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Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine

BACKGROUND: Ten years ago, we formulated two hypotheses about whole-cell diphtheria-tetanus-pertussis (DTP) vaccination: first, when given after BCG, DTP increases mortality in girls and, second, following DTP there is an increase in the female/male mortality rate ratio (MRR). A recent review by WHO...

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Autores principales: Aaby, Peter, Ravn, Henrik, Fisker, Ane B., Rodrigues, Amabelia, Benn, Christine S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155548/
https://www.ncbi.nlm.nih.gov/pubmed/27856947
http://dx.doi.org/10.1093/trstmh/trw073
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author Aaby, Peter
Ravn, Henrik
Fisker, Ane B.
Rodrigues, Amabelia
Benn, Christine S.
author_facet Aaby, Peter
Ravn, Henrik
Fisker, Ane B.
Rodrigues, Amabelia
Benn, Christine S.
author_sort Aaby, Peter
collection PubMed
description BACKGROUND: Ten years ago, we formulated two hypotheses about whole-cell diphtheria-tetanus-pertussis (DTP) vaccination: first, when given after BCG, DTP increases mortality in girls and, second, following DTP there is an increase in the female/male mortality rate ratio (MRR). A recent review by WHO found no convincing evidence that DTP increases mortality in females. METHODS: We used previous DTP reviews as well as the recent WHO review for assessing the hypotheses. As pre-specified we excluded studies with survival or frailty bias; if children had received BCG and DTP simultaneously; and if the children had received neonatal vitamin A. RESULTS: In seven studies of BCG-vaccinated children, DTP vaccination was associated with a 2.54 (95% CI 1.68–3.86) increase in mortality in girls (with no increase in boys [ratio 0.96, 0.55–1.68]). In 10 studies of BCG-vaccinated children, the female-to-male mortality ratio was 2.45 (1.48–4.06) times higher after DTP than before DTP. In 15 studies of children who had received DTP after previous BCG vaccination, mortality was 1.53 (1.21–1.93) times higher in girls than boys. The findings were similar in studies conducted before and after formulation of the hypotheses. CONCLUSIONS: The two hypotheses were confirmed in the studies that fulfilled pre-specified criteria.
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spelling pubmed-51555482016-12-16 Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine Aaby, Peter Ravn, Henrik Fisker, Ane B. Rodrigues, Amabelia Benn, Christine S. Trans R Soc Trop Med Hyg Original Articles BACKGROUND: Ten years ago, we formulated two hypotheses about whole-cell diphtheria-tetanus-pertussis (DTP) vaccination: first, when given after BCG, DTP increases mortality in girls and, second, following DTP there is an increase in the female/male mortality rate ratio (MRR). A recent review by WHO found no convincing evidence that DTP increases mortality in females. METHODS: We used previous DTP reviews as well as the recent WHO review for assessing the hypotheses. As pre-specified we excluded studies with survival or frailty bias; if children had received BCG and DTP simultaneously; and if the children had received neonatal vitamin A. RESULTS: In seven studies of BCG-vaccinated children, DTP vaccination was associated with a 2.54 (95% CI 1.68–3.86) increase in mortality in girls (with no increase in boys [ratio 0.96, 0.55–1.68]). In 10 studies of BCG-vaccinated children, the female-to-male mortality ratio was 2.45 (1.48–4.06) times higher after DTP than before DTP. In 15 studies of children who had received DTP after previous BCG vaccination, mortality was 1.53 (1.21–1.93) times higher in girls than boys. The findings were similar in studies conducted before and after formulation of the hypotheses. CONCLUSIONS: The two hypotheses were confirmed in the studies that fulfilled pre-specified criteria. Oxford University Press 2016-12 2016-12-09 /pmc/articles/PMC5155548/ /pubmed/27856947 http://dx.doi.org/10.1093/trstmh/trw073 Text en © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Articles
Aaby, Peter
Ravn, Henrik
Fisker, Ane B.
Rodrigues, Amabelia
Benn, Christine S.
Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine
title Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine
title_full Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine
title_fullStr Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine
title_full_unstemmed Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine
title_short Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine
title_sort is diphtheria-tetanus-pertussis (dtp) associated with increased female mortality? a meta-analysis testing the hypotheses of sex-differential non-specific effects of dtp vaccine
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155548/
https://www.ncbi.nlm.nih.gov/pubmed/27856947
http://dx.doi.org/10.1093/trstmh/trw073
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