Non-specific sex-differential effect of DTP vaccination may partially explain the excess girl child mortality in Ballabgarh, India.
Non-specific sex-differential effect of DTP vaccination may partially explain the excess girl child mortality in Ballabgarh, India.
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DOI：
10.1111/tmi.12192
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发表时间：
2013-11-01
期刊：
影响因子：
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通讯作者：
Pandav, C S
中科院分区：
文献类型：
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作者：
Krishnan, A;Srivastava, R;Pandav, C S
目的：验证balabgarh HDSS地区在规划条件下接种卡介苗、百白破和麻疹疫苗对儿童死亡率的影响存在性别差异的假设。方法：对2006年至2011年印度北部巴拉巴加尔区28个村庄的所有活产婴儿进行随访，直至2011年12月31日或36个月大，以较早者为准。根据国家免疫接种计划（预防结核病的卡介苗、白喉-破伤风-百日咳和麻疹的初级和加强剂）接种疫苗的资格，将分析期分为四个时期。使用Cox比例风险回归评估性别与接种疫苗状况导致的死亡风险之间的关联，在生存分析中使用年龄作为时间尺度，并根据财富指数、获得医疗保健的机会、村庄是否有卫生设施、父母受教育程度、家庭类型、儿童出生顺序和出生年份进行调整。结果：在3年的随访中，队列中的12,142名儿童中发生702例死亡（332名男孩和370名女孩），累计死亡率为每1000例活产57.5例，女孩死亡率高出35%。接种四种疫苗的年龄没有性别差异。在接种百白破初级疫苗（HR 1.65; 95% CI:1.17-2.32）和百白破疫苗（HR 2.21; 1.24-3.93）后，女孩的死亡率均显著增加。接种卡介苗1.06（0.67-1.67）或麻疹1.34（0.85-2.12）疫苗后，女孩无明显的道德超标现象。结论：本研究支持百白破疫苗接种是该研究人群中女孩死亡率较高的部分原因。
OBJECTIVE: To test the hypothesis that a gender differential exists in the effect on child mortality of BCG, DTP, measles vaccine as administered under programme conditions in Ballabgarh HDSS area.METHODS: All live births in 28 villages of Ballabgarh block in North India from 2006 to 2011 were followed until 31 December 2011 or 36 months of age whichever was earlier. The period of analysis was divided into four time periods based on eligibility for vaccines under the national immunisation schedule (BCG for tuberculosis, primary and booster doses of diphtheria-tetanus-pertussis and measles). Cox proportional hazards regression was used to assess the association between sex and risk of mortality by vaccination status using age as the timescale in survival analysis and adjusting for wealth index, access to health care, the presence of a health facility in the village, parental education, type of family, birth order of the child and year of birth.RESULTS: 702 deaths (332 boys and 370 girls) occurred among 12,142 children in the cohort in the 3 years of follow-up giving a cumulative mortality rate of 57.5 per 1000 live births with 35% excess girl child mortality. Age at vaccination for the four vaccines did not differ by sex. There was significant excess mortality among girls after immunisation with DTP, for both primary (HR 1.65; 95% CI:1.17-2.32) and DTPb (2.21; 1.24-3.93) vaccinations. No significant excess morality among girls was noted after exposure to BCG 1.06 (0.67-1.67) or measles 1.34 (0.85-2.12) vaccine.CONCLUSION: This study supports the contention that DTP vaccination is partially responsible for higher mortality among girls in this study population.