Routine vaccination and child survival in Guinea-Bissau

doi:10.1136/bmj.322.7282.360

BMJ 2001;322:360 ( 10 February )

Letters

Routine vaccination and child survival in Guinea-Bissau

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Lessons can be learnt from this study

WHO responds to Guinea-Bissau report

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Authors' reply to commentary

The first 150 words of the full text of this article appear below.

EDITOR $---$ In his commentary on our paper Fine claims that our observations lack the classic attributes of causality: gradient,strength, and coherence.¹

Firstly, the estimates only just reach conventional significance. However, the important finding was not the significanceof the estimates for the individual vaccines but the fact thatBCG and diphtheria, pertussis, and tetanus vaccines had oppositeeffects on mortality $---$ the difference being strongly significant(P=0.005).

Secondly, the association of diphtheria, pertussis, and tetanus vaccine with increased mortality could be due to higher vaccinationcoverage and higher mortality among children of young mothers.However, as we stated in our paper, adjustment for backgroundfactors had minimal effect on mortality estimates. Given the lowprevalence of young mothers and their slightly higher vaccinecoverage (table 2), adjustment for maternal age had little effect.Mortality ratios changed from 1.84 (1.10 to 3.10) to 1.82 (1.08to 3.07) with one dose of diphtheria, pertussis, . . . [Full text of this article]

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