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Nielsen S, Fisker AB, da Silva I, Byberg S, Biering-Sørensen S, Balé C, Barbosa A, Bjerregaard-Andersen M, Hansen NS, Do VA, Bæk O, Rasmussen SM, Damkjær L, Hvidt S, Baltzersen O, Rodrigues A, Martins C, Jensen KJ, Whittle HC, Smits G, van der Klis F, Aaby P, Benn CS. Effect of early two-dose measles vaccination on childhood mortality and modification by maternal measles antibody in Guinea-Bissau, West Africa: A single-centre open-label randomised controlled trial. EClinicalMedicine 2022; 49:101467. [PMID: 35747181 PMCID: PMC9156892 DOI: 10.1016/j.eclinm.2022.101467] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early 2-dose measles vaccine (MV) at 4 and 9 months of age vs. the WHO strategy of MV at 9 months of age reduced all-cause child mortality in a previous trial. We aimed to test two hypotheses: 1) a 2-dose strategy reduces child mortality between 4 and 60 months of age by 30%; 2) receiving early MV at 4 months in the presence versus absence of maternal measles antibodies (MatAb) reduces child mortality by 35%. METHODS Single-centre open-label community-based randomised controlled trial in Guinea-Bissau, with 2:1 block-randomisation by sex to a 2-dose (4 + 9 months) vs. 1-dose (9 months) MV strategy. Healthy children were eligible 4 weeks after the 3rd diphtheria-tetanus-pertussis-containing vaccine. Before randomisation a blood sample was collected to determine MatAb level. The primary outcome was all-cause mortality. Hazard ratios (HR) were derived from Cox regression in the per protocol population. We tested for interactions with national campaigns with oral polio vaccine (C-OPV). Trial registration: NCT01486355. FINDINGS Between August 2011-April 17th 2015, 6,636 children were enroled, 6,598[n2-dose=4,397; n1-dose=2,201] were included in the analysis of the primary outcome, The HR(2-dose/1-dose) between 4 and 60 months was 1.38 (95%CI: 0.92-2.06) [deaths: n2-dose=90; n1-dose=33]. Before the 9-month MV and the HR(1-dose/no dose) was 0.94 (0.45-1.96) [deaths: n2-dose=21; n1-dose=11]. The HR(2-dose/1-dose) was 0.81 (0.29-2.22) for children, who received no C-OPV [deaths/children: n2-dose=10/2,801; n1-dose=6/1,365], and 4.73 (1.44-15.6) for children, who received C-OPV before and after enrolment (p for interaction=0.027) [deaths/children: n2-dose=27/1,602; n1-dose=3/837]. In the 2-dose group receiving early MV at 4 months, mortality was 50% (20-68%) lower for those vaccinated in the presence of MatAb vs. the absence of MatAb [deaths/children: nMatAb=51/3,132; nnoMatAb=31/1,028]. INTERPRETATION The main result contrasts with previous findings but may, though based on a small number of events, be explained by frequent OPV campaigns that reduced the mortality rate, but apparently interacted negatively with early MV. The beneficial non-specific effects of MV in the presence of MatAb should be investigated further. FUNDING ERC, Danish National Research Foundation, the Danish Council for Development Research, Ministry of Foreign Affairs, Novo Nordisk Foundation, European Union and the Lundbeck Foundation.
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Affiliation(s)
- Sebastian Nielsen
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
| | - Ane B Fisker
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
| | - Isaquel da Silva
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Stine Byberg
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | | | - Carlitos Balé
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Amarildo Barbosa
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | | | | | - Vu An Do
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Ole Bæk
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | | | - Lone Damkjær
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Sophus Hvidt
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Olga Baltzersen
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Amabelia Rodrigues
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Cesario Martins
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Kristoffer J Jensen
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
| | - Hilton C Whittle
- London School of Hygiene and Topical Medicine, Keppel Street, London, UK
| | - Gaby Smits
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Fiona van der Klis
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
| | - Christine S. Benn
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
- Corresponding author at: Studiestræde 6, 1455 Copenhagen K, Denmark.
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Berendsen MLT, Schaltz-Buchholzer F, Bles P, Biering-Sørensen S, Jensen KJ, Monteiro I, Silva I, Aaby P, Benn CS. Parental Bacillus Calmette-Guérin vaccine scars decrease infant mortality in the first six weeks of life: A retrospective cohort study. EClinicalMedicine 2021; 39:101049. [PMID: 34430834 PMCID: PMC8365433 DOI: 10.1016/j.eclinm.2021.101049] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Live attenuated vaccines have been observed to have particularly beneficial effects for child survival when given in the presence of maternally transferred immunity (priming). We aimed to test this finding and furthermore explore the role of paternal priming. METHODS In an exploratory, retrospective cohort study in 2017, parental Bacillus Calmette-Guérin (BCG) scars were assessed for infants from the Bandim Health Project (BHP) who had participated in a 2008-2013 trial of neonatal BCG vaccination. Parental scar effects on mortality were estimated from birth to 42 days, the age of the scheduled diphtheria-tetanus-pertussis (DTP) vaccination, in Cox proportional hazard models adjusted with Inverse Probability of Treatment Weighting. FINDINGS For 66% (510/772) of main trial infants that were still registered in the BHP area, at least one parent was located. BCG scar prevalence was 77% (353/461) among mothers and 63% (137/219) among fathers. In the first six weeks of life, maternal scars were associated with a mortality reduction of 60% (95%CI, 4% to 83%) and paternal scars with 49% (-68% to 84%). The maternal scar association was most beneficial among infants that had received BCG vaccination at birth (73% (-1% to 93%)). Although priming was less evident for paternal scars, having two parents with scars reduced mortality by 89% (13% to 99%) compared with either one or none of the parents having a scar. INTERPRETATION Parental BCG scars were associated with strongly increased early-life survival. These findings underline the importance of future studies into the subject of inherited non-specific immunity and parental priming. FUNDING Danish National Research Foundation; European Research Council; Novo Nordisk Foundation; University of Southern Denmark.
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Affiliation(s)
- MLT Berendsen
- Bandim Health Project, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
- Corresponding author at: Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
| | - F. Schaltz-Buchholzer
- Bandim Health Project, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - P. Bles
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - KJ. Jensen
- Experimental and Translational Immunology, Department of Health Technology, Technical University of Denmark, Kgs Lyngby, Denmark
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Frederiksberg, Denmark
| | - I. Monteiro
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - I. Silva
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - P. Aaby
- Bandim Health Project, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - CS. Benn
- Bandim Health Project, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Denmark
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Schaltz-Buchholzer F, Roth A, de Bree LCJ, Biering-Sørensen S, Timmermann CAG, Monteiro I, Aaby P, Benn CS. Neonatal Bacille Calmette-Guérin vaccination and tuberculin skin test reactions at 2- and 6-months: Effects on mortality up to 1 year of age. Vaccine 2021; 39:7286-7294. [PMID: 34226104 DOI: 10.1016/j.vaccine.2021.06.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/10/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In randomized trials, Bacille Calmette-Guérin (BCG) vaccine has been associated with reduced all-cause mortality. BCG-induced Tuberculin Skin Test (TST) reactions have also been associated with reduced all-cause mortality. We aimed to assess the association between TST responses and subsequent mortality in three birth cohorts and conducted a meta-analysis of existing studies. METHODS Observational study within three Guinea-Bissau BCG trial birth cohorts (conducted 2002-04, 2009-2013 and 2014-18) that encompassed children who were BCG-vaccinated within 28 days with TSTs performed at 2- (n = 1389) and 6-months (n = 2635) of age. We evaluated TST reaction determinants by binomial regression and assessed the association between TSTs > 1 mm (reactors) vs. ≤ 1 mm (non-reactors) and subsequent mortality risk up to age 12 months in Cox-models providing Mortality Rate Ratios (MRRs). We searched PubMed for studies to calculate meta-estimates of the association between TST reactivity by age 2- and 6-months and all-cause mortality. RESULTS Large post-vaccination wheal size was associated with 6-month TST positivity and so was receiving BCG-Denmark or BCG-Japan, compared with BCG-Russia. By age 2 months, 22% (302/1389) of infants were TST reactors with a 2-12-month mortality risk of 1.7% (5/302) vs. 3.3% (36/1087) for non-reactors, the corresponding reactor/non-reactor MRR = 0.49 (0.19-1.26). By age 6 months, 44% (1149/2635) of infants were reactors and the 6-12-month mortality risk was 0.4% (4/1149) vs. 0.6% (9/1486) for non-reactors, the MRR = 0.87 (0.27-2.86). The literature search provided 3 studies. The meta-analysis revealed a uniform pattern of reduced mortality associated with TST reactivity, a TST response by 2 months being associated with an MRR of 0.59 (0.39-0.90); for 6-month TST responses the MRR was 0.65 (0.43-1.00). CONCLUSION Among BCG-vaccinated infants, TST reactions were associated with markedly reduced mortality. Improved vaccination technique and using certain BCG strains could lead to a higher TST reaction prevalence, which would enhance BCG's beneficial non-specific effects.
