The effect of early measles vaccination at 4.5 months of age on growth at 9 and 24 months of age in a randomized trial in Guinea-Bissau

Abstract

BackgroundProviding an early, additional measles vaccine (MV) at 4.5 months of age has been shown to reduce child mortality in low-income countries. We studied the effects on growth at 9 and 24 months of age.MethodsA randomized controlled trial was conducted in Guinea-Bissau from 2003–2007 including 6,648 children. Children were randomized 1:1:1 to receive Edmonston-Zagreb measles vaccine at 4.5 and 9 months of age (group A), no vaccine at 4.5 months and Edmonston-Zagreb measles vaccine at 9 months (group B), or no vaccine at 4.5 months and Schwarz measles vaccine at 9 months (group C) Data on anthropometrics were obtained at enrolment at 4.5 months of age and again at 9 and 24 months of age. Analyses were stratified by sex, season of enrolment, and neonatal vitamin A supplementation (NVAS) status, as all these factors have been shown to modify the effect of early MV on mortality.ResultsOverall there was no effect of early MV on anthropometry at 9 months. At 24 months children who had received early MV had a significantly larger mid-upper-arm-circumference (MUAC/in cm) (Difference = 0.08; 95% CI (0.02;0.14)) compared with children in the control group; this effect was most pronounced among girls (0.12 (0.03;0.20)). The effect of early MV on MUAC remained significant in the dry season and in girls who received placebo rather than NVAS.ConclusionEarly MV was associated with a larger MUAC particularly in girls. These results indicate that a two-dose measles vaccination schedule might not only reduce child mortality but also improve growth.Trial registrationClinicalTrials.gov NCT00168558. Registered September 9, 2005, retrospectively registeredElectronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0738-z) contains supplementary material, which is available to authorized users.

Sero-Prevalence of Measles in Southern Darfur State, Sudan

“…Serologic and epidemiologic studies suggest that 1-dose measles vaccine efficacy is approximately 85%-90% when given at nine months of age and that 2-dose effectiveness is >99% when the second dose is given at ≥12 months of age. A two-dose measles vaccination schedule might reduce not only child mortality but also improve growth [10]. This may confirm the previous studies on vaccination coverage in other parts of the world which shown socioeconomic status, insecurity, cultural diversity, community attitude towards measles and religion plays an important reason for lack of vaccine covered [25,26].…”

“…A second dose of measles-containing vaccine given during supplemental immunization activities played a vital role in raising the population's immunity levels. However, routine vaccination coverage remains low, and health systems are still weak [9,10]. The previous study showed that 86.8% of children were positive for the anti-measles virus-specific IgM antibodies [11].…”

The effect of early measles vaccination on morbidity and growth: A randomised trial from Guinea-Bissau

“…A previous study investigating the effect of early MV on anthropometrics found that early MV was associated with larger MUAC at 24 months of age after both groups had (also) received the 9 months MV, especially for girls (13). The effect was not detectable at 9 months of age.…”

Waning of Maternal Antibodies against Measles Suggests a Large Window of Susceptibility in Infants in Lao People’s Democratic Republic

“…However, humoral immunogenicity is reduced when measles vaccination is administered at 6 months, with an average seroconversion rate of 76% compared with 92% at 9 months [ 37 ]. As a result, vaccine effectiveness has been demonstrated to be lower in those under 9 months but whether or not administration would still be beneficial in terms of reducing disease severity and overall morbidity is an ongoing discussion [ 2 , 11 , 37 , 38 , 39 , 40 , 41 ]. Meta-analysis suggests that antibody levels are reduced in infants immunized before 9 months even after subsequent MCV1 and MCV2 vaccination, while differences in seropositivity, T cell responses, and vaccine effectiveness are not seen [ 42 ].…”