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Diphtheria-tetanus-pertussis vaccination administered after measles vaccine: increased female mortality?

Christine Stabell Benn1, Peter Aaby

  • 1Bandim Health Project, Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen S, Denmark. cb@ssi.dk

The Pediatric Infectious Disease Journal
|June 12, 2012
PubMed

Insights

Delayed diphtheria-tetanus-pertussis (DTP) vaccination after measles vaccine increases mortality risk in female children in low-income countries. This sex-differential effect highlights the importance of timely DTP immunization for young girls.

Area of Science:

  • Pediatrics
  • Immunology
  • Global Health

Background:

  • Standard childhood immunization schedules in low-income countries recommend diphtheria-tetanus-pertussis (DTP) vaccine at 6, 10, and 14 weeks and measles vaccine at 9 months.
  • Deviations from the schedule are common, with DTP often administered after the measles vaccine.
  • Prior studies suggest this delayed DTP vaccination may disproportionately increase mortality risk in female infants.

Purpose of the Study:

  • To investigate the association between delayed diphtheria-tetanus-pertussis (DTP) vaccination and sex-differential mortality.
  • To determine if missing DTP doses at 9 months impacts mortality risk differently in male and female children.

Main Methods:

  • Analysis of vaccination data from 455 children participating in a vitamin A trial in Guinea-Bissau.
  • Vaccination status for DTP was recorded at the time of measles vaccination (9 months of age).
  • Mortality risk was compared between children missing DTP doses and those who received all DTP doses by 36 months of age, stratified by sex.

Main Results:

  • Of 455 children, 141 (31%) were missing at least one DTP dose at 9 months.
  • Female children missing DTP vaccination showed a 3.55 times higher risk of mortality before 36 months (95% CI: 1.23-10.26).
  • No significant difference in mortality risk was observed for male children missing DTP vaccination (0.97 [0.34-2.80]).

Conclusions:

  • The findings support a negative impact of receiving diphtheria-tetanus-pertussis (DTP) vaccine after measles vaccine on female children's survival.
  • Timely administration of the DTP vaccine series is crucial, particularly for female infants, to mitigate potential mortality risks.
  • This sex-specific association warrants further investigation into the biological or social mechanisms underlying the observed disparities.

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