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Affiliation(s)
- Frederik Schaltz-Buchholzer
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Bandim Health Project, OPEN, Department of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - Adam Roth
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Public Health Agency of Sweden, Solna, Sweden; Institution for Translation Medicine, Lund University, Malmö, Sweden
| | - L Charlotte J de Bree
- Bandim Health Project, OPEN, Department of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark; Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Clara Amalie Gade Timmermann
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, Uni. Southern Denmark, Odense, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ivan Monteiro
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Bandim Health Project, OPEN, Department of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark; Danish Institute of Advanced Science, Uni. Southern Denmark, Odense, Denmark
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Hanifi SMA, Biering-Sørensen S, Jensen AKG, Aaby P, Bhuiya A. Penta is associated with an increased female-male mortality ratio: cohort study from Bangladesh. Hum Vaccin Immunother 2020; 17:197-204. [PMID: 32573310 DOI: 10.1080/21645515.2020.1763084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Diphtheria-tetanus-pertussis (DTP) vaccine may be associated with excess female deaths. There are few studies of possible nonspecific effects of the DTP-containing vaccine Penta (DTP-hepatitis B-Haemophilus influenzae type b). We therefore investigated whether Penta vaccinations were associated with excess female deaths in rural Bangladesh. Between June 29, 2011 and April 20, 2016, we examined the mortality rates of 7644 children followed between 6 weeks and 9 months of age. We analyzed mortality using crude mortality rate ratio (MRR) and age-adjusted MRR (aMRR) from a Cox proportional hazards model. Mortality was analyzed according to sex, number of doses of Penta, and the order in which BCG and Penta were administered. During follow-up, 43 children died. For children who were only BCG vaccinated (BCG-only), the adjusted F/M MRR was 0.47 (0.09-2.48). However, among children who had Penta as their most recent vaccination, the adjusted F/M MRR was 9.91 (1.16-84.44). Hence, the adjusted F/M MRR differed significantly for BCG-only and for Penta as the most recent administered vaccination. Although the mortality rate was low in rural Bangladesh, there was a marked difference between adjusted F/M MRR's for children vaccinated with BCG-only compared with children where Penta was the most recent administered vaccination. Although usually ascribed to differential treatment and access to care, DTP-containing vaccines may be part of the explanation for the excessive female mortality reported in some regions.
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Affiliation(s)
- Syed Manzoor Ahmed Hanifi
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) and OPEN, Institute of Clinical Research, University of Southern Denmark , Odense, Denmark
| | - Sofie Biering-Sørensen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut , Copenhagen, Denmark
| | - Aksel Karl Georg Jensen
- cResearch Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut , Copenhagen, Denmark.,Denmark and Section of Biostatistics, University of Copenhagen , Copenhagen, Denmark
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network , Apartado 861, Guinea-Dissau
| | - Abbas Bhuiya
- Former Deputy Executive Director, icddr,b , Dhaka, Bangladesh
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Jensen KJ, Biering-Sørensen S, Ursing J, Kofoed PEL, Aaby P, Benn CS. Seasonal variation in the non-specific effects of BCG vaccination on neonatal mortality: three randomised controlled trials in Guinea-Bissau. BMJ Glob Health 2020; 5:e001873. [PMID: 32201619 PMCID: PMC7059430 DOI: 10.1136/bmjgh-2019-001873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 11/23/2022] Open
Abstract
The BCG vaccine protects non-specifically against other diseases than tuberculosis. Three randomised controlled trials of early BCG in Guinea-Bissau found a 38% reduction in all-cause neonatal mortality. Little is known about the underlying mechanisms. In Guinea-Bissau, prevalent infectious diseases display distinct seasonality. Revisiting the three trials (>6500 infants) comparing early BCG versus no early BCG in low weight infants on all-cause neonatal mortality over 12 consecutive years, we explored the seasonal variation in BCG’s effect on mortality. In a subgroup of participants, adaptive and innate cytokine responses were measured 4 weeks after randomisation. Consistently over the course of the three trials and 12 years, the effect of BCG on all-cause neonatal mortality was particularly beneficial when administered in November to January, coincident with peaking malaria infections. During these months, BCG was also associated with stronger proinflammatory responses to heterologous challenge. Recent studies have suggested a protective effect of BCG against malaria. BCG may also ameliorate immune-compromising fatal effects of placental malaria in the newborn.
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Affiliation(s)
- Kristoffer Jarlov Jensen
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark.,Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | | | - Johan Ursing
- Department of Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden
| | - Poul-Erik Lund Kofoed
- Department of Pediatrics, Kolding Hospital, Kolding, Denmark.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
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Schaltz-Buchholzer F, Biering-Sørensen S, Lund N, Monteiro I, Umbasse P, Fisker AB, Andersen A, Rodrigues A, Aaby P, Benn CS. Early BCG Vaccination, Hospitalizations, and Hospital Deaths: Analysis of a Secondary Outcome in 3 Randomized Trials from Guinea-Bissau. J Infect Dis 2019; 219:624-632. [PMID: 30239767 DOI: 10.1093/infdis/jiy544] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 09/11/2018] [Indexed: 11/14/2022] Open
Abstract
Background This study was performed to examine the effects of early BCG vaccination on the risk, cause, and severity of infant hospitalizations. The analysis included 3 trials randomizing low-weight neonates to early BCG vaccination (intervention) versus no BCG vaccination (usual practice in low-weight neonates, control), with hospitalizations as secondary outcome. Methods Hospitalization data were collected at the pediatric ward of the National Hospital. Effects of BCG vaccination on hospitalization risk were assessed in Cox models providing overall and major disease-group incidence rate ratios (IRRs). Severity was assessed by means of in-hospital case-fatality rates and compared by group as cohort study risk ratios (RRs). Results Among 6583 infants (3297 in BCG group, 3286 controls), there were 908 infant hospitalizations (450 BCG, 458 controls) and 135 in-hospital deaths (56 BCG, 79 controls). The neonatal (28 days), 6-week, and infant (1-year) BCG versus control hospitalization IRRs were 0.97 (95% confidence interval [CI], .72-1.31), 0.95 (.73-1.24), and 0.96 (.84-1.10). Corresponding BCG versus control case-fatality rate RRs were 0.58 (95% CI, .35-.94), 0.56 (.35-.90), and 0.72 (.53-.99). BCG vaccination tended to reduce neonatal and infant sepsis hospitalization rates (IRR, 0.75 [95% CI, .50-1.13] and 0.78 [.55-1.11], respectively), and it reduced the neonatal in-hospital sepsis mortality rate (RR, 0.46; 95% CI, .22-.98). There were no confirmed hospitalizations for tuberculosis. Conclusions BCG vaccination did not affect hospitalization rates but reduced in-hospital mortality rates significantly, primarily by preventing fatal cases of sepsis. The observed beneficial effects of BCG on the in-hospital mortality rate were entirely nonspecific. Clinical Trials Registration NCT00146302, NCT00168610, and NCT00625482.
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Affiliation(s)
- Frederik Schaltz-Buchholzer
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research and Danish Institute of Advanced Science, University of Southern Denmark, Odense, and Odense University Hospital
| | - S Biering-Sørensen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - N Lund
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - I Monteiro
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - P Umbasse
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - A B Fisker
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research and Danish Institute of Advanced Science, University of Southern Denmark, Odense, and Odense University Hospital
| | - A Andersen
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - A Rodrigues
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - P Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - C S Benn
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research and Danish Institute of Advanced Science, University of Southern Denmark, Odense, and Odense University Hospital
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Biering-Sørensen S, Aaby P, Lund N, Monteiro I, Jensen KJ, Eriksen HB, Schaltz-Buchholzer F, Jørgensen ASP, Rodrigues A, Fisker AB, Benn CS. Early BCG-Denmark and Neonatal Mortality Among Infants Weighing <2500 g: A Randomized Controlled Trial. Clin Infect Dis 2019; 65:1183-1190. [PMID: 29579158 PMCID: PMC5849087 DOI: 10.1093/cid/cix525] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background BCG vaccine may reduce overall mortality by increasing resistance to nontuberculosis infections. In 2 randomized trials in Guinea-Bissau of early BCG-Denmark (Statens Serum Institut) given to low-weight (LW) neonates (<2500 g at inclusion) to reduce infant mortality rates, we observed a very beneficial effect in the neonatal period. We therefore conducted the present trial to test whether early BCG-Denmark reduces neonatal mortality by 45%. We also conducted a meta-analysis of the 3 BCG-Denmark trials. Methods In 2008–2013, we randomized LW neonates to “early BCG-Denmark” (intervention group; n = 2083) or “control” (local policy for LW and no BCG-Denmark; n = 2089) at discharge from the maternity ward or at first contact with the health center. The infants were randomized (1:1) without blinding in blocks of 24. Data was analyzed in Cox hazards models providing mortality rate ratios (MRRs). We had prespecified an analysis censoring follow-up at oral poliovirus vaccine campaigns. Results Early administration of BCG-Denmark was associated with a nonsignificant reduction in neonatal mortality rate (MRR, 0.70; 95% confidence interval [CI], .47–1.04) and a 34% reduction (0.66; .44–1.00) when censoring for oral poliovirus vaccine campaigns. There was no reduction in mortality rate for noninfectious diseases, but a 43% reduction in infectious disease mortality rate (MRR, 0.57; 95% CI, .35–.93). A meta-analysis of 3 BCG trials showed that early BCG-Denmark reduced mortality by 38% (MRR, 0.62; 95% CI, .46–.83) within the neonatal period and 16% (0.84; .71–1.00) by age 12 months. Conclusion Early administration of BCG-Denmark in LW infants is associated with major reductions in mortality rate. It is important that all LW infants receive early BCG in areas with high neonatal mortality rates. Clinical Trials Registration NCT00625482.
