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Reduced childhood mortality after standard measles vaccination at 4-8 months compared with 9-11 months of age.
BMJ. 1993 Nov 20; 307(6915):1308-11.BMJ

Abstract

OBJECTIVE

To evaluate the impact on mortality of standard Schwarz measles immunisation before 9 months of age.

DESIGN

Children vaccinated in 1980-3 at 4-5, 6-8, and 9-11 months of age were followed to migration, death, or the age of 5 years.

SETTING

One urban district and nine villages in two rural areas of Guinea-Bissau.

SUBJECT

307 children vaccinated at 4-8 months and 256 at 9-11 months.

MAIN OUTCOME MEASURES

Mortality from 9 months to 5 years of age for children immunised at 4-5, 6-8, and 9-11 months.

RESULTS

Mortality was significantly lower in children vaccinated at 6-8 months than at 9-11 months (mortality ratio = 0.63, (95% confidence interval 0.41 to 0.97), p = 0.047). As vaccination was provided in semiannual or annual campaigns it is unlikely that age at vaccination reflected a selection bias. The trend was the same in all three study areas. Improved survival after early immunisation was not related to better protection against measles infection. With a Cox multivariate regression model to adjust for age, sex, season at risk, season at birth, measles infection, and region, children vaccinated at 4-8 months had a mortality ratio of 0.61 (0.40 to 0.92, p = 0.020) compared with children vaccinated at 9-11 months. Reimmunised children tended to have lower mortality than children who received only one vaccine (0.59 (0.28 to 1.27, p = 0.176)).

CONCLUSION

Standard measles vaccination before 9 months is not associated with higher childhood mortality than is the currently recommended strategy of immunising from 9 months, and it may reduce mortality. This has implications for measles immunisation strategy in developing countries.

Authors+Show Affiliations

Epidemiology Research Unit, Statens Seruminstitut, Copenhagen, Denmark.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

8257884

Citation

Aaby, P, et al. "Reduced Childhood Mortality After Standard Measles Vaccination at 4-8 Months Compared With 9-11 Months of Age." BMJ (Clinical Research Ed.), vol. 307, no. 6915, 1993, pp. 1308-11.
Aaby P, Andersen M, Sodemann M, et al. Reduced childhood mortality after standard measles vaccination at 4-8 months compared with 9-11 months of age. BMJ. 1993;307(6915):1308-11.
Aaby, P., Andersen, M., Sodemann, M., Jakobsen, M., Gomes, J., & Fernandes, M. (1993). Reduced childhood mortality after standard measles vaccination at 4-8 months compared with 9-11 months of age. BMJ (Clinical Research Ed.), 307(6915), 1308-11.
Aaby P, et al. Reduced Childhood Mortality After Standard Measles Vaccination at 4-8 Months Compared With 9-11 Months of Age. BMJ. 1993 Nov 20;307(6915):1308-11. PubMed PMID: 8257884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduced childhood mortality after standard measles vaccination at 4-8 months compared with 9-11 months of age. AU - Aaby,P, AU - Andersen,M, AU - Sodemann,M, AU - Jakobsen,M, AU - Gomes,J, AU - Fernandes,M, PY - 1993/11/20/pubmed PY - 1993/11/20/medline PY - 1993/11/20/entrez KW - Africa KW - Africa South Of The Sahara KW - Age Factors KW - Child Mortality--changes KW - Child Survival KW - Comparative Studies KW - Delivery Of Health Care KW - Demographic Factors KW - Developing Countries KW - Diseases KW - Guinea-bissau KW - Health KW - Health Services KW - Immunization KW - Length Of Life KW - Longitudinal Studies KW - Measles--prevention and control KW - Mortality KW - Population KW - Population Characteristics KW - Population Dynamics KW - Portuguese Speaking Africa KW - Primary Health Care KW - Research Methodology KW - Research Report KW - Rural Population KW - Studies KW - Survivorship KW - Urban Population KW - Vaccination KW - Viral Diseases KW - Western Africa SP - 1308 EP - 11 JF - BMJ (Clinical research ed.) JO - BMJ VL - 307 IS - 6915 N2 - OBJECTIVE: To evaluate the impact on mortality of standard Schwarz measles immunisation before 9 months of age. DESIGN: Children vaccinated in 1980-3 at 4-5, 6-8, and 9-11 months of age were followed to migration, death, or the age of 5 years. SETTING: One urban district and nine villages in two rural areas of Guinea-Bissau. SUBJECT: 307 children vaccinated at 4-8 months and 256 at 9-11 months. MAIN OUTCOME MEASURES: Mortality from 9 months to 5 years of age for children immunised at 4-5, 6-8, and 9-11 months. RESULTS: Mortality was significantly lower in children vaccinated at 6-8 months than at 9-11 months (mortality ratio = 0.63, (95% confidence interval 0.41 to 0.97), p = 0.047). As vaccination was provided in semiannual or annual campaigns it is unlikely that age at vaccination reflected a selection bias. The trend was the same in all three study areas. Improved survival after early immunisation was not related to better protection against measles infection. With a Cox multivariate regression model to adjust for age, sex, season at risk, season at birth, measles infection, and region, children vaccinated at 4-8 months had a mortality ratio of 0.61 (0.40 to 0.92, p = 0.020) compared with children vaccinated at 9-11 months. Reimmunised children tended to have lower mortality than children who received only one vaccine (0.59 (0.28 to 1.27, p = 0.176)). CONCLUSION: Standard measles vaccination before 9 months is not associated with higher childhood mortality than is the currently recommended strategy of immunising from 9 months, and it may reduce mortality. This has implications for measles immunisation strategy in developing countries. SN - 0959-8138 UR - https://www.unboundmedicine.com/medline/citation/8257884/Reduced_childhood_mortality_after_standard_measles_vaccination_at_4_8_months_compared_with_9_11_months_of_age_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=8257884.ui DB - PRIME DP - Unbound Medicine ER -