Non-specific effects of diphtheria-tetanus-pertussis vaccination on child mortality in Cebu, The Philippines
Non-specific effects of diphtheria-tetanus-pertussis vaccination on child mortality in Cebu, The Philippines
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DOI：
10.1093/ije/dym142
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发表时间：
2007-10-01
影响因子：
7.7
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Chan, Grace J.;Moulton, Lawrence H.;Black, Robert E.
背景：探讨白喉、破伤风和百日咳（DTP）疫苗接种和性别对某高死亡率地区接种卡介苗（BCG）人群30月龄前死亡率的非特异性影响。方法：本分析采用了一项纵向研究，对菲律宾宿务都会区儿童生存监测初级保健服务的使用情况、发病率和死亡率进行了研究。参与者包括14537名年龄在30个月以下的儿童，他们在1988年7月至1991年1月期间接种了卡介苗。主要结局指标为全因死亡率。结果接种过bcg疫苗的儿童在30月龄前的死亡率比未接种过bcg疫苗的儿童低57%，风险比（HR）为0.43（95%可信区间（CI） 0.21-0.88）。未接种百白破疫苗的儿童中，女性死亡率低于男性[HR = 0.19 (0.04-0.86), P = 0.03]。接种百白破疫苗对男性的保护作用[HR 0.32(0.14-0.73)]明显高于女性[HR 0.86(0.18-4.23)]。接种百白破疫苗使男女死亡率增加（交互作用项P = 0.08）至0.76（0.52-1.12）。结论：在接种过bcg疫苗的30月龄以下儿童中，接种百白破疫苗可提高生存率。女性死亡率的增加与接种百白破疫苗后男性死亡率的降低有关，而不是与女性儿童死亡率的增加有关。
Background To determine the non-specific effects of diphtheria, tetanus and pertussis (DTP) vaccination and sex on mortality before 30 months of age among those who received Bacille Calmette Guerin (BCG) vaccine in a high mortality area.Methods This analysis used a longitudinal study of child survival monitoring the use of primary care services, morbidity and mortality in Metro Cebu, The Philippines. Participants included 14537 children under 30 months of age who received a BCG vaccination from July 1988 to January 1991. The main outcome measure was all-cause mortality.Results Mortality before 30 months of age was 57% lower among BCG-vaccinated children who received DTP vaccination than BCG-vaccinated children who did not receive DTP vaccination hazard ratio (HR) for vaccinated vs unvaccinated 0.43 [95% confidence interval (CI) 0.21-0.88]. Females had lower mortality rates [HR = 0.19 (0.04-0.86), P = 0.03] than males among DTP-unvaccinated children. The protective effect of DTP vaccination was more pronounced in males [HR 0.32 (0.14-0.73)] than in females [HR 0.86 (0.18-4.23)]. DTP vaccination increased (interaction term P = 0.08) the female-to-male mortality ratio to 0.76 (0.52-1.12).Conclusions Among BCG-vaccinated children under 30 months of age, DTP vaccination is associated with improved survival. The increased femalemale mortality ratio is associated with reduced mortality among males following DTP vaccination rather than increased mortality among female children.