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Affiliation(s)
- Sofie Biering-Sørensen
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Najaaraq Lund
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Ivan Monteiro
- Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Kristoffer Jarlov Jensen
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Department of Immunology and Vaccinology, National Veterinary Institute, Technical University of Denmark, Frederiksberg and
| | - Helle Brander Eriksen
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | | | | | | | - Ane Bærent Fisker
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Denmark
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Pinstrup Joergensen AS, Bjerregaard-Andersen M, Biering-Sørensen S, Byberg S, Camala L, Martins C, Rodrigues A, Aaby P, Stabell Benn C. Admission and mortality at the main neonatal intensive care unit in Guinea-Bissau. Trans R Soc Trop Med Hyg 2018; 112:335-341. [DOI: 10.1093/trstmh/try061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/08/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anne Sofie Pinstrup Joergensen
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institute, Artillerivej 5, Copenhagen S
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institute, Artillerivej 5, Copenhagen S
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg
| | - Sofie Biering-Sørensen
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institute, Artillerivej 5, Copenhagen S
| | - Stine Byberg
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institute, Artillerivej 5, Copenhagen S
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Luis Camala
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Department of Maternity, National Hospital Simão Mendes, Bissau, Guinea-Bissau
| | - Cesario Martins
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
| | | | - Peter Aaby
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institute, Artillerivej 5, Copenhagen S
| | - Christine Stabell Benn
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institute, Artillerivej 5, Copenhagen S
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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9
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Bæk O, Jensen KJ, Andersen A, Balé C, Martins C, Biering-Sørensen S, Poulsen A, Benn CS. Seasonal and sex-specific variations in haematological parameters in 4 to 5.5-month-old infants in Guinea-Bissau, West Africa. Trans R Soc Trop Med Hyg 2018; 111:30-37. [PMID: 28371872 PMCID: PMC5914425 DOI: 10.1093/trstmh/trx014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 03/22/2017] [Indexed: 12/02/2022] Open
Abstract
Objective This study investigated seasonal and sex-specific variations in the haematological parameters and established reference ranges for these parameters in healthy 4 to 5.5-month-old infants in Guinea-Bissau. Methods Within a randomised trial of early measles vaccination, over a period of 13 months blood samples were collected from infants aged 4 to 5.5 months. Haematological parameters were determined by an automated cell counter and compared in linear regression models providing geometric mean ratios (GMR). Results Blood samples from 501 infants (n=248 boys, 49.5%) were obtained, and 285 (56.9%) were collected in the rainy season. Median age was 4.7 months (range 3.7 to 7.2 months). Eosinophil and platelet counts were lower in the dry season (December to May) than in the rainy season (GMR 0.79 [95% CI 0.68–0.92]) and 0.93 [0.87–1.00], respectively). The calculated reference ranges were wider and generally higher than those from a US population of comparable age, but neutrophil levels were notably lower in Guinea-Bissau. Conclusions The study indicated that eosinophil and platelet counts of infants were subject to seasonal variations. The reference ranges for haematological values were comparable to other African populations and corroborated that neutropenia regularly occurs in African infants.
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Affiliation(s)
- Ole Bæk
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Hvidovre Hospital, DK-2650 Copenhagen, Denmark
| | - Kristoffer Jarlov Jensen
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Andreas Andersen
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Carlito Balé
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
| | - Cesario Martins
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
| | - Sofie Biering-Sørensen
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Anja Poulsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Christine Stabell Benn
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, DK-2300 Copenhagen, Denmark
- OPEN, University of Southern Denmark/Odense University Hospital, DK-4000 Odense, Denmark
- Corresponding author: Present address: Research Center for Vitamins and Vaccines, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Tel: +45 3268 8354; E-mail:
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10
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Biering-Sørensen S, Jensen KJ, Monterio I, Ravn H, Aaby P, Benn CS. Rapid Protective Effects of Early BCG on Neonatal Mortality Among Low Birth Weight Boys: Observations From Randomized Trials. J Infect Dis 2018; 217:759-766. [PMID: 29216358 PMCID: PMC5853955 DOI: 10.1093/infdis/jix612] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/29/2017] [Indexed: 12/22/2022] Open
Abstract
Background Three randomized trials (RCTs) in low-weight (<2.5 kg) infants have shown that Bacille Calmette-Guérin (BCG) vaccine nonspecifically reduces all-cause mortality in the neonatal period. Methods Using data from 3 RCTs of early BCG (n = 6583) we examined potential sex differences in the timing of the mortality reduction in the neonatal period, presenting metaestimates of the main outcome mortality rate ratios (MRR) for BCG-vaccinated and controls. Results Among controls, boys had a particularly high mortality during the first week after randomization: male-female MRR 2.71 (95% CI, 1.70-4.50). During the first week, BCG had a marked beneficial effect for boys, reducing mortality 3-fold (MRR [BCG/no BCG] = 0.36 [0.20-0.67]). In weeks 2-4 the effect waned for boys (MRR = 0.91 [0.51-1.69]). In girls, the pattern was opposite with a limited effect in the first week (MRR = 0.85 [0.46-1.54]), but a significant reduction in weeks 2-4 (MRR = 0.56 [0.31-1.00]). This was consistent in all 3 trials. Verbal autopsies linked early benefit to fewer sepsis-related deaths among BCG-vaccinated boys. Discussion The marked reduction in mortality in the days after BCG vaccination in boys emphasizes the importance of providing BCG soon after birth. Trial registration numbers ClinicalTrials.gov (NCT00146302) and ClinicalTrials.gov (NCT00625482).
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Affiliation(s)
- Sofie Biering-Sørensen
- Projécto de Saúde Bandim, INDEPTH Network, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen
| | - Kristoffer Jarlov Jensen
- Projécto de Saúde Bandim, INDEPTH Network, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen
- Section for Immunology and Vaccinology, National Veterinary Institute, Technical University of Denmark
| | - Ivan Monterio
- Projécto de Saúde Bandim, INDEPTH Network, Guinea-Bissau
| | - Henrik Ravn
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen
| | - Peter Aaby
- Projécto de Saúde Bandim, INDEPTH Network, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen
| | - Christine Stabell Benn
- Projécto de Saúde Bandim, INDEPTH Network, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen
- Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital Denmark
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11
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Andersen A, Fisker AB, Rodrigues A, Martins C, Ravn H, Lund N, Biering-Sørensen S, Benn CS, Aaby P. National Immunization Campaigns with Oral Polio Vaccine Reduce All-Cause Mortality: A Natural Experiment within Seven Randomized Trials. Front Public Health 2018; 6:13. [PMID: 29456992 PMCID: PMC5801299 DOI: 10.3389/fpubh.2018.00013] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A recent WHO review concluded that live BCG and measles vaccine (MV) may have beneficial non-specific effects (NSEs) reducing mortality from non-targeted diseases. NSEs of oral polio vaccine (OPV) were not examined. If OPV vaccination campaigns reduce the mortality rate, it would suggest beneficial NSEs. SETTING Between 2002 and 2014, Guinea-Bissau had 15 general OPV campaigns and other campaigns with OPV plus vitamin A supplementation (VAS), VAS-only, MV, and H1N1 vaccine. In this period, we conducted seven randomized controlled trials (RCTs) with mortality as main outcome. METHODS Within these RCTs, we assessed whether the mortality rate was lower after-campaign than before-campaign. We used Cox models with age as underlying time and further adjusted for low birth-weight, season and time trend in mortality. We calculated the adjusted mortality rate ratio (MRR) for after-campaign vs before-campaign. RESULTS The mortality rate was lower after OPV-only campaigns than before, the MRR being 0.81 (95% CI = 0.68-0.95). With each additional dose of campaign-OPV the mortality rate declined further (MRR = 0.87 (95% CI: 0.79-0.96) per dose) (test for trend, p = 0.005). No other type of campaign had similar beneficial effects. Depending on initial age and with follow-up to 3 years of age, the number needed to treat with campaign-OPV-only to save one life was between 68 and 230 children. CONCLUSION Bissau had no case of polio infection so the results suggest that campaign-OPV has beneficial NSEs. Discontinuation of OPV-campaigns in low-income countries may affect general child mortality levels negatively.
