Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural Bangladesh

BACKGROUND: WHO recommends BCG at birth and diphtheria-tetanus-pertussis (DTP)-containing vaccine at 6, 10 and 14 weeks of age. However, BCG and DTP are often co-administered in low-income countries. The health implications have not been examined. SETTING: We reanalysed data from Matlab, Bangladesh, to examine the influence of co-administration on mortality; 37,894 children born 1986-1999 were followed with registration of vaccinations and survival. METHODS: Using Cox models, survival was analysed from 6 weeks to 9 months of age when measles vaccine is given; 712 children died in this age group. We calculated mortality rate ratios (MRR) for children starting the vaccination schedule with BCG-first, BCG + DTP1-first or DTP1-first. RESULTS: Only 17% followed the WHO-schedule with BCG-first. Mortality was 16/1000 person-years for children who initiated the vaccination schedule with BCG + DTP1 but 32/1000 and 20/1000 for children who received BCG-first or DTP-first, respectively. Compared with BCG + DTP1-first and adjusting for background factors, the BCG-first-schedule was associated with 2-fold higher mortality (MRR = 1.94 (1.42–2.63)). DTP1 administered after BCG-first was associated with higher mortality than receiving DTP1 with BCG (MRR = 1.78 (1.03–3.03)). CONCLUSIONS: Co-administration of BCG and DTP may further reduce mortality. Since all observational studies support this trend, co-administration of BCG and DTP should be tested in randomised trials.