REDUCED CHILDHOOD MORTALITY AFTER STANDARD MEASLES VACCINATION AT 4-8 MONTHS COMPARED WITH 9-11 MONTHS OF AGE
REDUCED CHILDHOOD MORTALITY AFTER STANDARD MEASLES VACCINATION AT 4-8 MONTHS COMPARED WITH 9-11 MONTHS OF AGE
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DOI：
10.1136/bmj.307.6915.1308
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发表时间：
1993-11-20
影响因子：
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通讯作者：
FERNANDES, M
中科院分区：
文献类型：
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作者：
AABY, P;ANDERSEN, M;FERNANDES, M
评估9月龄前标准施瓦茨麻疹免疫接种对死亡率的影响。设计：对1980- 1983年接种疫苗的4-5、6-8和9-11月龄儿童进行随访，观察其迁移、死亡、研究对象：307名儿童，年龄为4- 5岁。研究地点：几内亚比绍的一个城区和两个农村地区的九个村庄。8个月和9-11个月时的256例。主要结果指标-在4-5、6-8和9-11个月时接种疫苗的儿童9个月至5岁的死亡率。结果-在6-8个月时接种疫苗的儿童的死亡率显著低于9-11个月时接种疫苗的儿童（死亡率=0.63，（95%置信区间0.41至0.97），p=0.047）。由于疫苗接种是在半年一次或一年一次的活动中提供的，因此接种疫苗时的年龄不太可能反映选择偏倚。这一趋势在所有三个研究领域都是相同的。早期免疫后存活率的提高与更好地预防麻疹感染无关。用考克斯多变量回归模型调整年龄、性别、危险季节、出生季节、麻疹感染和地区，与9-11个月接种疫苗的儿童相比，4-8个月接种疫苗的儿童死亡率为0.61（0.40至0.92，p=0.020）。再免疫的儿童往往有较低的死亡率比儿童谁收到只有一个疫苗（0.59（0.28至1.27，p=0.176））。结论标准麻疹疫苗接种前9个月是不相关的儿童死亡率高于目前推荐的免疫策略，从9个月，它可能会降低死亡率。这对发展中国家的麻疹免疫策略有影响。
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.