REDUCED CHILDHOOD MORTALITY AFTER STANDARD MEASLES VACCINATION AT 4-8 MONTHS COMPARED WITH 9-11 MONTHS OF AGE

被引:64
作者
AABY, P
ANDERSEN, M
SODEMANN, M
JAKOBSEN, M
GOMES, J
FERNANDES, M
机构
[1] UNIV COPENHAGEN,STAT PROGRAM,DK-1168 COPENHAGEN,DENMARK
[2] MINIST PUBL HLTH,BISSAU,GUINEA BISSAU
关键词
D O I
10.1136/bmj.307.6915.1308
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. Subjects-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.
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页码:1308 / 1311
页数:4
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