis comparing both HTMV groups with controls, the HTMV groups had a MR of 0.09 (0.01-0.71) between 5 and 9 months of age. In Kinshasa, the HTMV recipients who did not receive simultaneous DTP had an annual mortality rate of only 1.0% between 6 months and 3 years of age. Third, the female-male MR was related to subsequent DTP vaccinations. In Kinshasa, the female-male MR was only 0.40 (0.13-1.27) among the HTMV recipients who did not receive further doses of DTP. In Sudan, the female-male mortality ratio in the EZ group was 3.89 (95% CI 1.02-14.83) and the female-male MR increased with number of doses of DTP likely to have been given during follow-up (trend, p=0.043). Fourth, in Kinshasa, mortality was higher among children who had received HTMV and DTP simultaneously than among children who had received HTMV alone (MR=5.38 (1.37-21.2)). CONCLUSIONS: Measles vaccine is associated with non-specific beneficial effects. When not given with DTP, HTMV per se was associated with low mortality. Increased female mortality was not found among children who did not receive DTP after HTMV. Hence, our deductions were supported and the sequence or combination of vaccinations may have an effect on sex-specific mortality patterns in low-income countries.
机译：目的：西非研究假设高滴度麻疹疫苗（HTMV）后女性死亡率增加是由于随后的白喉-破伤风-百日咳（DTP）和脊髓灰质炎灭活（IPV）疫苗接种所致。在来自苏丹农村和金沙萨的HTMV研究中，我们从该假设中检验了两个推论。首先，HTMV接受者不给予DTP时，HTMV接受者的女性死亡率不会过高;其次，HTMV接受过DTP的儿童中，女性的死亡率不会过高。研究：苏丹的一项试验将510名儿童随机分为Edmonston-Zagreb（EZ）HTMV，Connaught HTMV或对照疫苗（脑膜炎球菌）。康诺特HTMV和对照组均在9个月时接受了标准麻疹疫苗。在Kinshasa研究中，有1023名儿童在6个月时接受一剂HTMV或在312和912个月时接受两剂。结论：首先，苏丹的试验是为数不多的针对麻疹疫苗的随机研究之一。 EZ HTMV组的5至9个月大的死亡率低于对照组，死亡率（MR）为0.00（p = 0.030）。该效果不是由于预防麻疹感染。第二，两项研究均提供了HTMV本身与低死亡率相关的证据。在将两个HTMV组与对照组进行比较的组合分析中，HTMV组在5至9个月大时的MR为0.09（0.01-0.71）。在金沙萨，没有同时接受DTP的HTMV接受者在6个月至3岁之间的年死亡率仅为1.0％。第三，雌雄MR与随后的DTP疫苗接种有关。在金沙萨，接受进一步剂量DTP的HTMV接受者中，男女的MR仅为0.40（0.13-1.27）。在苏丹，EZ组的男女死亡率为3.89（95％CI 1.02-14.83），并且随着随访期间可能给予DTP剂量的增加，男女MR升高（趋势，p = 0.043）。第四，在金沙萨，同时接受HTMV和DTP的儿童的死亡率高于仅接受HTMV的儿童（MR = 5.38（1.37-21.2））。结论：麻疹疫苗与非特异性有益作用有关。如果不使用DTP，则HTMV本身与低死亡率相关。在HTMV后未接受DTP的儿童中未发现女性死亡率增加。因此，我们的推论得到了支持，疫苗接种的顺序或组合可能对低收入国家的性别特异性死亡率产生影响。

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