Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural Bangladesh
Background: WHO recommends BCG at birth and diphtheria-tetanus-pertussis (DTP)-containing vaccine at 6, 10 and 14 weeks of age. However, BCG and DTP are often co-administered in low-income countries. The health implications have not been examined. Setting: We reanalysed data from Matlab, Bangladesh,...
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| Format: | Article |
| Language: | English |
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Elsevier
2017-08-01
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| Series: | EBioMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352396417302852 |
| _version_ | 1818293057780449280 |
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| author | Peter Aaby Andreas Andersen Henrik Ravn K. Zaman |
| author_facet | Peter Aaby Andreas Andersen Henrik Ravn K. Zaman |
| author_sort | Peter Aaby |
| collection | DOAJ |
| description | Background: WHO recommends BCG at birth and diphtheria-tetanus-pertussis (DTP)-containing vaccine at 6, 10 and 14 weeks of age. However, BCG and DTP are often co-administered in low-income countries. The health implications have not been examined.
Setting: We reanalysed data from Matlab, Bangladesh, to examine the influence of co-administration on mortality; 37,894 children born 1986-1999 were followed with registration of vaccinations and survival.
Methods: Using Cox models, survival was analysed from 6 weeks to 9 months of age when measles vaccine is given; 712 children died in this age group. We calculated mortality rate ratios (MRR) for children starting the vaccination schedule with BCG-first, BCG+DTP1-first or DTP1-first.
Results: Only 17% followed the WHO-schedule with BCG-first. Mortality was 16/1000 person-years for children who initiated the vaccination schedule with BCG+DTP1 but 32/1000 and 20/1000 for children who received BCG-first or DTP-first, respectively. Compared with BCG+DTP1-first and adjusting for background factors, the BCG-first-schedule was associated with 2-fold higher mortality (MRR = 1.94 (1.42–2.63)). DTP1 administered after BCG-first was associated with higher mortality than receiving DTP1 with BCG (MRR = 1.78 (1.03–3.03)).
Conclusions: Co-administration of BCG and DTP may further reduce mortality. Since all observational studies support this trend, co-administration of BCG and DTP should be tested in randomised trials. |
| first_indexed | 2024-12-13T03:09:48Z |
| format | Article |
| id | doaj.art-6641112d73f94a269d58fee9922e4299 |
| institution | Directory Open Access Journal |
| issn | 2352-3964 |
| language | English |
| last_indexed | 2024-12-13T03:09:48Z |
| publishDate | 2017-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EBioMedicine |
| spelling | doaj.art-6641112d73f94a269d58fee9922e42992022-12-22T00:01:38ZengElsevierEBioMedicine2352-39642017-08-0122C17318010.1016/j.ebiom.2017.07.012Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural BangladeshPeter Aaby0Andreas Andersen1Henrik Ravn2K. Zaman3Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, DenmarkResearch Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, DenmarkResearch Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, DenmarkInternational Centre for Diarrhoeal Disease Research, Dhaka, BangladeshBackground: WHO recommends BCG at birth and diphtheria-tetanus-pertussis (DTP)-containing vaccine at 6, 10 and 14 weeks of age. However, BCG and DTP are often co-administered in low-income countries. The health implications have not been examined. Setting: We reanalysed data from Matlab, Bangladesh, to examine the influence of co-administration on mortality; 37,894 children born 1986-1999 were followed with registration of vaccinations and survival. Methods: Using Cox models, survival was analysed from 6 weeks to 9 months of age when measles vaccine is given; 712 children died in this age group. We calculated mortality rate ratios (MRR) for children starting the vaccination schedule with BCG-first, BCG+DTP1-first or DTP1-first. Results: Only 17% followed the WHO-schedule with BCG-first. Mortality was 16/1000 person-years for children who initiated the vaccination schedule with BCG+DTP1 but 32/1000 and 20/1000 for children who received BCG-first or DTP-first, respectively. Compared with BCG+DTP1-first and adjusting for background factors, the BCG-first-schedule was associated with 2-fold higher mortality (MRR = 1.94 (1.42–2.63)). DTP1 administered after BCG-first was associated with higher mortality than receiving DTP1 with BCG (MRR = 1.78 (1.03–3.03)). Conclusions: Co-administration of BCG and DTP may further reduce mortality. Since all observational studies support this trend, co-administration of BCG and DTP should be tested in randomised trials.http://www.sciencedirect.com/science/article/pii/S2352396417302852BCGChild mortalityCo-administrationDiphtheria-tetanus-pertussis vaccineDTPNon-specific effects of vaccines |
| spellingShingle | Peter Aaby Andreas Andersen Henrik Ravn K. Zaman Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural Bangladesh EBioMedicine BCG Child mortality Co-administration Diphtheria-tetanus-pertussis vaccine DTP Non-specific effects of vaccines |
| title | Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural Bangladesh |
| title_full | Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural Bangladesh |
| title_fullStr | Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural Bangladesh |
| title_full_unstemmed | Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural Bangladesh |
| title_short | Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural Bangladesh |
| title_sort | co administration of bcg and diphtheria tetanus pertussis dtp vaccinations may reduce infant mortality more than the who schedule of bcg first and then dtp a re analysis of demographic surveillance data from rural bangladesh |
| topic | BCG Child mortality Co-administration Diphtheria-tetanus-pertussis vaccine DTP Non-specific effects of vaccines |
| url | http://www.sciencedirect.com/science/article/pii/S2352396417302852 |
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