Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine

被引:53
|
作者
Aaby, Peter [1 ,2 ]
Ravn, Henrik [2 ,3 ]
Fisker, Ane B. [1 ,2 ,3 ]
Rodrigues, Amabelia [1 ]
Benn, Christine S. [1 ,2 ,3 ]
机构
[1] Bandim Hlth Project, Indepth Network, Apartado 861, Bissau, Guinea Bissau
[2] Statens Serum Inst, CVIVA, Res Ctr Vitamins & Vaccines, Bandim Hlth Project, Artillerivej 5, DK-2300 Copenhagen S, Denmark
[3] Univ Southern Denmark, Odense Univ Hosp, OPEN, Inst Clin Res, Odense, Denmark
基金
新加坡国家研究基金会;
关键词
BCG; Diphtheria-tetanus-pertussis vaccine; DTP; Non-specific effects of vaccines; Sex-differential effects; Strategic Advisory Group of Experts on Immunization (SAGE); VITAMIN-A SUPPLEMENTATION; BIRTH-WEIGHT CHILDREN; ROUTINE VACCINATIONS; CHILDHOOD MORTALITY; GUINEA-BISSAU; MEASLES-VACCINE; RANDOMIZED-TRIAL; BCG VACCINATION; PEDIATRIC WARD; RURAL AREA;
D O I
10.1093/trstmh/trw073
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Ten years ago, we formulated two hypotheses about whole-cell diphtheria-tetanus-pertussis (DTP) vaccination: first, when given after BCG, DTP increases mortality in girls and, second, following DTP there is an increase in the female/male mortality rate ratio (MRR). A recent review by WHO found no convincing evidence that DTP increases mortality in females. Methods: We used previous DTP reviews as well as the recent WHO review for assessing the hypotheses. As pre-specified we excluded studies with survival or frailty bias; if children had received BCG and DTP simultaneously; and if the children had received neonatal vitamin A. Results: In seven studies of BCG-vaccinated children, DTP vaccination was associated with a 2.54 (95% CI 1.68-3.86) increase in mortality in girls (with no increase in boys [ratio 0.96, 0.55-1.68]). In 10 studies of BCG-vaccinated children, the female-to-male mortality ratio was 2.45 (1.48-4.06) times higher after DTP than before DTP. In 15 studies of children who had received DTP after previous BCG vaccination, mortality was 1.53 (1.21-1.93) times higher in girls than boys. The findings were similar in studies conducted before and after formulation of the hypotheses. Conclusions: The two hypotheses were confirmed in the studies that fulfilled pre-specified criteria.
引用
收藏
页码:570 / 581
页数:12
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