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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.
Vaccine 2014; 32(5):598-605V

Abstract

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.

Authors+Show Affiliations

Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark. Electronic address: a.fisker@bandim.org.Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark. Electronic address: hjn@ssi.dk.Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau. Electronic address: a.rodrigues@bandim.org.Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau. Electronic address: mariedrivsholm@gmail.com.Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau. Electronic address: c.bale@bandim.org.Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark. Electronic address: cb@ssi.dk.Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark. Electronic address: p.aaby@bandim.org.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24325827

Citation

Fisker, Ane Bærent, et al. "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." Vaccine, vol. 32, no. 5, 2014, pp. 598-605.
Fisker AB, Ravn H, Rodrigues A, et al. 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. Vaccine. 2014;32(5):598-605.
Fisker, A. B., Ravn, H., Rodrigues, A., Østergaard, M. D., Bale, C., Benn, C. S., & Aaby, P. (2014). 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. Vaccine, 32(5), pp. 598-605. doi:10.1016/j.vaccine.2013.11.074.
Fisker AB, et al. 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. Vaccine. 2014 Jan 23;32(5):598-605. PubMed PMID: 24325827.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Fisker,Ane Bærent, AU - Ravn,Henrik, AU - Rodrigues,Amabelia, AU - Østergaard,Marie Drivsholm, AU - Bale,Carlito, AU - Benn,Christine Stabell, AU - Aaby,Peter, Y1 - 2013/12/08/ PY - 2013/06/06/received PY - 2013/11/11/revised PY - 2013/11/21/accepted PY - 2013/12/12/entrez PY - 2013/12/12/pubmed PY - 2014/8/12/medline KW - BCG KW - BHP KW - Bacillus Calmette–Guérin vaccine KW - Bandim Health Project KW - Child mortality KW - DTP KW - Diphtheria–tetanus–pertussis vaccine KW - EPI KW - Expanded Programme on Immunisations KW - HDSS KW - MRR KW - MV KW - Measles vaccine KW - OPV KW - Pentavalent vaccine KW - YF KW - Yellow fever vaccine KW - diphtheria–tetanus–pertussis vaccine KW - health and demographic surveillance system KW - measles vaccine KW - mortality rate ratio KW - oral polio vaccine KW - yellow fever vaccine SP - 598 EP - 605 JF - Vaccine JO - Vaccine VL - 32 IS - 5 N2 - 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. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/24325827/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(13)01663-0 DB - PRIME DP - Unbound Medicine ER -