Routine vaccinations associated with divergent effects on female and male mortality at the paediatric ward in Bissau, Guinea-Bissau

Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial

“…The original study found a beneficial effect of VAS on overall mortality; the MRR between VAS and placebo recipients was 0.81 (95% CI: 0.68, 0.98) (22). In the present reanalysis, which focused on the children enrolled at the first round who had or did not have a child-held health card, the overall effect of VAS on mortality was similar: 0.79 (95% CI: 0.63, 0.98).…”

“…The live vaccines bacille Calmette-Guérin (BCG), which is recommended at birth, and measles vaccine (MV), which is recommended at 9 mo of age, are associated with decreased overall mortality (14)(15)(16)(17), whereas diphtheria-tetanus-pertussis vaccine (DTP), which is recommended at 6, 10, and 14 wk of age, is associated with increased mortality in areas where exposure to pertussis is limited because of high vaccination coverage (18)(19)(20). Intriguingly, both beneficial and negative effects of vaccines have been strongest in girls (21)(22)(23).…”

“…This would explain the mortality-age pattern after VAS. Because the nonspecific effects of vaccines are strongest in girls (21)(22)(23), the interaction between VAS and vaccines could be expected to be most pronounced in girls.…”

Non-specific and sex-differential effects of routine vaccines: What evidence is needed to take these effects into consideration in low-income countries?

“…36 Third, we have shown repeatedly that girls have higher mortality than boy after DTP vaccination as the most recent vaccine. 34,36,38,39,42,44 Fourth, given the sexdifferential effect of DTP, we tested the hypothesis that the problem of increased female mortality after HTMV was due to a change in the sequence of vaccinations. HTMV was given early at 4-5 months of age and most children received DTP after HTMV.…”

“…36 There is now a lot of evidence suggesting that DTP may have negative effects on child survival. 3,22,[34][35][36][37][38][39][40][41][42][43][44][45][46] First, all prospective observational studies testing several vaccines in the same population have shown that DTP has a negative effect on survival whereas BCG and MV have beneficial effects. 22,36,44,46 Second, we have shown in two "natural experiment" studies with minimal selection bias that DTP was associated with two-to three-fold reasoning.…”