Early DTP vaccination associated with higher female mortality and no difference in male mortality in a cohort of low birthweight children

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Early diphtheria-tetanus-pertussis vaccination associated with higher

female mortality and no difference in male mortality in a cohort of low

birthweight children: an observational study within a randomised trial

<http://adc.bmj.com/cgi/content/short/archdischild-2011-300646v1?g=w_adc_ahead_t\

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(13 Feb 2012)

Arch Dis Child doi:10.1136/archdischild-2011-300646

open access

Background: Studies from low-income countries have suggested that

diphtheria-tetanus-pertussis (DTP) vaccine provided after Bacille

Calmette-Guerin (BCG) vaccination may have a negative effect on female

survival. The authors examined the effect of DTP in a cohort of low

birthweight (LBW) infants.

Methods: 2320 LBW newborns were visited at 2, 6 and 12 months of age to

assess nutritional and vaccination status. The authors examined survival

until the 6-month visit for children who were DTP vaccinated and DTP

unvaccinated at the 2-month visit.

Results: Two-thirds of the children had received DTP at 2 months and 50

deaths occurred between the 2-month and 6-month visits. DTP vaccinated

children had a better anthropometric status for all indices than DTP

unvaccinated children. Small mid-upper arm circumference (MUAC) was the

strongest predictor of mortality. The death rate ratio (DRR) for DTP

vaccinated versus DTP unvaccinated children differed significantly for

girls (DRR 2.45; 95% CI 0.93 to 6.45) and boys (DRR 0.53; 95% CI 0.23 to

1.20) (p=0.018, homogeneity test). Adjusting for MUAC, the overall

effect for DTP vaccinated children was 2.62 (95% CI 1.34 to 5.09); DRR

was 5.68 (95% CI 1.83 to 17.7) for girls and 1.29 (95% CI 0.56 to 2.97)

for boys (p=0.023, homogeneity test). While anthropometric indices were

a strong predictor of mortality among boys, there was little or no

association for girls.

Conclusion: Surprisingly, even though the children with the best

nutritional status were vaccinated early, early DTP vaccination was

associated with increased mortality for girls.

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