Measles vaccination in the presence or absence of maternal measles antibody: impact on child survival
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BACKGROUND: Measles vaccine (MV) has a greater effect on child survival when administered in early infancy, when maternal antibody may still be present.
METHODS: To test whether MV has a greater effect on overall survival if given in the presence of maternal measles antibody, we reanalyzed data from 2 previously published randomized trials of a 2-dose schedule with MV given at 4-6 months and at 9 months of age. In both trials antibody levels had been measured before early measles vaccination.
RESULTS: In trial I (1993-1995), the mortality rate was 0.0 per 1000 person-years among children vaccinated with MV in the presence of maternal antibody and 32.3 per 1000 person-years without maternal antibody (mortality rate ratio [MRR], 0.0; 95% confidence interval [CI], 0-.52). In trial II (2003-2007), the mortality rate was 4.2 per 1000 person-years among children vaccinated in presence of maternal measles antibody and 14.5 per 1000 person-years without measles antibody (MRR, 0.29; 95% CI, .09-.91). Possible confounding factors did not explain the difference. In a combined analysis, children who had measles antibody detected when they received their first dose of MV at 4-6 months of age had lower mortality than children with no maternal antibody, the MRR being 0.22 (95% CI, .07-.64) between 4-6 months and 5 years.
CONCLUSIONS: Child mortality in low-income countries may be reduced by vaccinating against measles in the presence of maternal antibody, using a 2-dose schedule with the first dose at 4-6 months (earlier than currently recommended) and a booster dose at 9-12 months of age.
CLINICAL TRIALS REGISTRATION: NCT00168558.
Original language | English |
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Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America |
Volume | 59 |
Issue number | 4 |
Pages (from-to) | 484-92 |
Number of pages | 9 |
ISSN | 1058-4838 |
DOIs | |
Publication status | Published - 15 Aug 2014 |
- Antibodies, Viral, Child, Preschool, Developing Countries, Female, Humans, Immunity, Maternally-Acquired, Infant, Male, Measles, Measles Vaccine, Survival Analysis, Vaccination
Research areas
ID: 136852447