| Printable Copy |
 |
| Printable Copy |
|
Multiple reviews of measles vaccine and vitamin A treatment effectiveness have been published. However, most measles vaccine reviews have employed serologic data to determine effect estimates for measles-specific mortality. The most recent Cochrane review for vitamin A treatment of children with measles erroneously includes a supplementation trial.
In this study, the authors present a revised systematic review of measles vaccine and vitamin A treatment in order to determine effect estimates and corresponding uncertainty for the lives saved tool (LiST). More details excluded trials, revised effects and conclusions are accessible at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845860/
ABSTRACT
BACKGROUND: The current strategy utilized by WHO/United Nations Children s Fund (UNICEF) to reach the Global Immunization Vision and Strategy 2010 measles reduction goal includes increasing coverage of measles vaccine, vitamin A treatment and supplementation in addition to offering two doses of vaccine to all children.
METHODS: We conducted a systematic review of published randomized controlled trials (RCTs) and quasi-experimental (QE) studies in order to determine effect estimates of measles vaccine and vitamin A treatment for the Lives Saved Tool (LiST). We utilized a standardized abstraction and grading format in order to determine effect estimates for measles mortality employing the standard Child Health Epidemiology Research Group Rules for Evidence Review.
RESULTS: We identified three measles vaccine RCTs and two QE studies with data on prevention of measles disease. A meta-analysis of these studies found that vaccination was 85% [95% confidence interval (CI) 83–87] effective in preventing measles disease, which will be used as a proxy for measles mortality in LiST for countries vaccinating before one year of age. The literature also suggests that a conservative 95% effect estimate is reasonable to employ when vaccinating at 1 year or later and 98% for two doses of vaccine based on serology reviews. We included six high-quality RCTs in the meta-analysis of vitamin A treatment of measles which found no significant reduction in measles morality. However, when stratifying by vitamin A treatment dose, at least two doses were found to reduce measles mortality by 62% (95% CI 19–82).
CONCLUSION: Measles vaccine and vitamin A treatment are effective interventions to prevent measles mortality in children.