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
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
复制标题
DOI：
10.1016/j.ebiom.2017.07.012
复制
发表时间：
2017-08-01
期刊：
影响因子：
11.1
通讯作者：
Zaman, K.
中科院分区：
文献类型：
--
作者：
Aaby, Peter;Andersen, Andreas;Zaman, K.
背景：世卫组织建议在出生时接种卡介苗，并在6、10和14周龄时推荐含有白喉-破伤风-百日咳(DTP)的疫苗。然而，在低收入国家，卡介苗和DTP通常是联合管理的。背景：我们重新分析了来自孟加拉国MatLab的数据，以检验联合接种对死亡率的影响；37,894名出生于1986-1999年的儿童被跟踪登记接种疫苗和存活。方法：使用Cox模型，分析接种麻疹疫苗时6周至9个月的存活；712名儿童在这个年龄段死亡。我们计算了开始接种BCG-First、BCG+DTP1-First或DTP1-First的儿童死亡率比(MRR)。结果：只有17%的儿童遵循WHO的BCG优先接种计划。开始接种卡介苗+DTP1疫苗的儿童死亡率为16/1000人年，而先接种卡介苗或DTP的儿童死亡率分别为32/1000和20/1000。与BCG+DTP1-First相比，调整了背景因素后，BCG-First方案的死亡率是BCG-First方案的2倍(MRR=1.94(1.42-2.63))。与卡介苗联合应用相比，先用卡介苗后应用DTP1的死亡率更高(MRR=1.78(1.03~3.03))。结论：联合应用卡介苗和DTP可进一步降低死亡率。由于所有观察性研究都支持这一趋势，卡介苗和DTP的联合给药应该在随机试验中进行测试。(C)2017年作者。爱思唯尔出版公司(Elsevier B.V.)
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. (C) 2017 The Authors. Published by Elsevier B.V.