National Immunization Campaigns with Oral Polio Vaccine Reduce All-Cause Mortality: A Natural Experiment within Seven Randomized Trials

Andreas Andersen, Ane Baerent Fisker, Amabelia Rodrigues, Cesario Martins, Henrik Ravn, Najaaraq Lund, Sofie Biering-Sorensen, Christine Stabell Benn, Peter Aaby

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

97 Downloads (Pure)

Resumé

Background: A recent WHO review concluded that live BCG and measles vaccine (MV) may have beneficial non-specific effects (NSEs) reducing mortality from non-targeted diseases. NSEs of oral polio vaccine (OPV) were not examined. If OPV vaccination campaigns reduce the mortality rate, it would suggest beneficial NSEs.

Setting: Between 2002 and 2014, Guinea-Bissau had 15 general OPV campaigns and other campaigns with OPV plus vitamin A supplementation (VAS), VAS-only, MV, and H1N1 vaccine. In this period, we conducted seven randomized controlled trials (RCTs) with mortality as main outcome.

Methods: Within these RCTs, we assessed whether the mortality rate was lower after-campaign than before-campaign. We used Cox models with age as underlying time and further adjusted for low birth-weight, season and time trend in mortality. We calculated the adjusted mortality rate ratio (MRR) for after-campaign vs before-campaign.

Results: The mortality rate was lower after OPV-only campaigns than before, the MRR being 0.81 (95% CI = 0.68-0.95). With each additional dose of campaign-OPV the mortality rate declined further (MRR = 0.87 (95% CI: 0.79-0.96) per dose) (test for trend, p  = 0.005). No other type of campaign had similar beneficial effects. Depending on initial age and with follow-up to 3 years of age, the number needed to treat with campaign-OPV-only to save one life was between 68 and 230 children.

Conclusion: Bissau had no case of polio infection so the results suggest that campaign-OPV has beneficial NSEs. Discontinuation of OPV-campaigns in low-income countries may affect general child mortality levels negatively.

OriginalsprogEngelsk
Artikelnummer13
TidsskriftFrontiers in Public Health
Vol/bind6
Antal sider10
ISSN2296-2565
DOI
StatusUdgivet - feb. 2018

Fingeraftryk

Randomized Controlled Trials
Guinea-Bissau
Numbers Needed To Treat
Immunization Programs
Child Mortality
Low Birth Weight Infant
Proportional Hazards Models

Citer dette

Andersen, Andreas ; Fisker, Ane Baerent ; Rodrigues, Amabelia ; Martins, Cesario ; Ravn, Henrik ; Lund, Najaaraq ; Biering-Sorensen, Sofie ; Benn, Christine Stabell ; Aaby, Peter. / National Immunization Campaigns with Oral Polio Vaccine Reduce All-Cause Mortality : A Natural Experiment within Seven Randomized Trials. I: Frontiers in Public Health. 2018 ; Bind 6.
@article{3a506dc01b0048fe96e6057321c729b6,
title = "National Immunization Campaigns with Oral Polio Vaccine Reduce All-Cause Mortality: A Natural Experiment within Seven Randomized Trials",
abstract = "Background: A recent WHO review concluded that live BCG and measles vaccine (MV) may have beneficial non-specific effects (NSEs) reducing mortality from non-targeted diseases. NSEs of oral polio vaccine (OPV) were not examined. If OPV vaccination campaigns reduce the mortality rate, it would suggest beneficial NSEs.Setting: Between 2002 and 2014, Guinea-Bissau had 15 general OPV campaigns and other campaigns with OPV plus vitamin A supplementation (VAS), VAS-only, MV, and H1N1 vaccine. In this period, we conducted seven randomized controlled trials (RCTs) with mortality as main outcome.Methods: Within these RCTs, we assessed whether the mortality rate was lower after-campaign than before-campaign. We used Cox models with age as underlying time and further adjusted for low birth-weight, season and time trend in mortality. We calculated the adjusted mortality rate ratio (MRR) for after-campaign vs before-campaign.Results: The mortality rate was lower after OPV-only campaigns than before, the MRR being 0.81 (95{\%} CI = 0.68-0.95). With each additional dose of campaign-OPV the mortality rate declined further (MRR = 0.87 (95{\%} CI: 0.79-0.96) per dose) (test for trend, p  = 0.005). No other type of campaign had similar beneficial effects. Depending on initial age and with follow-up to 3 years of age, the number needed to treat with campaign-OPV-only to save one life was between 68 and 230 children. Conclusion: Bissau had no case of polio infection so the results suggest that campaign-OPV has beneficial NSEs. Discontinuation of OPV-campaigns in low-income countries may affect general child mortality levels negatively.",
keywords = "campaigns, child mortality, MDG4, oral polio vaccine, non-specific effects of vaccines",
author = "Andreas Andersen and Fisker, {Ane Baerent} and Amabelia Rodrigues and Cesario Martins and Henrik Ravn and Najaaraq Lund and Sofie Biering-Sorensen and Benn, {Christine Stabell} and Peter Aaby",
year = "2018",
month = "2",
doi = "10.3389/fpubh.2018.00013",
language = "English",
volume = "6",
journal = "Frontiers in Public Health",
issn = "2296-2565",
publisher = "Frontiers Media",

