A RANDOMIZED TRIAL OF A STANDARD DOSE OF EDMONSTON-ZAGREB MEASLES VACCINE GIVEN AT 4.5 MONTHS OF AGE: EFFECT ON TOTAL HOSPITAL ADMISSIONS

Tuesday, 23rd of September 2014 Print
[source]Journal of Infectious Diseases[|source]

Data from randomized trials have confirmed that measles vaccine has beneficial nonspecific effects, and therefore measles vaccine probably reduces severity or provide protection against infections other than measles. Little is known about the underlying mechanisms behind these nonspecific effects of measles vaccine; in particular, there is no information on how measles vaccine affects morbidity patterns. To understand possible biological mechanisms and the health implications of these findings, it will be important to determine which morbidity patterns are affected by the nonspecific effects.

In this report, the authors used data from the national pediatric ward in Bissau, Guinea-Bissau, to examine whether measles vaccine affected the rate of hospital admission and whether effects differed for different types of infection. The report presents data comparing the admission rate from enrollment and until the 9-month measles vaccination for children randomly assigned to receive measles vaccine or no measles vaccine at 4.5 months of age. Detailed findings and recommendations are accessible at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017359/

 

ABSTRACT

Observational studies and trials from low-income countries indicate that measles vaccine has beneficial nonspecific effects, protecting against non–measles-related mortality. It is not known whether measles vaccine protects against hospital admissions. Between 2003 and 2007, 6417 children who had received the third dose of diphtheria, tetanus, and pertussis vaccine were randomly assigned to receive measles vaccine at 4.5 months or no measles vaccine; all children were offered measles vaccine at 9 months of age. Using hospital admission data from the national pediatric ward in Bissau, Guinea-Bissau, we compared admission rates between enrollment and the 9-month vaccination in Cox models, providing admission hazard rate ratios (HRRs) for measles vaccine versus no measles vaccine. All analyses were conducted stratified by sex and reception of neonatal vitamin A supplementation (NVAS). Before enrollment the 2 groups had similar admission rates. Following enrollment, the measles vaccine group had an admission HRR of 0.70 (95% confidence interval [CI], .52–.95), with a ratio of 0.53 (95% CI, .32–.86) for girls and 0.86 (95% CI, .58–1.26) for boys. For children who had not received NVAS, the admission HRR was 0.53 (95% CI, .34–.84), with an effect of 0.30 (95% CI, .13–.70) for girls and 0.73 (95% CI, .42–1.28) for boys (P = .08, interaction test). The reduction in admissions was separately significant for measles infection (admission HRR, 0 [95% CI, 0–.24]) and respiratory infections (admission HRR, 0.37 [95% CI, .16–.89]). Early measles vaccine may have major benefits for infant morbidity patterns and healthcare costs.

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