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Affiliation(s)
- Andreas Andersen
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Ane Baerent Fisker
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | | | - Cesario Martins
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Henrik Ravn
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Institute for Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Najaaraq Lund
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Sofie Biering-Sørensen
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Christine Stabell Benn
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Institute for Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Peter Aaby
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Institute for Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
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12
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Do VA, Biering-Sørensen S, Fisker AB, Balé C, Rasmussen SM, Christensen LD, Jensen KJ, Martins C, Aaby P, Benn CS. Effect of an Early Dose of Measles Vaccine on Morbidity Between 18 Weeks and 9 Months of Age: A Randomized, Controlled Trial in Guinea-Bissau. J Infect Dis 2017; 215:1188-1196. [PMID: 28077730 PMCID: PMC5441109 DOI: 10.1093/infdis/jiw512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/18/2016] [Indexed: 01/21/2023] Open
Abstract
Background Children in Guinea-Bissau receive measles vaccine (MV) at 9 months of age, but studies have shown that an additional dose before 9 months of age might have beneficial nonspecific effects. Within a randomized trial designed to examine nonspecific effects of early MV receipt on mortality, we conducted a substudy to investigate the effect of early MV receipt on morbidity. Methods Children were randomly assigned at a ratio of 2:1 to receive 2 doses of MV at 18 weeks and age 9 months (intervention group) or 1 dose of MV at age 9 months, in accordance with current practice (control group). Children were visited weekly from enrollment to age 9 months; the mother reported morbidity, and the field assistants examined the children. Using Cox and binomial regression models, we compared the 2 randomization groups. Results Among the 1592 children, early measles vaccination was not associated with a higher risk of the well-known adverse events of fever, rash, and convulsions within the first 14 days. From 15 days after randomization to age 9 months, early measles vaccination was associated with reductions in maternally reported diarrhea (hazard ratio [HR], 0.89; 95% confidence interval [CI], .82-.97), vomiting (HR, 0.86; 95% CI, .75-.98), and fever (HR, 0.93; 95% CI, .87-1.00). Conclusion Early MV receipt was associated with reduced general morbidity in the following months, supporting that early MV receipt may improve the general health of children.
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Affiliation(s)
- Vu An Do
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau
| | - Sofie Biering-Sørensen
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau
| | - Ane Bærent Fisker
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau
| | - Carlito Balé
- Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau
| | - Stine Møller Rasmussen
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau
| | - Lone Damkjær Christensen
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau
| | - Kristoffer Jarlov Jensen
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.,Section for Immunology and Vaccinology, National Veterinary Institute, Technical University of Denmark, Bülowsvej 27, DK-1870 Frederiksberg C
| | - Cesário Martins
- Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau
| | - Peter Aaby
- Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.,Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, J.B. Winsløws Vej 9a, DK-5000 Odense C, Denmark
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13
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Rasmussen SM, Biering-Sørensen S, Byberg S, Andersen A, Bjerregaard-Andersen M, Rodrigues A, Benn CS, Martins CL, Aaby P. The effect of early measles vaccination at 4.5 months of age on growth at 9 and 24 months of age in a randomized trial in Guinea-Bissau. BMC Pediatr 2016; 16:199. [PMID: 27912735 PMCID: PMC5135799 DOI: 10.1186/s12887-016-0738-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/26/2016] [Indexed: 11/23/2022] Open
Abstract
Background Providing an early, additional measles vaccine (MV) at 4.5 months of age has been shown to reduce child mortality in low-income countries. We studied the effects on growth at 9 and 24 months of age. Methods A randomized controlled trial was conducted in Guinea-Bissau from 2003–2007 including 6,648 children. Children were randomized 1:1:1 to receive Edmonston-Zagreb measles vaccine at 4.5 and 9 months of age (group A), no vaccine at 4.5 months and Edmonston-Zagreb measles vaccine at 9 months (group B), or no vaccine at 4.5 months and Schwarz measles vaccine at 9 months (group C) Data on anthropometrics were obtained at enrolment at 4.5 months of age and again at 9 and 24 months of age. Analyses were stratified by sex, season of enrolment, and neonatal vitamin A supplementation (NVAS) status, as all these factors have been shown to modify the effect of early MV on mortality. Results Overall there was no effect of early MV on anthropometry at 9 months. At 24 months children who had received early MV had a significantly larger mid-upper-arm-circumference (MUAC/in cm) (Difference = 0.08; 95% CI (0.02;0.14)) compared with children in the control group; this effect was most pronounced among girls (0.12 (0.03;0.20)). The effect of early MV on MUAC remained significant in the dry season and in girls who received placebo rather than NVAS. Conclusion Early MV was associated with a larger MUAC particularly in girls. These results indicate that a two-dose measles vaccination schedule might not only reduce child mortality but also improve growth. Trial registration ClinicalTrials.gov NCT00168558. Registered September 9, 2005, retrospectively registered Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0738-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S M Rasmussen
- Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Bandim Health Project, Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - S Biering-Sørensen
- Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Bandim Health Project, Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - S Byberg
- Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Bandim Health Project, Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A Andersen
- Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Bandim Health Project, Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - M Bjerregaard-Andersen
- Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Bandim Health Project, Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark.,Department of Endocrinology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A Rodrigues
- Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau
| | - C S Benn
- Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau. .,Bandim Health Project, Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - C L Martins
- Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau
| | - P Aaby
- Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Bandim Health Project, Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
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14
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Fisker AB, Biering-Sørensen S, Lund N, Djana Q, Rodrigues A, Martins CL, Benn CS. Contrasting female-male mortality ratios after routine vaccinations with pentavalent vaccine versus measles and yellow fever vaccine. A cohort study from urban Guinea-Bissau. Vaccine 2016; 34:4551-4557. [PMID: 27475473 DOI: 10.1016/j.vaccine.2016.07.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/16/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In addition to protection against the target diseases, vaccines may have non-specific effects (NSEs). Measles vaccine (MV) has beneficial NSEs, providing protection against non-measles deaths, most so for girls. By contrast, though protecting against diphtheria, tetanus and pertussis, DTP vaccine is associated with increased female mortality relative to male mortality. In 2008, Guinea-Bissau replaced DTP with the DTP-containing pentavalent vaccine (Penta; DTP-H. influenza type B-Hepatitis B) at 6, 10 and 14weeks and yellow fever vaccine (YF) was to be given with MV. We investigated possible sex-differential mortality rates following Penta and MV+YF vaccination. METHODS Bandim Health Project (BHP) registers vaccines given by the three government health centres in the study area and vital status through demographic surveillance. We assessed the association between sex and mortality by vaccination status in Cox proportional hazards models with age as underlying timescale. Follow-up was censored at a subsequent vaccination contact or after 6months of follow-up. RESULTS Between September 2008 and April 2011, we registered 23,448 vaccination contacts for children aged 42-365days; 17,313 were for Penta and 3028 for MV (2907 co-administered with YF). During follow-up 112 children died. The female/male mortality rate ratio was 1.73 (1.11-2.70) following Penta and 0.38 (0.12-1.19) after MV (p=0.02 for same effect). Adjusting for maternal education or weight-for-age at the time of vaccination did not change the estimates. CONCLUSION Penta appears to have the same negative effects on mortality as those seen for DTP. Assessing post-vaccination mortality for boys and girls is necessary to improve the vaccination programme.
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Affiliation(s)
- Ane B Fisker
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark; OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, 5000 Odense C, Denmark.
| | - Sofie Biering-Sørensen
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Najaaraq Lund
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Queba Djana
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau.
| | - Amabelia Rodrigues
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau.
| | - Cesario L Martins
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau.
| | - Christine S Benn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark; OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, 5000 Odense C, Denmark.
