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首页> 外文期刊>Vaccine >Diphtheria-tetanus-pertussis vaccine administered simultaneously with measles vaccine is associated with increased morbidity and poor growth in girls. A randomised trial from Guinea-Bissau
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Diphtheria-tetanus-pertussis vaccine administered simultaneously with measles vaccine is associated with increased morbidity and poor growth in girls. A randomised trial from Guinea-Bissau

机译：与麻疹疫苗同时使用的白喉-破伤风-百日咳疫苗与发病率增加和女孩生长不良有关。几内亚比绍的一项随机试验

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Background: Combined vaccination with diphtheria-tetanus-pertussis (DTP) and measles vaccine (MV) has been associated with increased mortality in observational studies. Among children missing MV and a dose of DTP and oral polio vaccine (OPV), we conducted a randomised trial of providing MV + DTP + OPV simultaneously, as currently recommended, or MV + OPV only, and examined the effect on morbidity and growth. We hypothesised that the MV + OPV group would experience less morbidity and grow better. Due to previous observations of sex differences in the non-specific effects of vaccinations, we analysed all data stratified by sex.Methods: At the Bandim Health Project in Guinea-Bissau. 568 children who were due to receive MV and who were missing either DTP3 or DTP booster were enrolled in the study. A subgroup of 332 children was followed intensively to register adverse events and infections in the first month after vaccination. A subgroup of 276 children was followed every third month for a year to monitor growth. All children were followed for one year for infectious diseases, consultations, and hospitalisations.Results: As expected, adverse events were more common in the MV + DTP + OPV group; diarrhoea and use of medication were increased among girls but not among boys (both p = 0.02, test of interaction between DTP and sex). Febrile disease with vesicular rash, as well as consultations and hospitalisations tended to be more common in the MV + DTP + OPV group than in the MV + OPV group; the hazard ratio (HR) for febrile disease with vesicular rash was 1.86 (1.00; 3.47). The strongest tendencies for more febrile diseases and hospitalisations in the MV + DTP + OPV group were found in girls. Overall, growth did not differ by randomisation group. However, results differed by sex. Girls in the MV + DTP + OPV group had a consistent pattern of worse z-scores for weight, height, and mid-upper-arm-circumference (MUAC) than girls in the MV + OPV group. The effect was opposite for boys, with boys in the MV + OPV group faring worse than those in the MV + DTP + OPV group, the interaction test for sex and DTP being significant for weight at 6 and 9 months, for MUAC at 12 months and for weight-for-height at 3 and 9 months after randomisation.Conclusion: This is the first randomised trial of the non-specific effects of DTP and supports that these effects may be sex-differential and of clinical and anthropometric importance. Combined vaccination with DTP + MV + OPV may be detrimental for girls
机译：背景：在观察性研究中，白喉-破伤风-百日咳（DTP）和麻疹疫苗（MV）的联合疫苗接种已导致死亡率增加。在缺少MV和一定剂量的DTP和口服脊髓灰质炎疫苗（OPV）的儿童中，我们进行了一项随机试验，按照目前的建议同时提供MV + DTP + OPV，或仅提供MV + OPV，并研究了其对发病率和生长的影响。我们假设MV + OPV组的发病率会降低，并且会更好地成长。由于以前在接种疫苗的非特异性作用中观察到性别差异，因此我们分析了所有按性别分层的数据。方法：几内亚比绍的班迪姆健康项目。 568名因接受MV而缺少DTP3或DTP加强疫苗的儿童入选了该研究。在接种疫苗后的第一个月，对332名儿童进行了密切跟踪，以记录不良事件和感染。每隔三个月随访276名儿童，以监测其成长情况。结果：正如预期的那样，MV + DTP + OPV组的不良事件更为常见;所有儿童均接受了一年的传染病，咨询和住院治疗。女孩的腹泻和药物使用增加，但男孩没有增加（p = 0.02，DTP和性别之间的相互作用测试）。与MV + OPV组相比，MV + DTP + OPV组的发热性水疱疹性疾病以及会诊和住院治疗更为常见。高热疾病伴水疱疹的危险比（HR）为1.86（1.00; 3.47）。在女孩中，MV + DTP + OPV组出现更多发热疾病和住院的最强烈趋势。总体而言，随机分组的增长无差异。但是，结果因性别而异。 MV + DTP + OPV组的女孩的体重，身高和上臂中段（MUAC）的z得分比MV + OPV组的女孩更差。男生的影响相反，MV + OPV组的男生比MV + DTP + OPV组的男生差得​​多，性别和DTP的交互作用测试在6和9个月时体重显着，对于MUAC在12个月时显着结论：这是DTP的非特异性作用的第一个随机试验，支持这些作用可能是性别差异的，并且在临床和人体测量学上具有重要意义。 DTP + MV + OPV联合疫苗接种可能对女孩有害

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