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首页> 外文期刊>Vaccine >Age-specific changes in the female-male mortality ratio related to the pattern of vaccinations: an observational study from rural Gambia
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Age-specific changes in the female-male mortality ratio related to the pattern of vaccinations: an observational study from rural Gambia

机译：与疫苗接种方式有关的男女死亡率特定年龄变化：来自冈比亚农村的一项观察性研究

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BACKGROUND: According to studies from Guinea-Bissau and Senegal, live vaccines may reduce the female-male mortality ratio (MR) whereas inactivated vaccines increase this ratio. We used data from The Gambia to examine whether similar tendencies could be found in a different setting. SETTING: Forty villages in the Farafenni area in rural Gambia. SUBJECTS: A population of 17,000 was followed with demographic surveillance between 1998 and 2002; 537 children less than 5 years of age died in this period. METHODS: We used two vaccination surveys and community mortality data to examine, first, the female-male mortality ratio (MR) in the age groups in which DTP and MV are recommended and have a high coverage. Second, using vaccination cards seen post-mortem, we examined the distribution of live or inactivated vaccines as last vaccination in different age groups. Third, we examined the effect of DTP and MV administered simultaneously. MAIN OUTCOME MEASURES: The female-male MR in different age groups and for different vaccines. RESULTS: Vaccination coverage was high for BCG, third dose of DTP (DTP3) and MV, reaching a level of 80-90% within a few months of the recommended age of vaccination. First, the female-male MR was 0.93 (0.63-1.38) in the first 2 months of life when children had received no vaccination or the combination of BCG, HBV and OPV. From 2 to 8 months of age, with DTP and HBV being the main vaccinations, the female-male MR was 1.28 (0.86-1.89). Between 9 and 17 months of age, with MV as the main vaccination, this ratio dropped to 0.73 (0.50-1.07), a significant inversion of the female-male MR (p=0.045). Second, using information from vaccination cards of dead children, boys who died at 2-4 months of age were more likely to have received live BCG and girls to have received inactivated DTP and HBV as last vaccination (p0.001). At 5-8 months of age, essentially all dead children had received DTP as last vaccination and the female-male MR was 1.68 (0.96-2.93), whereas the MR was 0.70 (0.43-1.15) at 12-17 months of age when nearly all dead children had received MV (p=0.022). Third, compared with the general population of children who had received MV, dead children who had received MV were more likely to have received DTP3 simultaneously with MV (relative risk (RR)=5.59 (2.10-14.8)) or after MV (RR=2.61 (1.13-6.05)). CONCLUSION: Most children dying at a specific age had received the recommended vaccines. BCG and MV as last vaccination was associated with a low female-male MR, whereas DTP as last vaccination was associated with a high female-male MR. These trends are consistent with observations from other African countries.
机译：背景：根据几内亚比绍和塞内加尔的研究，活疫苗可降低雌雄死亡率（MR），而灭活疫苗可增加这一比率。我们使用了来自冈比亚的数据来检查是否可以在不同的环境中找到类似的趋势。地点：冈比亚农村地区法拉芬尼地区的40个村庄。研究对象：1998年至2002年间，对17,000名人口进行了人口统计学监测。在此期间，有537名5岁以下的儿童死亡。方法：我们使用了两次疫苗接种调查和社区死亡率数据，首先检查了推荐使用DTP和MV并具有较高覆盖率的年龄组的男女死亡率（MR）。其次，使用验尸后的疫苗接种卡，我们检查了不同年龄组中活疫苗或灭活疫苗的最后一次接种情况。第三，我们检查了同时施用DTP和MV的效果。主要观察指标：不同年龄组，不同疫苗的雌雄MR。结果：卡介苗，第三次DTP（DTP3）和MV的疫苗接种率很高，在推荐疫苗接种年龄的几个月内达到80-90％的水平。首先，当孩子未接种疫苗或BCG，HBV和OPV联合使用时，出生后头2个月的雌雄MR为0.93（0.63-1.38）。在2至8个月大时，以DTP和HBV为主要疫苗，雌雄MR为1.28（0.86-1.89）。在以MV为主要疫苗的9至17个月大时，该比率下降至0.73（0.50-1.07），这是雌雄MR的显着倒置（p = 0.045）。其次，使用死去儿童疫苗接种卡中的信息，在2-4个月大时死亡的男孩更有可能接受活卡介苗，而女孩最后一次接种疫苗则具有灭活的DTP和HBV（p <0.001）。在5-8个月大时，基本上所有死去的孩子都接受了DTP作为最后一次疫苗接种，雌雄MR为1.68（0.96-2.93），而在12-17个月时，MR为0.70（0.43-1.15）几乎所有死去的孩子都接受过MV（p = 0.022）。第三，与接受MV的儿童的总人口相比，接受MV的死亡儿童更有可能同时接受MV（相对风险（RR）= 5.59（2.10-14.8））或接受MV后接受DTP3（RR = 2.61（1.13-6.05））。结论：大多数死于特定年龄的儿童均已接种推荐的疫苗。 BCG和MV作为最后一次疫苗接种与女性-男性MR低相关，而DTP作为最后一次疫苗接种与女性-男性MR高相关。这些趋势与其他非洲国家的观察结果一致。

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