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15
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Timmermann CAG, Biering-Sørensen S, Aaby P, Fisker AB, Monteiro I, Rodrigues A, Benn CS, Ravn H. Tuberculin reaction and BCG scar: association with infant mortality. Trop Med Int Health 2015; 20:1733-44. [PMID: 26426863 DOI: 10.1111/tmi.12614] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test the hypothesis that having a scar and a positive tuberculin skin test (TST) response after vaccination with Bacille Calmette-Guérin (BCG) is associated with reduced infant mortality. METHODS We studied cohorts of 2709 normal-birthweight (NBW) and 1102 low-birthweight (LBW) infants in Guinea-Bissau. Children were enrolled in randomised trials between year 2002 and 2008 and received BCG vaccination at birth. BCG scars and TST responses were assessed at 2 and 6 months of age. The infants were followed for mortality to 12 months of age, and survival was analysed using Cox regression. RESULTS At age 2 months, 88% of NBW children and 91% of LBW children had a BCG scar, and 36% and 17% had a TST response, respectively. The LBW infants had nearly twofold higher mortality (4.5%) than the NBW infants (2.8%) between 2 and 12 months of age. In the LBW cohort, the adjusted mortality rate ratio (MRR) comparing children with a BCG scar with those without was 0.42 (95% CI = 0.19; 0.93). There was a similar tendency for TST positivity: MRR = 0.47 (95% CI = 0.14; 1.54). For LBW children who had both a positive TST reaction and a scar, the MRR was 0.22 (95% CI = 0.05; 0.87). For NBW children, a scar and a positive TST were associated with 20% reductions in mortality, which did not reach statistical significance. CONCLUSION We confirmed previous observations that having a scar and a TST response after BCG vaccination is associated with lower mortality risk. The possibility of revaccinating scar-negative children should be considered.
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Affiliation(s)
- Clara Amalie Gade Timmermann
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sofie Biering-Sørensen
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Bissau, Guinea-Bissau.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Bissau, Guinea-Bissau.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Ane Baerent Fisker
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Bissau, Guinea-Bissau.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Ivan Monteiro
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Amabelia Rodrigues
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Bissau, Guinea-Bissau.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Bissau, Guinea-Bissau.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Henrik Ravn
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Bissau, Guinea-Bissau.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
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Biering-Sørensen S, Andersen A, Ravn H, Monterio I, Aaby P, Benn CS. Early BCG vaccine to low-birth-weight infants and the effects on growth in the first year of life: a randomised controlled trial. BMC Pediatr 2015; 15:137. [PMID: 26416147 PMCID: PMC4587923 DOI: 10.1186/s12887-015-0452-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Randomised trials have shown that early Bacille Calmette-Guérin (BCG) vaccine reduces overall neonatal and infant mortality. However, no study has examined how BCG affects growth. We investigated the effect on infant growth of early BCG vaccine given to low-birth-weight (LBW) infants. METHODS Two-thousand three hundred forty-three LBW infants were randomly allocated 1:1 to "early BCG" (intervention group) or "late BCG" (current practice). Furthermore, a subgroup (N = 1717) were included in a two-by-two randomised trial in which they were additionally randomised 1:1 to vitamin A supplementation (VAS) or placebo. Anthropometric measurements were obtained 2, 6, and 12 months after enrolment. RESULTS Overall there was no effect of early BCG on growth in the first year of life. The effect of early BCG on weight and mid-upper-arm circumference at 2 months tended to be beneficial among girls but not among boys (interaction between "early BCG" and sex: weight p = 0.03 and MUAC p = 0.04). This beneficial effect among girls was particularly seen among the largest infants weighing 2.0 kg or more at inclusion. CONCLUSION Though BCG vaccination is not recommended to be given to LBW infants at birth in Guinea-Bissau, early BCG had no negative effect on infant growth and may have had a beneficial effect for girls. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT00146302).
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Affiliation(s)
- Sofie Biering-Sørensen
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, DK-2300, Copenhagen S, Denmark. .,Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau.
| | - Andreas Andersen
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, DK-2300, Copenhagen S, Denmark.
| | - Henrik Ravn
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, DK-2300, Copenhagen S, Denmark. .,Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, DK-5000, Odense C, Denmark.
| | - Ivan Monterio
- Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau.
| | - Peter Aaby
- Projécto de Saúde Bandim, INDEPTH Network, Codex 1004, Bissau, Guinea-Bissau.
| | - Christine Stabell Benn
- Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, DK-2300, Copenhagen S, Denmark. .,Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, DK-5000, Odense C, Denmark.
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Lund N, Andersen A, Hansen ASK, Jepsen FS, Barbosa A, Biering-Sørensen S, Rodrigues A, Ravn H, Aaby P, Benn CS. The Effect of Oral Polio Vaccine at Birth on Infant Mortality: A Randomized Trial. Clin Infect Dis 2015. [PMID: 26219694 PMCID: PMC4614411 DOI: 10.1093/cid/civ617] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Neonates were randomized to oral polio vaccine (OPV) and followed for mortality. Among those enrolled within the first 2 days, OPV was associated with a 42% (10%–62%) reduction in infant infectious disease mortality. OPV at birth may provide nonspecific protection against infections. Background. Routine vaccines may have nonspecific effects on mortality. An observational study found that OPV given at birth (OPV0) was associated with increased male infant mortality. We investigated the effect of OPV0 on infant mortality in a randomized trial in Guinea-Bissau. Methods. A total of 7012 healthy normal-birth-weight neonates were randomized to BCG only (intervention group) or OPV0 with BCG (usual practice). All children were to receive OPV with pentavalent vaccine (diphtheria, tetanus, pertussis, Haemophilus influenzae type b, and hepatitis B) at 6, 10, and 14 weeks of age. Seven national OPV campaigns were also conducted during the trial period. Children were followed to age 12 months. We used Cox regression to calculate hazard ratios (HRs) for mortality. Results. The trial contradicted the original hypothesis about OPV0 increasing male infant mortality. Within 12 months, 73 children in the BCG + OPV group and 87 children in the BCG-only group died, all from infectious diseases. Comparing BCG + OPV0 vs BCG only, the HR was 0.83 (95% confidence interval [CI], .61–1.13): 0.72 (95% CI, .47–1.10) in boys and 0.97 (95% CI, .61–1.54) in girls. For children enrolled within the first 2 days of life, the HR for BCG + OPV0 vs BCG only was 0.58 (95% CI, .38–.90). From enrollment until the time of OPV campaigns, the HR was 0.68 (95% CI, .45–1.00), the beneficial effect being separately significant for males (0.55 [95% CI, .32–.95]). Conclusions. This is the only randomized trial of the effect of OPV0 on mortality. OPV0 may be associated with nonspecific protection against infectious disease mortality, particularly when given early in life. There are reasons to monitor mortality when OPV is being phased out. Clinical Trials Registration. NCT00710983.
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Affiliation(s)
- Najaaraq Lund
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen Department of Pediatrics, Kolding Hospital/University of Southern Denmark, Kolding
| | - Andreas Andersen
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen
| | | | - Frida S Jepsen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | | | | | | | - Henrik Ravn
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen Institute of Clinical Research, University of Southern Denmark/Odense University Hospital
| | - Peter Aaby
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen Institute of Clinical Research, University of Southern Denmark/Odense University Hospital
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18
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Biering-Sørensen S, Jensen KJ, Aamand SH, Blok B, Andersen A, Monteiro I, Netea MG, Aaby P, Benn CS, Hasløv KR. Variation of growth in the production of the BCG vaccine and the association with the immune response. An observational study within a randomised trial. Vaccine 2015; 33:2056-65. [DOI: 10.1016/j.vaccine.2015.02.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/20/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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Bjerregaard-Andersen M, Biering-Sørensen S, Gomes GM, Bidonga A, Jensen DM, Rodrigues A, Christensen K, Aaby P, Beck-Nielsen H, Benn CS, Sodemann M. Infant twin mortality and hospitalisations after the perinatal period - a prospective cohort study from Guinea-Bissau. Trop Med Int Health 2014; 19:1477-87. [PMID: 25244312 DOI: 10.1111/tmi.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine mortality and hospitalisations among infant twins and singletons after the perinatal period in Guinea-Bissau. METHODS The study was conducted from September 2009 to November 2012 by the Bandim Health Project (BHP). Newborn twins and unmatched singleton controls were included at the National Hospital Simão Mendes in the capital Bissau. Children were examined clinically at enrolment. Maternal, pregnancy and obstetric information was collected and HIV testing offered at birth. Follow-up occurred at home at 2, 6 and 12 months and through linkage with the paediatric admission register at the National Hospital. RESULTS About 495 twins and 333 singletons were alive on day 7 after birth. In total, 36 twins and 12 singletons died during follow-up, the post-perinatal infant mortality rate being 91/1000 person-years for twins and 42/1000 for singletons (HR = 2.11, 95% CI: 1.09-4.07). In a multivariable analysis among twins only, birth weight <2000 g [3.32, (1.36-8.07)], death of the cotwin perinatally [2.54, (1.16-5.57)] and severe maternal illness during pregnancy [2.35, (1.00-5.51)] were significant risk factors for twin death. In the subgroup with available HIV status, maternal HIV infection was strongly associated with twin mortality [3.16, (1.24-8.05)]. Death occurred at home for 60% of twins and 67% of singletons. During follow-up, 90 first-time hospital admissions were registered, with similar rates observed for twins (139/1000) and singletons (143/1000) [0.97, (0.61-1.52)]. CONCLUSION The post-perinatal infant mortality rate of twins was double that of singletons. No excess in twin hospitalisations was observed, possibly implying obstacles to hospital admission for twins in case of severe illness.
