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

Mette Møller Steiniche; Sanne Marie Thysen; Aksel Karl Georg Jensen; Amabelia Rodrigues; Cesario Martins; Dan Wolf Meyrowitsch; Peter Aaby; Ane Bærent Fisker

doi:10.1016/j.vaccine.2020.01.096

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

Mette Møller Steiniche, Sanne Marie Thysen, Aksel Karl Georg Jensen, Amabelia Rodrigues, Cesario Martins, Dan Wolf Meyrowitsch, Peter Aaby, Ane Bærent Fisker

5 Citations (Scopus)

Abstract

BACKGROUND: Measles vaccine (MV) has beneficial non-specific effects protecting against non-measles infections in some situations. Within a trial of the effect of MV on mortality, we assessed effects of early MV on the secondary outcomes consultations and growth, overall, and by sex and exposure to campaigns with oral polio vaccine (OPV).

MATERIALS AND METHODS: Children were randomly assigned to MV at 4.5 + 9 months or MV at 9 months as recommended. At enrolment and 9 months children had their mid-upper-arm-circumference (MUAC) and weight measured. Consultations (out/inpatient) were registered at monthly home visits. Weight-for-age and MUAC-for-age Z-scores were obtained using the WHO growth reference and compared by group in linear regression models. Consultation rates between enrolment and 9 months were compared in Cox proportional hazards models, providing consultation Hazard Ratios (HRs) for early MV versus no early MV. We tested whether the effect of early MV was modified by OPV campaigns by splitting observation time at exposure to OPV campaigns.

RESULTS: Among 3548 children enrolled between 2012 and 2015, early MV had no effect on MUAC-for-age (mean difference comparing early MV vs. no MV -0.01, 95% CI -0.06-0.04), weight-for-age (mean difference -0.03, 95% CI -0.07-0.02) or rates of consultations (HR = 1.03, 95% CI 0.92-1.16). The rate of consultations for children enrolled was lower after exposure to OPV campaigns (HR = 0.81, 95% CI 0.71-0.92). The effect of MV differed before exposure to OPV campaigns (HR = 1.12, 95% CI 0.98-1.29) and after OPV campaigns (HR = 0.83, 95% CI 0.67-1.03) (test for interaction: p = 0.03). Associations did not differ by sex.

CONCLUSION: Early MV had no overall effect on consultation rates and growth between enrolment and 9 months of age. However, early MV tended to have beneficial effects for children subsequently exposed to OPV campaigns. As beneficial effects were observed in subgroups, the results should be interpreted with caution.

CLINICAL TRIALS REGISTRATION: NCT01644721.

Original language	English
Journal	Vaccine
Volume	38
Issue number	11
Pages (from-to)	2487-2494
Number of pages	8
ISSN	0264-410X
DOIs	https://doi.org/10.1016/j.vaccine.2020.01.096
Publication status	Published - 4 Mar 2020
Externally published	Yes

Keywords

Child Development
Female
Guinea-Bissau/epidemiology
Humans
Infant
Male
Measles/prevention & control
Measles Vaccine/administration & dosage
Morbidity
Vaccination

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10.1016/j.vaccine.2020.01.096

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@article{3197d04391ec478184683a708a41255c,

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

abstract = "BACKGROUND: Measles vaccine (MV) has beneficial non-specific effects protecting against non-measles infections in some situations. Within a trial of the effect of MV on mortality, we assessed effects of early MV on the secondary outcomes consultations and growth, overall, and by sex and exposure to campaigns with oral polio vaccine (OPV).MATERIALS AND METHODS: Children were randomly assigned to MV at 4.5 + 9 months or MV at 9 months as recommended. At enrolment and 9 months children had their mid-upper-arm-circumference (MUAC) and weight measured. Consultations (out/inpatient) were registered at monthly home visits. Weight-for-age and MUAC-for-age Z-scores were obtained using the WHO growth reference and compared by group in linear regression models. Consultation rates between enrolment and 9 months were compared in Cox proportional hazards models, providing consultation Hazard Ratios (HRs) for early MV versus no early MV. We tested whether the effect of early MV was modified by OPV campaigns by splitting observation time at exposure to OPV campaigns.RESULTS: Among 3548 children enrolled between 2012 and 2015, early MV had no effect on MUAC-for-age (mean difference comparing early MV vs. no MV -0.01, 95\% CI -0.06-0.04), weight-for-age (mean difference -0.03, 95\% CI -0.07-0.02) or rates of consultations (HR = 1.03, 95\% CI 0.92-1.16). The rate of consultations for children enrolled was lower after exposure to OPV campaigns (HR = 0.81, 95\% CI 0.71-0.92). The effect of MV differed before exposure to OPV campaigns (HR = 1.12, 95\% CI 0.98-1.29) and after OPV campaigns (HR = 0.83, 95\% CI 0.67-1.03) (test for interaction: p = 0.03). Associations did not differ by sex.CONCLUSION: Early MV had no overall effect on consultation rates and growth between enrolment and 9 months of age. However, early MV tended to have beneficial effects for children subsequently exposed to OPV campaigns. As beneficial effects were observed in subgroups, the results should be interpreted with caution.CLINICAL TRIALS REGISTRATION: NCT01644721.",

keywords = "Child Development, Female, Guinea-Bissau/epidemiology, Humans, Infant, Male, Measles/prevention \& control, Measles Vaccine/administration \& dosage, Morbidity, Vaccination",

