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Non-live pentavalent vaccines after live measles vaccine may increase mortality

Ane Bærent Fisker1, Sanne Marie Thysen2

  • 1Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, 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, 5000 Odense C, Denmark.

Vaccine
|September 10, 2018
PubMed

Insights

The live measles vaccine (MV) offers survival benefits beyond measles prevention. However, the sequence of MV and pentavalent vaccine (Penta) administration impacts child mortality, with out-of-sequence dosing potentially increasing risks.

Area of Science:

  • Immunology
  • Public Health
  • Pediatrics

Background:

  • Live measles vaccine (MV) may confer non-specific effects (NSEs) reducing child mortality.
  • Non-live pentavalent vaccine (Penta) lacks these beneficial NSEs.
  • Vaccine sequencing may influence child survival outcomes.

Purpose of the Study:

  • To investigate the impact of measles vaccine and pentavalent vaccine (Penta3) administration sequence on child survival in Guinea-Bissau.
  • To determine if out-of-sequence vaccination affects mortality rates.

Main Methods:

  • Prospective follow-up of 7094 children vaccinated with MV from 9 months to 5 years of age.
  • Comparison of survival rates based on the sequence of MV and Penta3 administration using Cox proportional-hazards models.
  • Analysis of mortality risk associated with receiving Penta doses out-of-sequence or missing doses.

Main Results:

  • Receiving Penta3 after MV (out-of-sequence) was associated with a non-significant increased hazard ratio (aHR) of 1.19 (95% CI: 0.84-1.69).
  • Administering missing Penta doses during the MV visit showed a trend towards higher mortality (aHR = 1.87; 95% CI: 0.96-3.65).
  • Not receiving missing Penta doses was not associated with increased mortality (aHR = 0.93; 95% CI: 0.57-1.54).

Conclusions:

  • Vaccine sequencing, particularly the timing of pentavalent vaccine relative to measles vaccine, may influence child survival.
  • Further research is needed to understand the implications of vaccine scheduling on non-specific effects and overall child mortality.
  • The findings suggest potential risks associated with deviations from recommended vaccination schedules.
Keywords:
Child mortalityExpanded programme on immunizationsHeterologous immunityNon-specific effects of vaccines

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