Aaby Peter, Jensen Henrik, Samb Badara, Cisse Badara, Sodemann Morten, Jakobsen Marianne, Poulsen Anja, Rodrigues Amabelia, Lisse Ida Maria, Simondon Francois, Whittle Hilton
Projecto de Saúde de Bandim, Danish Epidemiology Science Centre, Apartado 861, Bissau, Guinea-Bissau.
Lancet. 2003 Jun 28;361(9376):2183-8. doi: 10.1016/S0140-6736(03)13771-3.
Females given high-titre measles vaccine (HTMV) have high mortality; diphtheria-tetanus-pertussis (DTP) vaccination might be associated with increased female mortality. We aimed to assess whether DTP or inactivated poliovirus (IPV) administered after HTMV was associated with increased female-male mortality ratio.
In three trials from West Africa, 2000 children were randomised to HTMV or control vaccine at 4-5 months of age; a second vaccination was given at age 9-10 months (standard measles vaccine). Children in high-titre groups were given IPV or DTP-IPV. Another 944 children received HTMV as routine vaccination in Senegal.
When we compared high-titre and control groups, no difference in mortality between the first and the second vaccination was noted. After the second vaccination, the female-male mortality ratio was 1.84 (95% CI 1.19-2.84) in children in the high-titre groups who received DTP-IPV or IPV, and 0.59 (0.34-1.04) in controls who received standard measles vaccine (p=0.007). Children who received HTMV but no additional DTP-IPV or IPV had a female-male mortality ratio of 0.83 (0.41-1.67). This ratio was 2.22 (1.04-4.71) for children who received DTP-IPV after routine HTMV and 1.00 (0.68-1.47) for those who did not. When we combined the results from all trials, the female-male mortality ratio was 1.93 (1.33-2.81) for those who received DTP or IPV after HTMV, and 0.96 (0.69-1.34) for those who did not (p=0.006).
A change in sequence of vaccinations, rather than HTMV itself, may have been the cause of increased female mortality in these trials.
接种高滴度麻疹疫苗（HTMV）的女性死亡率较高；白喉-破伤风-百日咳（DTP）疫苗接种可能与女性死亡率增加有关。我们旨在评估在HTMV之后接种DTP或灭活脊髓灰质炎病毒（IPV）是否与男女性死亡率之比增加有关。
在西非的三项试验中，2000名儿童在4至5月龄时被随机分配接受HTMV或对照疫苗；在9至10月龄时进行第二次接种（标准麻疹疫苗）。高滴度组的儿童接种IPV或DTP-IPV。另外944名儿童在塞内加尔作为常规疫苗接种接受HTMV。
当我们比较高滴度组和对照组时，第一次和第二次接种后的死亡率没有差异。第二次接种后，接受DTP-IPV或IPV的高滴度组儿童的男女性死亡率之比为1.84（95%CI 1.19-2.84），接受标准麻疹疫苗的对照组儿童为0.59（0.34-1.04）（p=0.007）。接受HTMV但未额外接种DTP-IPV或IPV的儿童的男女性死亡率之比为0.83（0.41-1.67）。在常规HTMV接种后接受DTP-IPV的儿童中，该比例为2.22（1.04-4.71），未接受的儿童为1.00（0.68-1.47）。当我们汇总所有试验的结果时，在HTMV之后接受DTP或IPV的儿童的男女性死亡率之比为1.93（1.33-2.81），未接受的儿童为0.96（0.69-1.34）（p=0.006）。
在这些试验中，疫苗接种顺序的改变而非HTMV本身可能是女性死亡率增加的原因。
