DTP in low income countries: improved child survival or survival bias?

doi:10.1136/bmj.330.7495.845-a

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Henrik Jensen, statistician (HJN@ssi.dk),
Christine S Benn, senior researcher,
Peter Aaby, professor

Bandim Health Project, Danish Epidemiology Science Centre, Statens Serum Institut, DK-2300 Copenhagen S, Denmark

EDITOR—We proposed that BCG and measles vaccine have non-specific beneficial effects, whereas diphtheria-tetanus-pertussis (DTP) vaccination might have no beneficial effect.1 In response, the World Health Organization commissioned several studies.2^–4 A WHO expert task force found substantial evidence against a deleterious effect of DTP; all studies showed DTP to be associated with reduced mortality. A negative DTP effect was found only in Guinea-Bissau, and this was presumed to be due to a country specific issue or a peculiarity of the data.5

In our survival analysis, vaccination status was a …