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Affiliation(s)
- M Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Statens Serum Institute, Copenhagen, Denmark
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20
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Jensen KJ, Larsen N, Biering-Sørensen S, Andersen A, Eriksen HB, Monteiro I, Hougaard D, Aaby P, Netea MG, Flanagan KL, Benn CS. Heterologous immunological effects of early BCG vaccination in low-birth-weight infants in Guinea-Bissau: a randomized-controlled trial. J Infect Dis 2014; 211:956-67. [PMID: 25210141 PMCID: PMC4340366 DOI: 10.1093/infdis/jiu508] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Bacillus Calmette–Guérin (BCG) seems to have beneficial nonspecific effects; early BCG vaccination of low-birth-weight (LBW) newborns reduces neonatal mortality by >40% due to prevention of primarily septicemia and pneumonia. Methods. Within a randomized trial in LBW infants in Guinea-Bissau of early BCG vs the usual postponed BCG, a subgroup was bled 4 weeks after randomization. Levels of interleukin (IL)-1β, IL-5, IL-6, IL-10, IL-17, interferon (IFN)-γ and tumor necrosis factor (TNF)-α were measured from whole-blood assays stimulated with innate agonists to Toll-like receptor (TLR)-2, -4 or -7/8, or purified protein derivative (PPD). Results. Among 467 infants, BCG significantly increased the in vitro cytokine responses to purified protein derivative of Mycobacterium tuberculosis (PPD), as expected. BCG was also associated with increased responses to heterologous innate stimulation, particularly of the cytokines IL-1β, IL-6, TNF-α, and IFN-γ. Conclusion. Four weeks after immunization, BCG-vaccinated infants have a significantly increased production of cytokines upon heterologous challenge, particularly T helper cell type 1 polarizing and typically monocyte-derived pro-inflammatory cytokines. BCG may accelerate the development of the neonatal immune system, mediating comprehensive protection against infections and mortality.
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Affiliation(s)
- Kristoffer Jarlov Jensen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Department of Cardiovascular and Renal Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark Projécto de Saúde Bandim, Indepth Network, codex 1004, Bissau, Guinea-Bissau
| | - Nanna Larsen
- Danish Centre for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - Sofie Biering-Sørensen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen
| | - Andreas Andersen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen
| | - Helle Brander Eriksen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen
| | - Ivan Monteiro
- Projécto de Saúde Bandim, Indepth Network, codex 1004, Bissau, Guinea-Bissau
| | - David Hougaard
- Danish Centre for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - Peter Aaby
- Projécto de Saúde Bandim, Indepth Network, codex 1004, Bissau, Guinea-Bissau
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katie L Flanagan
- Department of Immunology, Monash University, Melbourne, Australia
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Projécto de Saúde Bandim, Indepth Network, codex 1004, Bissau, Guinea-Bissau OPEN, University of Southern Denmark/Odense University Hospital
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21
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Lund N, Biering-Sørensen S, Andersen A, Monteiro I, Camala L, Jørgensen MJ, Aaby P, Benn CS. Neonatal vitamin A supplementation associated with a cluster of deaths and poor early growth in a randomised trial among low-birth-weight boys of vitamin A versus oral polio vaccine at birth. BMC Pediatr 2014; 14:214. [PMID: 25163399 PMCID: PMC4236664 DOI: 10.1186/1471-2431-14-214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/11/2014] [Indexed: 11/19/2022] Open
Abstract
Background The effect of oral polio vaccine administered already at birth (OPV0) on child survival was not examined before being recommended in 1985. Observational data suggested that OPV0 was harmful for boys, and trials have shown that neonatal vitamin A supplementation (NVAS) at birth may be beneficial for boys. We set out to test this research question in a randomised trial. Methods The trial was carried out at the Bandim Health Project, Guinea-Bissau. We planned to enrol 900 low-birth weight (LBW) boys in a randomised trial to investigate whether NVAS instead of OPV0 could lower infant mortality for LBW boys. At birth, the children were randomised to OPV (usual treatment) or VAS (intervention treatment) and followed for 6 months for growth and 12 months for survival. Hazard Ratios (HR) for mortality were calculated using Cox regression. We compared the individual anthropometry measurements to the 2006 WHO growth reference. We compared differences in z-scores by linear regression. Relative risks (RR) of being stunted or underweight were calculated in Poisson regression models with robust standard errors. Results In the rainy season we detected a cluster of deaths in the VAS group and the trial was halted immediately with 232 boys enrolled. The VAS group had significantly higher mortality than the OPV0 group in the rainy season (HR: 9.91 (1.23 – 80)). All deaths had had contact with the neonatal nursery; of seven VAS boys enrolled during one week in September, six died within two months of age, whereas only one died among the six boys receiving OPV (p = 0.05). Growth (weight and arm-circumference) in the VAS group was significantly worse until age 3 months. Conclusion VAS at birth instead of OPV was not beneficial for the LBW boys in this study. With the premature closure of the trial it was not possible to answer the research question. However, the results of this study call for extra caution when testing the effect of NVAS in the future. Trial registration http://www.clinicaltrials.gov NCT00625482. Registered 18 February 2008.
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Affiliation(s)
- Najaaraq Lund
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.
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Eriksen HB, Lund N, Biering-Sørensen S, Correia C, Barbosa A, Andersen A, Aaby P, Jeppesen DL, Benn CS. Does oral polio vaccine at birth affect the size of the thymus? Observations within a randomized trial. Vaccine 2014; 32:3293-9. [PMID: 24726247 DOI: 10.1016/j.vaccine.2014.03.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 02/05/2014] [Accepted: 03/26/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND There is increasing evidence that vaccines have an effect on general mortality which goes beyond specific disease protection. Oral polio vaccine (OPV) is widely used in low-income countries, but in observational studies in Guinea-Bissau we observed that not receiving OPV at birth was associated with reduced overall male infant mortality and enhanced immune response to BCG vaccine. We therefore initiated a randomized trial to test the overall effect of OPV at birth (OPV0). OBJECTIVE A small thymic gland is a predictor of mortality in high-mortality settings. Within the trial we aimed to test whether no-OPV0 was associated with increased thymic size. METHODS In 511 normal birth weight infants who were randomized to receive or not receive OPV0, thymic index and thymus/weight index were measured before randomization and after 2 weeks (N=49), 4 weeks (N=308) or 6 weeks (N=27). The association between OPV0 and the log transformed thymic size indicators were analyzed in ANCOVA models with thymic size at follow-up as the outcome and adjusting for thymic size at enrollment and age at follow-up. Estimates were reported as geometric mean ratios (GMR) with 95% confidence intervals, comparing no-OPV0 to OPV0. RESULTS No-OPV0 was not associated with thymic index after 2 weeks (GMR: 1.14 (0.99-1.30)), after 4 weeks (GMR: 0.98 (0.93-1.05)) or after 6 weeks (GMR: 1.00 (0.81-1.23)). However, no-OPV0 was associated with increased thymus/weight index after 2 weeks (GMR: 1.22 (1.06-1.40)), but the effect was not seen after 4 weeks (GMR: 0.97 (0.92-1.03)) and 6 weeks (GMR: 0.99 (0.82-1.19)). There were no strong sex-differences. DISCUSSION Overall there was no effect on thymic size of OPV0 when administered with BCG. The results could indicate that if an effect occurs, it is only within the first weeks after vaccination.
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Affiliation(s)
- Helle Brander Eriksen
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300 København S, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Kettegårds Alle 30, 2650 Hvidovre, Denmark.
| | - Najaaraq Lund
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300 København S, Denmark.
| | - Sofie Biering-Sørensen
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300 København S, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.
| | - Cizete Correia
- Bandim Health Project, INDEPTH Network, Bissau, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.
| | - Amarildo Barbosa
- Bandim Health Project, INDEPTH Network, Bissau, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.
| | - Andreas Andersen
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300 København S, Denmark.
| | - Peter Aaby
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300 København S, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.
| | - Dorthe L Jeppesen
- Pediatric Department, Copenhagen University Hospital, Hvidovre, Kettegårds Alle 30, 2650 Hvidovre, Denmark.
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Artillerivej 5, 2300 København S, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Apartado 861, 1004 Bissau Codex, Guinea-Bissau; OPEN, University of Southern Denmark, Windsløwparken 19, 3., 5000 Odense C, Denmark.
