Co-administration of live measles and yellow fever vaccines and inactivated pentavalent vaccines is associated with increased mortality compared with measles and yellow fever vaccines only. An observational study from Guinea-Bissau

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• 作者：Ane B忙rent Fisker ; Henrik Ravn ; Amabelia Rodrigues ; Marie Drivsholm 脴stergaard ; Carlito Bale ; Christine Stabell Benn ; Peter Aaby
• 关键词：BCG ; Bacillus Calmette&ndash ; Gué ; rin vaccine ; BHP ; Bandim Health Project ; DTP ; diphtheria&ndash ; tetanus&ndash ; pertussis vaccine ; EPI ; Expanded Programme on Immunisations ; HDSS ; health and demographic surveillance system ; MRR ; mortality rate ratio ; MV ; measles vaccine ; OPV ; oral polio vaccine ; YF ; yellow fever vaccine
• 刊名：Vaccine
• 出版年：23 January, 2014
• 年：2014
• 卷：32
• 期：5
• 页码：598-605
• 全文大小：759 K

文摘

Background

Studies from low-income countries indicate that co-administration of inactivated diphtheria-tetanus-pertussis (DTP) vaccine and live attenuated measles vaccine (MV) is associated with increased mortality compared with receiving MV only. Pentavalent (DTP-H. Influenza type B-Hepatitis B) vaccine is replacing DTP in many low-income countries and yellow fever vaccine (YF) has been introduced to be given together with MV. Pentavalent and YF vaccines were introduced in Guinea-Bissau in 2008. We investigated whether co-administration of pentavalent vaccine with MV and yellow fever vaccine has similar negative effects.

Methods

In 2007-2011, we conducted a randomised placebo-controlled trial of vitamin A at routine vaccination contacts among children aged 6-23 months in urban and rural Guinea-Bissau. In the present study, we included 2331 children randomised to placebo who received live vaccines only (MV or MV + YF) or a combination of live and inactivated vaccines (MV + DTP or MV + YF + pentavalent). Mortality was compared in Cox proportional hazards models stratified for urban/rural enrolment adjusted for age and unevenly distributed baseline factors.

Results

While DTP was still used 685 children received MV only and 358 MV + DTP; following the change in programme, 940 received MV + YF only and 348 MV + YF + pentavalent. During 6 months of follow-up, the adjusted mortality rate ratio (MRR) for co-administered live and inactivated vaccines compared with live vaccines only was 3.24 (1.20-8.73). For MV + YF + pentavalent compared with MV + YF only, the adjusted MRR was 7.73 (1.79-33.4).

Conclusion

In line with previous studies of DTP, the present results indicate that pentavalent vaccine co-administered with MV and YF is associated with increased mortality.