Reduced All-cause Child Mortality After General Measles Vaccination Campaign in Rural Guinea-Bissau

Fisker, Ane Bærent; Rodrigues, Amabélia; Martins, Cesário; Ravn, Henrik; Byberg, Stine; Thysen, Sanne Marie; Storgaard, Line Margrethe Hust; Pedersen, Marie; Fernandes, Manuel; Benn, Christine Stabell; Aaby, Péter

doi:10.1097/inf.0000000000000896

Cited by 30 publications

(24 citation statements)

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“…Nonetheless the country experienced a large decline in mortality in the 2000s and actually reached the MDG4. The repeated national OPV and MV campaigns conducted since 1999 may have had major effects in terms of reducing general mortality (Fisker et al, 2015; unpublished data; authors).…”

Section: Discussionmentioning

confidence: 99%

Revaccination with Live Attenuated Vaccines Confer Additional Beneficial Nonspecific Effects on Overall Survival: A Review

et al. 2016

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BackgroundLive vaccines against measles (MV), tuberculosis (BCG), polio (OPV) and smallpox reduce mortality more than explained by target-disease prevention. The beneficial nonspecific effects (NSEs) of MV are strongest when MV is given in presence of maternal antibodies. We therefore hypothesised that revaccination in presence of prior immunity enhances beneficial NSEs.MethodsLiterature search for studies of revaccination and mortality.FindingsIn two randomised trials (RCTs), two doses versus one dose of MV reduced all-cause mortality by 63% (95% CI: 23–83%) from 9 to 18 months of age. In a quasi-experimental study two doses before and after 9 months compared with one dose of MV after 9 months of age reduced mortality by 59% (25–81%). BCG-revaccination significantly enhanced BCG's effect against overall child mortality in two RCTs. In a natural experiment study of OPV campaigns over a 13-year-period in Guinea-Bissau, each additional dose of OPV was associated with a 13% (4–21%) reduction in mortality rate. The beneficial NSEs of smallpox vaccination for survival increased significantly with the number of smallpox vaccination scars.InterpretationRevaccination with live vaccines led to substantial reductions in overall mortality. These findings challenge current understanding of vaccines and may explain the beneficial effects of campaigns with live vaccines.

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Section: Discussionmentioning

confidence: 99%

Revaccination with Live Attenuated Vaccines Confer Additional Beneficial Nonspecific Effects on Overall Survival: A Review

et al. 2016

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“…Further analysis of our data (unpublished) showed some reduction in cause specific mortality from pneumonia and septicaemia in under 2 year olds during this period but rose thereafter. It could be that the fall was due to other interventions or the non-specific effects of vaccination campaigns (Table 3) and the limitations of this study design did not enable the contribution of Hib vaccine to be adequately determined [26,50]. Between 2012 and 2013, there was a fall in mortality coinciding with introduction of pneumococcal and rotavirus vaccines.…”