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Christensen LD, Eriksen HB, Biering-Sørensen S, Balé C, Do VA, Andersen A, Martins CL, Sodemann M, Aaby P, Benn CS. The effect of early measles vaccination on thymic size. A randomized study from Guinea-Bissau. Vaccine 2014; 32:1641-4. [PMID: 24522160 DOI: 10.1016/j.vaccine.2014.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/05/2014] [Accepted: 01/14/2014] [Indexed: 11/27/2022]
Abstract
UNLABELLED In low-income countries early measles vaccine (MV) is associated with reduced child mortality which cannot be explained by prevention of measles. A large thymus gland in infancy is also associated with reduced mortality. We hypothesized that early MV is associated with increased thymic size. Within a randomized trial providing MV at age 4.5 and 9 months or MV only at age 9 months, thymic size was assessed by ultrasound at age 4.5 months, before randomization to early MV or no early MV, and 4 weeks later. Among 656 children, there was no effect of early MV on thymic size, the geometric mean size ratio being 0.99 (95% CI: 0.96-1.02). In a post hoc analysis early MV was associated with a negative effect in healthy children but a positive effect in ill children. In conclusion, early MV at age 4.5 months had no overall effect on thymus size 4 weeks later. TRIAL REGISTRATION http://clinicaltrials.gov, NCT01486355.
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Affiliation(s)
| | - Helle Brander Eriksen
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Denmark.
| | - Sofie Biering-Sørensen
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
| | - Carlitos Balé
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
| | - Vu An Do
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Denmark.
| | - Andreas Andersen
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Denmark.
| | | | - Morten Sodemann
- Faculty of Health Sciences, University of Southern Denmark, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
| | - Peter Aaby
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; OPEN, Institute for Clinical Research, University of Southern Denmark and Odense University Hospital, Denmark.
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Kiraly N, Benn CS, Biering-Sørensen S, Rodrigues A, Jensen KJ, Ravn H, Allen KJ, Aaby P. Vitamin A supplementation and BCG vaccination at birth may affect atopy in childhood: long-term follow-up of a randomized controlled trial. Allergy 2013; 68:1168-76. [PMID: 23991838 DOI: 10.1111/all.12216] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recent evidence suggests that immunogenic interventions such as vaccines and micronutrients may affect atopic sensitization and atopic disease. We aimed to determine whether neonatal BCG vaccination, vitamin A supplementation and other vaccinations affect atopy in childhood. METHODS In Guinea-Bissau, low-birthweight infants were randomized to early (intervention) or delayed (usual policy) BCG. A subgroup was also randomly assigned vitamin A supplementation or placebo in a two-by-two factorial design. Participants were followed up at age 3-9 years. The main outcome was atopy defined as skin prick test reaction ≥3 mm. Secondary outcomes were symptoms of eczema, asthma and food allergy. RESULTS Two hundred eighty-one children had valid skin prick tests performed, and 14% (39/281) were atopic. There was no significant difference in atopy between the early and delayed BCG groups (OR, 0.71; 95% CI, 0.34-1.47). Atopy was significantly reduced in children who had responded to BCG with a scar (OR, 0.42; 0.19-0.94). Vitamin A supplementation was associated with increased atopy (OR, 2.88; 1.26-6.58), especially in those who received simultaneous BCG (5.99; 1.99-18.1, P = 0.09 for interaction between vitamin A supplementation and BCG). Early vs delayed BCG was not associated with symptoms of atopic disease, but vitamin A supplementation increased odds of wheeze within the past 12 months (OR, 2.45; 1.20-4.96). CONCLUSIONS There were no statistically significant effects of early vs delayed BCG on atopy or symptoms of atopic disease. Having a BCG scar was associated with reduced atopy, whereas neonatal vitamin A supplementation was associated with increased atopy. STUDY REGISTRATION Clinicaltrials.gov NCT 01420705.
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Affiliation(s)
| | | | | | - A. Rodrigues
- Bandim Health Project; Indepth Network; Bissau; Guinea-Bissau; Australia
| | - K. J. Jensen
- Bandim Health Project; Indepth Network; Bissau; Guinea-Bissau; Australia
| | - H. Ravn
- Research Center for Vitamins and Vaccines (CVIVA); Bandim Health Project; Statens Serum Institute; Copenhagen; Denmark
| | - K. J. Allen
- Murdoch Childrens Research Institute; Parkville; VIC; Australia
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Biering-Sørensen S, Fisker AB, Ravn H, Camala L, Monteiro I, Aaby P, Benn CS. The effect of neonatal vitamin A supplementation on growth in the first year of life among low-birth-weight infants in Guinea-Bissau: two by two factorial randomised controlled trial. BMC Pediatr 2013; 13:87. [PMID: 23702185 PMCID: PMC3680237 DOI: 10.1186/1471-2431-13-87] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/15/2013] [Indexed: 12/04/2022] Open
Abstract
Background Vitamin A supplementation (VAS) may amplify the effect of vaccines. We therefore investigated if neonatal VAS given with and without Bacille Calmette-Guérin (BCG) vaccine to low-birth-weight (LBW) neonates had an effect on growth in the first year of life. We hypothesised that VAS would be particularly beneficial when provided with BCG. Methods We conducted a randomised two-by-two factorial trial in Guinea-Bissau; 1,717 LBW neonates were randomly allocated to VAS or placebo at birth as well as early or the usual postponed BCG vaccination. Anthropometric measurements were obtained at 2, 6, and 12 months after inclusion. Results Overall there was no effect of neonatal VAS on growth in the first year of life. By 2 months, VAS tended to have a beneficial effect on weight and head circumference when given with BCG but not when given without BCG (interaction: weight-for-age p = 0.07 and head circumference-for-age: p = 0.06). By 6 months, there was a beneficial effect of VAS on head circumference and weight among children who had not received DTP vaccine 2 months after inclusion (weight: 0.18 (0.00; 0.36) and head circumference 0.27 (0.06; 0.48)), but no beneficial effect among those who had received DTP. Conclusion The results support other trials indicating that neonatal VAS does not have consistent effects on childhood growth and if anything the effects seem to be temporary. They also show that the effect may differ by vaccination status, being beneficial when given with BCG at birth and when DTP is delayed. Trial registration http://www.ClinicalTrials.gov (NCT00168610) (nct00168610)
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Aaby P, Ravn H, Roth A, Rodrigues A, Lisse IM, Diness BR, Lausch KR, Lund N, Rasmussen J, Biering-Sørensen S, Whittle H, Benn CS. Early diphtheria-tetanus-pertussis vaccination associated with higher female mortality and no difference in male mortality in a cohort of low birthweight children: an observational study within a randomised trial. Arch Dis Child 2012; 97:685-91. [PMID: 22331681 PMCID: PMC3409557 DOI: 10.1136/archdischild-2011-300646] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Studies from low-income countries have suggested that diphtheria-tetanus-pertussis (DTP) vaccine provided after Bacille Calmette-Guerin (BCG) vaccination may have a negative effect on female survival. The authors examined the effect of DTP in a cohort of low birthweight (LBW) infants. METHODS 2320 LBW newborns were visited at 2, 6 and 12 months of age to assess nutritional and vaccination status. The authors examined survival until the 6-month visit for children who were DTP vaccinated and DTP unvaccinated at the 2-month visit. RESULTS Two-thirds of the children had received DTP at 2 months and 50 deaths occurred between the 2-month and 6-month visits. DTP vaccinated children had a better anthropometric status for all indices than DTP unvaccinated children. Small mid-upper arm circumference (MUAC) was the strongest predictor of mortality. The death rate ratio (DRR) for DTP vaccinated versus DTP unvaccinated children differed significantly for girls (DRR 2.45; 95% CI 0.93 to 6.45) and boys (DRR 0.53; 95% CI 0.23 to 1.20) (p=0.018, homogeneity test). Adjusting for MUAC, the overall effect for DTP vaccinated children was 2.62 (95% CI 1.34 to 5.09); DRR was 5.68 (95% CI 1.83 to 17.7) for girls and 1.29 (95% CI 0.56 to 2.97) for boys (p=0.023, homogeneity test). While anthropometric indices were a strong predictor of mortality among boys, there was little or no association for girls. CONCLUSION Surprisingly, even though the children with the best nutritional status were vaccinated early, early DTP vaccination was associated with increased mortality for girls.
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Affiliation(s)
- Peter Aaby
- Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Henrik Ravn
- Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Adam Roth
- Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark,Department of Medical Microbiology, Lund University, Malmö, Sweden
| | | | - Ida Maria Lisse
- Department of Pathology, Herlev University Hospital, Copenhagen, Denmark
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Biering-Sørensen S, Søndergaard G, Vitting Andersen K, Andersen AMN, Mortensen LH. Time trends in socio-economic factors and risk of hospitalisation with infectious diseases in pre-school children 1985-2004: a Danish register-based study. Paediatr Perinat Epidemiol 2012; 26:226-35. [PMID: 22471682 DOI: 10.1111/j.1365-3016.2011.01255.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to examine socio-economic differences in the risk of hospitalisation among children aged 0-5 years in Denmark from 1985 to 2004. All children born between 1985 and 2004 (n=1,278,286) were followed for hospital admissions for infectious diseases from the 29th day of life until the children reached the age of 6 years or the end of 2004, whichever came first. Information on parental socio-economic position (education, labour market attachment and household income) was gathered through record linkage with administrative registries. Infections were grouped into upper respiratory, lower respiratory, gastrointestinal, ear and fever infections. The data were analysed using Cox regression. Children of parents on sick leave or early retirement had an increased risk of being hospitalised with an infection compared with children of employed parents. A clear inverse educational gradient in risk of offspring hospitalisation was also found. From 1985 to 2004 the inverse associations between parental education and risk of hospitalisation grew stronger, whereas the comparatively weaker association between household income and risk of offspring hospitalisation decreased in magnitude. The association between socio-economic status and hospitalisation was strongest for lower respiratory, gastrointestinal and ear infections. This study documented a socially patterned hospitalisation of pre-school children in Denmark. Future studies should investigate possible explanations for the increased risk among children from families with low socio-economic status.