}

National Immunization Campaigns with Oral Polio Vaccine Reduce All-Cause Mortality : A Natural Experiment within Seven Randomized Trials. / Andersen, Andreas; Fisker, Ane Baerent; Rodrigues, Amabelia; Martins, Cesario; Ravn, Henrik; Lund, Najaaraq; Biering-Sorensen, Sofie; Benn, Christine Stabell; Aaby, Peter.

I: Frontiers in Public Health, Bind 6, 13, 02.2018.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - National Immunization Campaigns with Oral Polio Vaccine Reduce All-Cause Mortality

T2 - A Natural Experiment within Seven Randomized Trials

AU - Andersen, Andreas

AU - Fisker, Ane Baerent

AU - Rodrigues, Amabelia

AU - Martins, Cesario

AU - Ravn, Henrik

AU - Lund, Najaaraq

AU - Biering-Sorensen, Sofie

AU - Benn, Christine Stabell

AU - Aaby, Peter

PY - 2018/2

Y1 - 2018/2

N2 - Background: A recent WHO review concluded that live BCG and measles vaccine (MV) may have beneficial non-specific effects (NSEs) reducing mortality from non-targeted diseases. NSEs of oral polio vaccine (OPV) were not examined. If OPV vaccination campaigns reduce the mortality rate, it would suggest beneficial NSEs.Setting: Between 2002 and 2014, Guinea-Bissau had 15 general OPV campaigns and other campaigns with OPV plus vitamin A supplementation (VAS), VAS-only, MV, and H1N1 vaccine. In this period, we conducted seven randomized controlled trials (RCTs) with mortality as main outcome.Methods: Within these RCTs, we assessed whether the mortality rate was lower after-campaign than before-campaign. We used Cox models with age as underlying time and further adjusted for low birth-weight, season and time trend in mortality. We calculated the adjusted mortality rate ratio (MRR) for after-campaign vs before-campaign.Results: The mortality rate was lower after OPV-only campaigns than before, the MRR being 0.81 (95% CI = 0.68-0.95). With each additional dose of campaign-OPV the mortality rate declined further (MRR = 0.87 (95% CI: 0.79-0.96) per dose) (test for trend, p  = 0.005). No other type of campaign had similar beneficial effects. Depending on initial age and with follow-up to 3 years of age, the number needed to treat with campaign-OPV-only to save one life was between 68 and 230 children. Conclusion: Bissau had no case of polio infection so the results suggest that campaign-OPV has beneficial NSEs. Discontinuation of OPV-campaigns in low-income countries may affect general child mortality levels negatively.

AB - Background: A recent WHO review concluded that live BCG and measles vaccine (MV) may have beneficial non-specific effects (NSEs) reducing mortality from non-targeted diseases. NSEs of oral polio vaccine (OPV) were not examined. If OPV vaccination campaigns reduce the mortality rate, it would suggest beneficial NSEs.Setting: Between 2002 and 2014, Guinea-Bissau had 15 general OPV campaigns and other campaigns with OPV plus vitamin A supplementation (VAS), VAS-only, MV, and H1N1 vaccine. In this period, we conducted seven randomized controlled trials (RCTs) with mortality as main outcome.Methods: Within these RCTs, we assessed whether the mortality rate was lower after-campaign than before-campaign. We used Cox models with age as underlying time and further adjusted for low birth-weight, season and time trend in mortality. We calculated the adjusted mortality rate ratio (MRR) for after-campaign vs before-campaign.Results: The mortality rate was lower after OPV-only campaigns than before, the MRR being 0.81 (95% CI = 0.68-0.95). With each additional dose of campaign-OPV the mortality rate declined further (MRR = 0.87 (95% CI: 0.79-0.96) per dose) (test for trend, p  = 0.005). No other type of campaign had similar beneficial effects. Depending on initial age and with follow-up to 3 years of age, the number needed to treat with campaign-OPV-only to save one life was between 68 and 230 children. Conclusion: Bissau had no case of polio infection so the results suggest that campaign-OPV has beneficial NSEs. Discontinuation of OPV-campaigns in low-income countries may affect general child mortality levels negatively.

KW - campaigns

KW - child mortality

KW - MDG4

KW - oral polio vaccine

KW - non-specific effects of vaccines

U2 - 10.3389/fpubh.2018.00013

DO - 10.3389/fpubh.2018.00013

M3 - Journal article

C2 - 29456992

VL - 6

JO - Frontiers in Public Health

JF - Frontiers in Public Health

SN - 2296-2565

M1 - 13

ER -