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Early diphtheria-tetanus-pertussis vaccination associated with higher female mortality and no difference in male mortality in a cohort of low birthweight children: an observational study within a randomised trial

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Název: Early diphtheria-tetanus-pertussis vaccination associated with higher female mortality and no difference in male mortality in a cohort of low birthweight children: an observational study within a randomised trial
Autoři: Aaby, Peter, Ravn, Henrik, Roth, Adam, Rodrigues, Amabelia, Lisse, Ida Maria, Diness, Birgitte Rode, Lausch, Karen Rokkedal, Lund, Najaaraq, Rasmussen, Julie, Biering-Sorensen, Sofie, Whittle, Hilton, Benn, Christine Stabell
Přispěvatelé: Lund University, Faculty of Medicine, Department of Translational Medicine, Clinical Microbiology, Malmö, Lunds universitet, Medicinska fakulteten, Institutionen för translationell medicin, Klinisk mikrobiologi, Malmö, Originator
Zdroj: Archives of Disease in Childhood. 97(8):685-691
Témata: Medical and Health Sciences, Clinical Medicine, Pediatrics, Medicin och hälsovetenskap, Klinisk medicin, Pediatrik
Popis: Background Studies from low-income countries have suggested that diphtheria-tetanus-pertussis (DTP) vaccine provided after Bacille Calmette-Guerin (BCG) vaccination may have a negative effect on female survival. The authors examined the effect of DTP in a cohort of low birthweight (LBW) infants. Methods 2320 LBW newborns were visited at 2, 6 and 12 months of age to assess nutritional and vaccination status. The authors examined survival until the 6-month visit for children who were DTP vaccinated and DTP unvaccinated at the 2-month visit. Results Two-thirds of the children had received DTP at 2 months and 50 deaths occurred between the 2-month and 6-month visits. DTP vaccinated children had a better anthropometric status for all indices than DTP unvaccinated children. Small mid-upper arm circumference (MUAC) was the strongest predictor of mortality. The death rate ratio (DRR) for DTP vaccinated versus DTP unvaccinated children differed significantly for girls (DRR 2.45; 95% CI 0.93 to 6.45) and boys (DRR 0.53; 95% CI 0.23 to 1.20) (p=0.018, homogeneity test). Adjusting for MUAC, the overall effect for DTP vaccinated children was 2.62 (95% CI 1.34 to 5.09); DRR was 5.68 (95% CI 1.83 to 17.7) for girls and 1.29 (95% CI 0.56 to 2.97) for boys (p=0.023, homogeneity test). While anthropometric indices were a strong predictor of mortality among boys, there was little or no association for girls. Conclusion Surprisingly, even though the children with the best nutritional status were vaccinated early, early DTP vaccination was associated with increased mortality for girls.
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  Data: Early diphtheria-tetanus-pertussis vaccination associated with higher female mortality and no difference in male mortality in a cohort of low birthweight children: an observational study within a randomised trial
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  Data: <searchLink fieldCode="AR" term="%22Aaby%2C+Peter%22">Aaby, Peter</searchLink><br /><searchLink fieldCode="AR" term="%22Ravn%2C+Henrik%22">Ravn, Henrik</searchLink><br /><searchLink fieldCode="AR" term="%22Roth%2C+Adam%22">Roth, Adam</searchLink><br /><searchLink fieldCode="AR" term="%22Rodrigues%2C+Amabelia%22">Rodrigues, Amabelia</searchLink><br /><searchLink fieldCode="AR" term="%22Lisse%2C+Ida+Maria%22">Lisse, Ida Maria</searchLink><br /><searchLink fieldCode="AR" term="%22Diness%2C+Birgitte+Rode%22">Diness, Birgitte Rode</searchLink><br /><searchLink fieldCode="AR" term="%22Lausch%2C+Karen+Rokkedal%22">Lausch, Karen Rokkedal</searchLink><br /><searchLink fieldCode="AR" term="%22Lund%2C+Najaaraq%22">Lund, Najaaraq</searchLink><br /><searchLink fieldCode="AR" term="%22Rasmussen%2C+Julie%22">Rasmussen, Julie</searchLink><br /><searchLink fieldCode="AR" term="%22Biering-Sorensen%2C+Sofie%22">Biering-Sorensen, Sofie</searchLink><br /><searchLink fieldCode="AR" term="%22Whittle%2C+Hilton%22">Whittle, Hilton</searchLink><br /><searchLink fieldCode="AR" term="%22Benn%2C+Christine+Stabell%22">Benn, Christine Stabell</searchLink>
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  Data: Lund University, Faculty of Medicine, Department of Translational Medicine, Clinical Microbiology, Malmö, Lunds universitet, Medicinska fakulteten, Institutionen för translationell medicin, Klinisk mikrobiologi, Malmö, Originator
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  Data: <i>Archives of Disease in Childhood</i>. 97(8):685-691
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  Data: <searchLink fieldCode="DE" term="%22Medical+and+Health+Sciences%22">Medical and Health Sciences</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+Medicine%22">Clinical Medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Pediatrics%22">Pediatrics</searchLink><br /><searchLink fieldCode="DE" term="%22Medicin+och+hälsovetenskap%22">Medicin och hälsovetenskap</searchLink><br /><searchLink fieldCode="DE" term="%22Klinisk+medicin%22">Klinisk medicin</searchLink><br /><searchLink fieldCode="DE" term="%22Pediatrik%22">Pediatrik</searchLink>
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  Data: Background Studies from low-income countries have suggested that diphtheria-tetanus-pertussis (DTP) vaccine provided after Bacille Calmette-Guerin (BCG) vaccination may have a negative effect on female survival. The authors examined the effect of DTP in a cohort of low birthweight (LBW) infants. Methods 2320 LBW newborns were visited at 2, 6 and 12 months of age to assess nutritional and vaccination status. The authors examined survival until the 6-month visit for children who were DTP vaccinated and DTP unvaccinated at the 2-month visit. Results Two-thirds of the children had received DTP at 2 months and 50 deaths occurred between the 2-month and 6-month visits. DTP vaccinated children had a better anthropometric status for all indices than DTP unvaccinated children. Small mid-upper arm circumference (MUAC) was the strongest predictor of mortality. The death rate ratio (DRR) for DTP vaccinated versus DTP unvaccinated children differed significantly for girls (DRR 2.45; 95% CI 0.93 to 6.45) and boys (DRR 0.53; 95% CI 0.23 to 1.20) (p=0.018, homogeneity test). Adjusting for MUAC, the overall effect for DTP vaccinated children was 2.62 (95% CI 1.34 to 5.09); DRR was 5.68 (95% CI 1.83 to 17.7) for girls and 1.29 (95% CI 0.56 to 2.97) for boys (p=0.023, homogeneity test). While anthropometric indices were a strong predictor of mortality among boys, there was little or no association for girls. Conclusion Surprisingly, even though the children with the best nutritional status were vaccinated early, early DTP vaccination was associated with increased mortality for girls.
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