Welaga Paul, Hodgson Abraham, Debpuur Cornelius, Aaby Peter, Binka Fred, Azongo Daniel, Oduro Abraham
Navrongo Health Research Centre, Navrongo, Ghana.
OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Front Public Health. 2018 Feb 12;6:28. doi: 10.3389/fpubh.2018.00028. eCollection 2018.
Measles vaccine (MV) administered as the last vaccine after the third dose of diphtheria-tetanus-pertussis (DTP) may be associated with better child survival unrelated to prevention of measles infection. Other studies have shown that MV administered after DTP was more beneficial and was associated with lower mortality compared with DTP administered after MV or DTP administered simultaneously with MV. We compared the difference in mortality between measles vaccinated after DTP3 and measles-unvaccinated children in Navrongo, Ghana.
This was a follow-up study involving annual cohort of children aged 9-23 months from 1996 to 2012. We assessed survival in relation to the measles vaccination status within the first 12 months from interview date and until 5 years of age using Cox proportional hazards models.
In all, 38,333 children were included in the study. The proportion of children vaccinated with MV-after-DTP3 increased from 45% in 1996 to 95% in 2012. The adjusted hazard ratio (HR) for measles unvaccinated compared with MV-after-DTP3 vaccinated children was 1.38 (1.15-1.66) in the first 12 months after assessment of vaccination status and 1.22 (1.05-1.41) with follow-up to 5 years of age. The national immunization days campaigns with oral polio vaccine or MV might have reduced the effect of being MV-after-DTP3 vaccinated vs MV-unvaccinated. For 12 months of follow-up, the HR before a campaign for MV-unvaccinated children was 1.63 (1.23-2.17) compared to those who received MV-after-DTP3. After the campaign, the HR reduced to 1.23 (0.97-1.54). Stratifying the analysis by sex, measles-unvaccinated boys had a HR of 1.69 (1.33-2.61) compared to measles-unvaccinated girls who had a HR 1.06 (0.79-1.40) during 1-year follow-up. In 1989, only 7% of children in the area had received MV-after-DTP3; the increase in MV-after-DTP3 coverage from 1989 to 2012 may have lowered mortality rate among children aged 9 months to 3 years by 24%.
Though an observational study, our findings suggest that measles vaccination, administered in the recommended sequence, is associated with improved child survival and may have contributed importantly to the mortality decline toward the achievement of Millennium Development Goal 4.
在白喉-破伤风-百日咳（DTP）第三剂之后接种麻疹疫苗（MV）可能与儿童更好的生存状况相关，这与预防麻疹感染无关。其他研究表明，与在MV之后接种DTP或与MV同时接种DTP相比，在DTP之后接种MV更有益，且与较低的死亡率相关。我们比较了加纳纳夫龙戈地区在DTP3之后接种麻疹疫苗的儿童与未接种麻疹疫苗的儿童之间的死亡率差异。
这是一项随访研究，纳入了1996年至2012年每年9至23个月大的儿童队列。我们使用Cox比例风险模型评估了从访谈日期起的前12个月内以及直至5岁时与麻疹疫苗接种状况相关的生存情况。
该研究共纳入38333名儿童。DTP3之后接种MV的儿童比例从1996年的45%增至2012年的95%。在评估疫苗接种状况后的前12个月内，未接种麻疹疫苗的儿童与DTP3之后接种MV的儿童相比，调整后的风险比（HR）为1.38（1.15 - 1.66）；随访至5岁时，HR为1.22（1.05 - 1.41）。全国口服脊髓灰质炎疫苗或MV免疫日活动可能降低了DTP3之后接种MV与未接种MV之间的差异效果。在12个月的随访中，在开展MV活动之前，未接种MV的儿童的HR为1.63（1.23 - 2.17），而接受DTP3之后接种MV的儿童为1.63（1.23 - 2.17）。活动之后，HR降至1.23（0.97 - 1.54）。按性别分层分析，在1年随访期间，未接种麻疹疫苗的男孩的HR为1.69（1.33 - 2.61），而未接种麻疹疫苗的女孩的HR为1.06（0.79 - 1.40）。1989年，该地区只有7%的儿童接受了DTP3之后接种MV；从1989年至2012年DTP3之后接种MV覆盖率的增加可能使9个月至3岁儿童的死亡率降低了24%。
尽管这是一项观察性研究，但我们的研究结果表明，按照推荐顺序接种麻疹疫苗与儿童生存状况改善相关，并且可能对朝着实现千年发展目标4降低死亡率做出了重要贡献。