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Affiliation(s)
- Sofie Biering-Sørensen
- Bandim Health Project, Statens Serum Institut Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
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Fisker AB, Aaby P, Bale C, Balde I, Biering-Sørensen S, Agergaard J, Martins C, Bibby BM, Benn CS. Does the effect of vitamin A supplements depend on vaccination status? An observational study from Guinea-Bissau. BMJ Open 2012; 2:e000448. [PMID: 22240648 PMCID: PMC3278485 DOI: 10.1136/bmjopen-2011-000448] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective Vitamin A supplementation (VAS) is estimated to reduce all-cause mortality by 24%. Previous studies indicate that the effect of VAS may vary with vaccination status. The authors evaluated the effect of VAS provided in campaigns on child survival overall and by sex and vaccination status at the time of supplementation. Design Observational cohort study. Setting and participants The study was conducted in the urban study area of the Bandim Health Project in Guinea-Bissau. The authors documented participation or non-participation in two national vitamin A campaigns in December 2007 and July 2008 for children between 6 and 35 months of age. Vaccination status was ascertained by inspection of vaccination cards. All children were followed prospectively. Outcome measures Mortality rates for supplemented and non-supplemented children were compared in Cox models providing mortality rate ratios (MRRs). Results The authors obtained information from 93% of 5567 children in 2007 and 90% of 5799 children in 2008. The VAS coverage was 58% in 2007 and 68% in 2008. Mortality in the supplemented group was 1.5% (44 deaths/2873 person-years) and 1.6% (20 deaths/1260 person-years) in the non-supplemented group (adjusted MRR=0.78 (0.46; 1.34)). The effect was similar in boys and girls. Vaccination cards were seen for 86% in 2007 and 84% in 2008. The effect of VAS in children who had measles vaccine as their last vaccine (2814 children, adjusted MRR=0.34 (0.14; 0.85)) differed from the effect in children who had diphtheria-tetanus-pertussis vaccine as their last vaccine (3680 children, adjusted MRR=1.29 (0.52; 3.22), p=0.04 for interaction). Conclusion The effect of VAS differed by most recent vaccination, being beneficial after measles vaccine but not after diphtheria-tetanus-pertussis vaccine.
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Affiliation(s)
- Ane B Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Statens Serum Institut, Copenhagen S, Denmark
- Department of Biostatistics, Institute of Public Health, University of Aarhus, Aarhus, Denmark
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Statens Serum Institut, Copenhagen S, Denmark
| | - Carlito Bale
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Ibraima Balde
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Sofie Biering-Sørensen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Statens Serum Institut, Copenhagen S, Denmark
| | - Jane Agergaard
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark
| | - Cesario Martins
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Bo M Bibby
- Department of Biostatistics, Institute of Public Health, University of Aarhus, Aarhus, Denmark
| | - Christine S Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Statens Serum Institut, Copenhagen S, Denmark
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Aaby P, Roth A, Ravn H, Napirna BM, Rodrigues A, Lisse IM, Stensballe L, Diness BR, Lausch KR, Lund N, Biering-Sørensen S, Whittle H, Benn CS. Randomized trial of BCG vaccination at birth to low-birth-weight children: beneficial nonspecific effects in the neonatal period? J Infect Dis 2011; 204:245-52. [PMID: 21673035 DOI: 10.1093/infdis/jir240] [Citation(s) in RCA: 414] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Observational studies have suggested that BCG may have nonspecific beneficial effects on survival. Low-birth-weight (LBW) children are not given BCG at birth in Guinea-Bissau; we conducted a randomized trial of BCG at birth (early BCG) vs delayed BCG. METHODS In the period 2004-2008 we recruited 2320 LBW children in Bissau. The children were visited at home at 2, 6, and 12 months of age. With a pretrial infant mortality of 250 per 1000, we hypothesized a 25% reduction in infant mortality for LBW children. RESULTS Infant mortality was only 101 per 1000 during the trial. In the primary analysis, infant mortality was reduced insignificantly by 17% (mortality rate ratio [MRR] = .83 [.63-1.08]). In secondary analyses, early BCG vaccine was safe with an MRR of .49 (.21-1.15) after 3 days and .55 (.34-.89) after 4 weeks. The reduction in neonatal mortality was mainly due to fewer cases of neonatal sepsis, respiratory infection, and fever. The impact of early BCG on infant mortality was marked for children weighing <1.5 kg (MRR = .43 [.21-.85]) who had lower coverage for diphtheria-tetanus-pertussis vaccinations. CONCLUSIONS Though early BCG did not reduce infant mortality significantly, it may have a beneficial effect in the neonatal period. This could be important for public health because BCG is often delayed in low-income countries.
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Affiliation(s)
- Peter Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
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Coolidge JAS, Herner EB, Bülow SLM, Biering-Sørensen S. [Obesity and life-style in 5-8-year-old children]. Ugeskr Laeger 2010; 172:2535-2539. [PMID: 20836964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The purpose of this study was to describe the prevalence of overweight and variations in physical activity and smoking habits among parents in three suburbs of Copenhagen, focusing on differences related to ethnic Danish and bilingual children, respectively. MATERIAL AND METHODS The health profile was completed as part of a physician health check-up at school start. The questionnaire included registration of the parents' employment status, parental smoking habits, and health behaviour among the children. The children's height and weight were registered. A total of 823 children were included (participation rate of 96.1%) of which 201 were bilingual. RESULTS 21.2% of the children had a weight exceeding the 90 percentile (based on a Danish standard). Of these, 8.7% had a weight exceeding the 97 percentile. 32.2% of the bilingual children were overweight while 18% of the ethnic Danish children were overweight (p = 0.001). Fewer children were overweight in the more affluent suburb to the north of Copenhagen than in the two other suburbs. Fewer bilingual children were involved in organized sports and walked or cycled to school. More bilingual children were exposed to passive smoking in the home and spent longer time in front of a screen. CONCLUSION At school start, approximately one fifth of the children in three Copenhagen suburbs had a weight exceeding the 90 percentile and approximately 9% over the 97 percentile. Bilingual children were more often exposed to risk factors predisposing to lifestyle diseases.
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Søndergaard G, Biering-Sørensen S, Ishøy Michelsen S, Schnor O, Nybo Andersen AM. Non-participation in preventive child health examinations at the general practitioner in Denmark: a register-based study. Scand J Prim Health Care 2008; 26:5-11. [PMID: 18297556 PMCID: PMC3406629 DOI: 10.1080/02813430801940877] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To examine demographic and socioeconomic characteristics of parents and children in families not participating in preventive child health examinations at the general practitioner in a society with free and easy access to healthcare. DESIGN Population-covering register linkage study. SETTING Denmark, 2002-2004. SUBJECTS Two cohorts comprising all children born in Denmark between 1 July 1998 and 30 June 1999 (n =70 891) and in 2002 (n =65 995), respectively. The demographic and socioeconomic characteristics of these children and the adults living in the same household as these were identified through register linkage. MAIN OUTCOME MEASURES Crude and mutually adjusted odds ratios for non-participation in scheduled preventive child health examinations at the GP (age 5 weeks, 5 months, 12 months, 4 years, and 5 years) according to child characteristics (sex, number of hospitalizations, and older siblings) and parental characteristics (age, educational level, attachment to labour market, ethnicity, household income, and number of adults in the household). RESULTS Children of young and single parents were less likely to receive a preventive child health examination. Increased odds ratios for non-participation were found for children of parents outside the labour market, with low educational level, and especially for the combination of these. Non-participation increased with decreasing household income and with the number of older siblings. CONCLUSION Despite the fact that Denmark has free and easy access to the GP, the utilization of preventive child health examinations is lower among the more deprived part of the population.
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Affiliation(s)
- Grethe Søndergaard
- 1National Institute of Public Health, University of Southern Denmark, Copenhagen
| | | | | | - Ole Schnor
- 1National Institute of Public Health, University of Southern Denmark, Copenhagen
| | - Anne-Marie Nybo Andersen
- 1National Institute of Public Health, University of Southern Denmark, Copenhagen
- 2Division of Epidemiology, University of Southern Denmark, Odense, Denmark
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