Routine vaccinations and child survival: follow up study in Guinea-Bissau, West Africa  Commentary: an unexpected finding that needs confirmation or rejection

doi:10.1136/bmj.321.7274.1435

BMJ 2000;321:1435 ( 9 December )

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Routine vaccinations and child survival: follow up study in Guinea-Bissau, West Africa

Ines Kristensen, physician, ^a Peter Aaby, anthropologist, ^a Henrik Jensen, statistician. ^b

^a Bandim Health Project, Apartado 861, Bissau, Guinea-Bissau, ^b Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen, Denmark

Correspondence to: P Aaby, Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark psb{at}sol.gtelecom.gw

Objective: To examine the association between routinechildhood vaccinations and survival among infants in Guinea-Bissau.
Design: Follow upstudy.
Participants: 15 351 women and their children born during1990 and1996.
Setting: Rural Guinea-Bissau.
Main outcome measures: Infant mortality over six months (betweenage 0-6 months and 7-13 months for BCG, diphtheria, tetanus, andpertussis, and polio vaccines and between 7-13 months and 14-20months for measlesvaccine).
Results: Mortality was lower in the group vaccinatedwith any vaccine compared with those not vaccinated, the mortalityratio being 0.74 (95% confidence interval 0.53 to 1.03). Aftercluster, age, and other vaccines were adjusted for, BCG was associatedwith significantly lower mortality (0.55 (0.36 to 0.85)). However,recipients of one dose of diphtheria, tetanus, and pertussis orpolio vaccines had higher mortality than children who had receivednone of these vaccines (1.84 (1.10 to 3.10) for diphtheria, tetanus,and pertussis). Recipients of measles vaccine had a mortalityratio of 0.48 (0.27 to 0.87). When deaths from measles were excludedfrom the analysis the mortality ratio was 0.51 (0.28 to 0.95).Estimates were unchanged by controls for backgroundfactors.
Conclusions: These trends are unlikely to be explainedexclusively by selection biases since different vaccines wereassociated with opposite tendencies. Measles and BCG vaccinesmay have beneficial effects in addition to protection againstmeasles andtuberculosis.

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