Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Increased Female-Male Mortality Ratio Associated With Inactivated Polio and Diphtheria-Tetanus-Pertussis Vaccines: Observations From Vaccination Trials in Guinea-Bissau

Aaby, Peter MSc*†; Garly, May-Lill MD, PhD*†; Nielsen, Jens MSc*†; Ravn, Henrik PhD*†; Martins, Cesario MD, MSc*; Balé, Carlitos MD*; Rodrigues, Amabelia PhD*; Benn, Christine Stabell MD, PhD*†; Lisse, Ida Maria MD*†

The Pediatric Infectious Disease Journal: March 2007 - Volume 26 - Issue 3 - p 247-252
doi: 10.1097/01.inf.0000256735.05098.01
Original Study

Background: The 2-fold increase in female mortality after high-titer measles vaccine may have occurred because many children received diphtheria-tetanus-pertussis (DTP) vaccine or inactivated polio vaccine (IPV) after high-titer measles vaccine.

Objective: We examined whether DTP vaccine and IPV were associated with increased female mortality when they were the most recent vaccine administered to children who had not received measles vaccine.

Setting and Design: IPV was used as a control vaccine in 4 randomized trials of early measles vaccination (MV) with enrollment at 4–6 months of age conducted in Guinea-Bissau. Many children had not received all 3 DTP vaccinations before enrollment, and therefore received DTP after IPV or MV. We examined whether DTP vaccination status at enrollment affected the female-male mortality ratio. Population: 9544 children enrolled in 4 trials. Main outcome measure: The female-male mortality ratio in different vaccine groups.

Results: Females had a higher mortality rate than males among children randomized to receive IPV (mortality rate ratio [MR] 1.52, 95% CI 1.02–2.28), but females had a similar mortality rate to males among children randomized to receive MV (MR 1.01, 0.69–1.46) and among children in the IPV group after they had received MV at 9 months of age or later (MR 0.88, 0.68–1.14). Children who had not received a third dose of DTP before enrollment (and were likely to receive DTP after MV or IPV) tended to have a higher mortality than children who had received all 3 doses of DTP (MR 1.30, 0.97–1.73). This effect was seen only among girls (MR 1.61, 1.08–2.40) and not among boys (MR 1.02, 0.67–1.54). Girls had a lower mortality when MV was the most recent vaccine received rather than DTP or IPV (MR 0.49, 0.28–0.87).

Conclusions: Randomization to IPV was associated with higher female than male mortality. However, the increased female mortality might result from additional doses of DTP received after enrollment and before measles vaccination.

Supplemental Digital Content is Available in the Text.

From the *Projecto de Saúde de Bandim, Indepth Network, Bissau, Guinea-Bissau; and †Bandim Health Project, Danish Epidemiology Science Centre, Statens Serum Institut, Denmark.

Accepted for publication December 18, 2006.

Supported by the Danish Council for Development Research, Danish Medical Research Council, DANIDA, the Danish National Research Foundation and the EU Commission’s INCO programme (No. IC18T95-0011) as well as a research professorship grant sponsored by the Novo Nordisk Foundation (to P.A.).

The Bandim Health Project is affiliated to but not funded by Statens Serum Institut, which is a producer of IPV.

Address for correspondence: Peter Aaby, MSc, Danish Epidemiology Science Centre, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.