author = "Steiniche, \{Mette M{\o}ller\} and Thysen, \{Sanne Marie\} and Jensen, \{Aksel Karl Georg\} and Amabelia Rodrigues and Cesario Martins and Meyrowitsch, \{Dan Wolf\} and Peter Aaby and Fisker, \{Ane B{\ae}rent\}",

year = "2020",

month = mar,

day = "4",

doi = "10.1016/j.vaccine.2020.01.096",

language = "English",

volume = "38",

pages = "2487--2494",

journal = "Vaccine",

issn = "0264-410X",

publisher = "Elsevier Ltd",

number = "11",

}

TY - JOUR

T1 - The effect of early measles vaccination on morbidity and growth

T2 - A randomised trial from Guinea-Bissau

AU - Steiniche, Mette Møller

AU - Thysen, Sanne Marie

AU - Jensen, Aksel Karl Georg

AU - Rodrigues, Amabelia

AU - Martins, Cesario

AU - Meyrowitsch, Dan Wolf

AU - Aaby, Peter

AU - Fisker, Ane Bærent

PY - 2020/3/4

Y1 - 2020/3/4

N2 - BACKGROUND: Measles vaccine (MV) has beneficial non-specific effects protecting against non-measles infections in some situations. Within a trial of the effect of MV on mortality, we assessed effects of early MV on the secondary outcomes consultations and growth, overall, and by sex and exposure to campaigns with oral polio vaccine (OPV).MATERIALS AND METHODS: Children were randomly assigned to MV at 4.5 + 9 months or MV at 9 months as recommended. At enrolment and 9 months children had their mid-upper-arm-circumference (MUAC) and weight measured. Consultations (out/inpatient) were registered at monthly home visits. Weight-for-age and MUAC-for-age Z-scores were obtained using the WHO growth reference and compared by group in linear regression models. Consultation rates between enrolment and 9 months were compared in Cox proportional hazards models, providing consultation Hazard Ratios (HRs) for early MV versus no early MV. We tested whether the effect of early MV was modified by OPV campaigns by splitting observation time at exposure to OPV campaigns.RESULTS: Among 3548 children enrolled between 2012 and 2015, early MV had no effect on MUAC-for-age (mean difference comparing early MV vs. no MV -0.01, 95% CI -0.06-0.04), weight-for-age (mean difference -0.03, 95% CI -0.07-0.02) or rates of consultations (HR = 1.03, 95% CI 0.92-1.16). The rate of consultations for children enrolled was lower after exposure to OPV campaigns (HR = 0.81, 95% CI 0.71-0.92). The effect of MV differed before exposure to OPV campaigns (HR = 1.12, 95% CI 0.98-1.29) and after OPV campaigns (HR = 0.83, 95% CI 0.67-1.03) (test for interaction: p = 0.03). Associations did not differ by sex.CONCLUSION: Early MV had no overall effect on consultation rates and growth between enrolment and 9 months of age. However, early MV tended to have beneficial effects for children subsequently exposed to OPV campaigns. As beneficial effects were observed in subgroups, the results should be interpreted with caution.CLINICAL TRIALS REGISTRATION: NCT01644721.

AB - BACKGROUND: Measles vaccine (MV) has beneficial non-specific effects protecting against non-measles infections in some situations. Within a trial of the effect of MV on mortality, we assessed effects of early MV on the secondary outcomes consultations and growth, overall, and by sex and exposure to campaigns with oral polio vaccine (OPV).MATERIALS AND METHODS: Children were randomly assigned to MV at 4.5 + 9 months or MV at 9 months as recommended. At enrolment and 9 months children had their mid-upper-arm-circumference (MUAC) and weight measured. Consultations (out/inpatient) were registered at monthly home visits. Weight-for-age and MUAC-for-age Z-scores were obtained using the WHO growth reference and compared by group in linear regression models. Consultation rates between enrolment and 9 months were compared in Cox proportional hazards models, providing consultation Hazard Ratios (HRs) for early MV versus no early MV. We tested whether the effect of early MV was modified by OPV campaigns by splitting observation time at exposure to OPV campaigns.RESULTS: Among 3548 children enrolled between 2012 and 2015, early MV had no effect on MUAC-for-age (mean difference comparing early MV vs. no MV -0.01, 95% CI -0.06-0.04), weight-for-age (mean difference -0.03, 95% CI -0.07-0.02) or rates of consultations (HR = 1.03, 95% CI 0.92-1.16). The rate of consultations for children enrolled was lower after exposure to OPV campaigns (HR = 0.81, 95% CI 0.71-0.92). The effect of MV differed before exposure to OPV campaigns (HR = 1.12, 95% CI 0.98-1.29) and after OPV campaigns (HR = 0.83, 95% CI 0.67-1.03) (test for interaction: p = 0.03). Associations did not differ by sex.CONCLUSION: Early MV had no overall effect on consultation rates and growth between enrolment and 9 months of age. However, early MV tended to have beneficial effects for children subsequently exposed to OPV campaigns. As beneficial effects were observed in subgroups, the results should be interpreted with caution.CLINICAL TRIALS REGISTRATION: NCT01644721.

KW - Child Development

KW - Female

KW - Guinea-Bissau/epidemiology

KW - Humans

KW - Infant

KW - Male

KW - Measles/prevention & control

KW - Measles Vaccine/administration & dosage

KW - Morbidity

KW - Vaccination

U2 - 10.1016/j.vaccine.2020.01.096

DO - 10.1016/j.vaccine.2020.01.096

M3 - Journal article

C2 - 32061387

SN - 0264-410X

VL - 38

SP - 2487

EP - 2494

JO - Vaccine

JF - Vaccine

IS - 11

ER -

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

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Keywords

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