Section: Discussionmentioning

confidence: 99%

Observations from Mortality Trends at The Children’s Hospital, Accra, 2003-2013

Tette¹,

Neizer²,

Nyarko³

et al. 2016

PLoS ONE

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ObjectiveFacility-based studies provide an unparalleled opportunity to assess interventions deployed in hospitals to reduce child mortality which is not easily captured in the national data. We examined mortality trends at the Princess Marie Louise Children’s Hospital (PML) and related it to interventions deployed in the hospital and community to reduce child mortality and achieve the Millennium Development Goal 4 (MDG 4).MethodsThe study was a cross-sectional review of data on consecutive patients who died at the hospital over a period of 11 years, between 2003 and 2013. The total admissions for each year, the major hospital-based and population-based interventions, which took place within the period, were also obtained.ResultsOut of a total of 37,012 admissions, 1,314 (3.6%) deaths occurred and admissions tripled during the period. The average annual change in mortality was -7.12% overall, -7.38% in under-fives, and -1.47% in children ≥5 years. The majority of the deaths, 1,187 (90.3%), occurred in under-fives. The observed decrease in under-five (and overall) mortality rate occurred in a specific and peculiar pattern. Most of the decrease occurred during the period between 2003 and 2006. After that there was a noticeable increase from 2006 to 2008. Then, the rate slowly decreased until the end of the study period in 2013. There was a concomitant decline in malaria mortality following a pattern similar to the decline observed in other parts of the continent during this period. Several interventions might have contributed to the reduction in mortality including the change in malaria treatment policy, improved treatment of malnutrition and increasing paediatric input.ConclusionUnder-fives mortality at PML has declined considerably; however, the reduction in mortality in older children has been minimal and thus requires special attention. Data collection for mortality reviews should be planned and commissioned regularly in hospitals to assess the effects of interventions and understand the context in which they occur. This will provide benchmarks and an impetus for improving care, identify shortfalls and ensure that the gains in child survival are maintained.

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“…Thus, it could be documented that in these areas the infant mortality rate dropped from 192 per 1000 in the early 1990’s [4], to 135 per 1000 in the 2003–5 [5]. It has been suggested that the observed decline in mortality may be due to a drop in the malaria prevalence [6, 7], or improved coverage of routine vaccinations or even the increasing number of campaigns with vaccines and vitamin A supplementation [8, 9]. However, the main reasons for the decline in mortality have not been determined.…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors for infant mortality in the 1992-3 and 2002-3 birth cohorts in rural Guinea-Bissau

et al. 2017

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IntroductionThough still high, the infant mortality rate in Guinea-Bissau has declined. We aimed to identify risk factors including vaccination coverage, for infant mortality in the rural population of Guinea-Bissau and assess whether these risk factors changed from 1992–3 to 2002–3.MethodsThe Bandim Health Project (BHP) continuously surveys children in rural Guinea-Bissau. We investigated the association between maternal and infant factors (especially DTP and measles coverage) and infant mortality. Hazard ratios (HR) were calculated using Cox regression. We tested for interactions with sex, age groups (defined by current vaccination schedule) and cohort to assess whether the risk factors were the same for boys and girls, in different age groups in 1992–3 and in 2002–3.ResultsThe infant mortality rate declined from 148/1000 person years (PYRS) in 1992–3 to 124/1000 PYRS in 2002–3 (HR = 0.88;95%CI:0.77–0.99); this decline was significant for girls (0.77;0.64–0.94) but not for boys (0.97;0.82–1.15) (p = 0.10 for interaction). Risk factors did not differ significantly by cohort in either distribution or effect. Mortality decline was most marked among girls aged 9–11 months (0.56;0.37–0.83). There was no significant mortality decline for girls 1.5–8 months of age (0.93;0.68–1.28) (p = 0.05 for interaction). DTP and measles coverage increased from 1992–3 to 2002–3.ConclusionsRisk factors did not change with the decline in mortality. Due to beneficial non-specific effects for girls, the increased coverage of measles vaccination may have contributed to the disproportional decline in mortality by sex and age group.

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Reduced All-cause Child Mortality After General Measles Vaccination Campaign in Rural Guinea-Bissau

Abstract: Mortality levels were stable during 2004 and 2005, but a significant drop occurred after the 2006 MV campaign and was not explained by the prevention of measles deaths. If MV campaigns reduce nonmeasles-related mortality, the policies for measles vaccination should take this into account.

Cited by 30 publications

References 33 publications

Revaccination with Live Attenuated Vaccines Confer Additional Beneficial Nonspecific Effects on Overall Survival: A Review

Revaccination with Live Attenuated Vaccines Confer Additional Beneficial Nonspecific Effects on Overall Survival: A Review

Observations from Mortality Trends at The Children’s Hospital, Accra, 2003-2013

Analysis of risk factors for infant mortality in the 1992-3 and 2002-3 birth cohorts in rural Guinea-Bissau

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