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Effect of early measles vaccine on pneumococcal colonization: A randomized trial from Guinea-Bissau
Nadja Skadkær Hansen1,2, Stine Byberg1,2, Lars Hervig Jacobsen1,2
1Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.
Insights
Early measles vaccination (MV) at 18 weeks did not affect pneumococcal colonization or density in infants. Higher antibiotic use in controls might have masked potential benefits of the measles vaccine.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Measles vaccine (MV) may offer non-specific health benefits, including protection against respiratory infections.
- Streptococcus pneumoniae is a leading cause of childhood bacterial pneumonia, with nasopharyngeal colonization preceding infection.
Purpose of the Study:
- To investigate if early MV administration at 18 weeks reduces pneumococcal colonization and/or density up to 9 months of age.
- To assess the impact of early MV on nasopharyngeal carriage of Streptococcus pneumoniae in infants.
Main Methods:
- A randomized controlled trial in Guinea-Bissau involving 512 infants randomized to receive early MV or no early MV.
- Nasopharyngeal swabs collected at baseline, 6.5 months, and 9 months to quantify pneumococcal density using qPCR.
- Poisson and OLS regression used to estimate prevalence ratios and geometric mean ratios of pneumococcal colonization and density.
Main Results:
- Early MV administration showed no significant effect on pneumococcal colonization prevalence (PR6.5=1.02, PR9=1.04) or density (GMR6.5=1.02, GMR9=0.69).
- Antibiotic treatment was associated with reduced pneumococcal colonization and density.
- A trend suggested lower antibiotic use in the early MV group, potentially confounding results.
Conclusions:
- Early measles vaccination at 18 weeks of age did not demonstrate a measurable impact on pneumococcal colonization or density.
- Higher antibiotic consumption in the control group may have obscured any potential beneficial effect of early MV on pneumococcal carriage.
Background:
Measles vaccine (MV) may have non-specific beneficial effects for child health and particularly seems to prevent respiratory infections. Streptococcus pneumoniae is the leading cause of bacterial pneumonia among children worldwide, and nasopharyngeal colonization precedes infection.
Objective:
We investigated whether providing early MV at 18 weeks of age reduced pneumococcal colonization and/or density up to 9 months of age.
Method:
The study was conducted in 2013-2014 in Guinea-Bissau. Pneumococcal vaccine was not part of the vaccination program. Infants aged 18 weeks were block-randomized 2:1 to early or no early MV; at age 9 months, all children were offered MV as per current policy. Nasopharyngeal swabs were taken at baseline, age 6.5 months, and age 9 months. Pneumococcal density was determined by q-PCR. Prevalence ratios of pneumococcal colonization and recent antibiotic treatment (yes/no) by age 6.5 months (PR6.5) and age 9 months (PR9) were estimated using Poisson regression with robust variance estimates while the pneumococcal geometric mean ratio (GMR6.5 and GMR9) was obtained using OLS regression.
Results:
Analyses included 512 children; 346 early MV-children and 166 controls. At enrolment, the pneumococcal colonization prevalence was 80% (411/512). Comparing early MV-children with controls, the PR6.5 was 1.02 (95%CI = 0.94-1.10), and the PR9 was 1.04 (0.96-1.12). The GMR6.5 was 1.02 (0.55-1.89), and the GMR9 was 0.69 (0.39-1.21). Early MV-children tended to be less frequently treated with antibiotics prior to follow up (PR6.5 0.60 (0.34-1.05) and PR9 0.87 (0.50-1.53)). Antibiotic treatment was associated with considerably lower colonization rates, PR6.5 0.85 (0.71-1.01) and PR9 0.66 (0.52-0.84), as well as lower pneumococcal density, GMR6.5 0.32 (0.12-0.86) and GMR9 0.52 (0.18-1.52).
Conclusion:
Early MV at age 18 weeks had no measurable effect on pneumococcal colonization prevalence or density. Higher consumption of antibiotics among controls may have blurred an effect of early MV.
Trial Registration:
clinicaltrials.gov NCT01486355.