Randomized Trial of 2 Versus 1 Dose of Measles Vaccine: Effect on Hospital Admission of Children After 9 Months of Age

Marie Brønd, Cesario L Martins, Stine Byberg, Christine S Benn, Hilton Whittle, May-Lill Garly, Peter Aaby, Ane B Fisker

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background: Two doses of measles vaccine (MV) might reduce the nonmeasles mortality rate more than 1 dose of MV does. The effect of 2 versus 1 dose on morbidity has not been examined. Within a randomized trial of the effect of 2 doses versus 1 dose of MV on mortality in Guinea-Bissau, we investigated the effect on hospital admissions.

Methods: Children were randomly assigned 1:2 to receive MV at 4.5 and 9 months of age or the currently recommended dose at 9 months. We compared hospital admission rates among children between 9 and 18 months of age in a Cox regression model with age as the underlying time scale. Half of the children had received neonatal vitamin A supplementation (NVAS) in another trial. The beneficial effect of MV at 4.5 and 9 months on mortality was limited to children who had not received NVAS; therefore, we investigated the interaction of MV with NVAS on admission rates.

Results: Among 5626 children (2 doses of MV, 1960 children; 1 dose of MV, 3666), we identified 311 hospital admissions of children between 9 and 18 months of age. Overall, compared to 1 dose of MV, 2 doses reduced the risk of hospital admission for children who had not received NVAS (hazard ratio [HR], 0.66 [95% confidence interval (CI), 0.47-0.93]), but we found no effect among NVAS recipients (HR, 1.16 [95% CI, 0.82-1.63]) (P = .02 for interaction).

Conclusions: The benefit of 2 doses of MV was limited to children who had not received NVAS. NVAS is not generally recommended; hence, an early 2-dose measles vaccination policy might reduce hospital admissions more than the current policy of providing the first MV at 9 months of age.

Trial registration: ClinicalTrials.gov identifier NCT00168558.

OriginalsprogEngelsk
TidsskriftPediatric Infectious Diseases Society. Journal
Vol/bind7
Udgave nummer3
Sider (fra-til)226–233
ISSN2048-7193
DOI
StatusUdgivet - 17. aug. 2018

Fingeraftryk

Guinea-Bissau
Confidence Intervals
Measles
Proportional Hazards Models

Citer dette

Brønd, Marie ; Martins, Cesario L ; Byberg, Stine ; Benn, Christine S ; Whittle, Hilton ; Garly, May-Lill ; Aaby, Peter ; Fisker, Ane B. / Randomized Trial of 2 Versus 1 Dose of Measles Vaccine : Effect on Hospital Admission of Children After 9 Months of Age. I: Pediatric Infectious Diseases Society. Journal. 2018 ; Bind 7, Nr. 3. s. 226–233.
@article{a77418ca7dfd4104a7e6abfa99c4a777,
title = "Randomized Trial of 2 Versus 1 Dose of Measles Vaccine: Effect on Hospital Admission of Children After 9 Months of Age",
abstract = "Background: Two doses of measles vaccine (MV) might reduce the nonmeasles mortality rate more than 1 dose of MV does. The effect of 2 versus 1 dose on morbidity has not been examined. Within a randomized trial of the effect of 2 doses versus 1 dose of MV on mortality in Guinea-Bissau, we investigated the effect on hospital admissions.Methods: Children were randomly assigned 1:2 to receive MV at 4.5 and 9 months of age or the currently recommended dose at 9 months. We compared hospital admission rates among children between 9 and 18 months of age in a Cox regression model with age as the underlying time scale. Half of the children had received neonatal vitamin A supplementation (NVAS) in another trial. The beneficial effect of MV at 4.5 and 9 months on mortality was limited to children who had not received NVAS; therefore, we investigated the interaction of MV with NVAS on admission rates.Results: Among 5626 children (2 doses of MV, 1960 children; 1 dose of MV, 3666), we identified 311 hospital admissions of children between 9 and 18 months of age. Overall, compared to 1 dose of MV, 2 doses reduced the risk of hospital admission for children who had not received NVAS (hazard ratio [HR], 0.66 [95{\%} confidence interval (CI), 0.47-0.93]), but we found no effect among NVAS recipients (HR, 1.16 [95{\%} CI, 0.82-1.63]) (P = .02 for interaction).Conclusions: The benefit of 2 doses of MV was limited to children who had not received NVAS. NVAS is not generally recommended; hence, an early 2-dose measles vaccination policy might reduce hospital admissions more than the current policy of providing the first MV at 9 months of age.Trial registration: ClinicalTrials.gov identifier NCT00168558.",
keywords = "Dietary Supplements, Drug Administration Schedule, Female, Guinea-Bissau/epidemiology, Hospitalization/statistics & numerical data, Humans, Immunization Schedule, Infant, Male, Measles Vaccine/administration & dosage, Measles/mortality, Proportional Hazards Models, Vitamin A/administration & dosage, Vitamins/administration & dosage",
author = "Marie Br{\o}nd and Martins, {Cesario L} and Stine Byberg and Benn, {Christine S} and Hilton Whittle and May-Lill Garly and Peter Aaby and Fisker, {Ane B}",
year = "2018",
month = "8",
day = "17",
doi = "10.1093/jpids/pix042",
language = "English",
volume = "7",
pages = "226–233",
journal = "Pediatric Infectious Diseases Society. Journal",
issn = "2048-7193",
publisher = "Heinemann",
number = "3",

}

Randomized Trial of 2 Versus 1 Dose of Measles Vaccine : Effect on Hospital Admission of Children After 9 Months of Age. / Brønd, Marie; Martins, Cesario L; Byberg, Stine; Benn, Christine S; Whittle, Hilton; Garly, May-Lill; Aaby, Peter; Fisker, Ane B.

I: Pediatric Infectious Diseases Society. Journal, Bind 7, Nr. 3, 17.08.2018, s. 226–233.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Randomized Trial of 2 Versus 1 Dose of Measles Vaccine

T2 - Effect on Hospital Admission of Children After 9 Months of Age

AU - Brønd, Marie

AU - Martins, Cesario L

AU - Byberg, Stine

AU - Benn, Christine S

AU - Whittle, Hilton

AU - Garly, May-Lill

AU - Aaby, Peter

AU - Fisker, Ane B

PY - 2018/8/17

Y1 - 2018/8/17

N2 - Background: Two doses of measles vaccine (MV) might reduce the nonmeasles mortality rate more than 1 dose of MV does. The effect of 2 versus 1 dose on morbidity has not been examined. Within a randomized trial of the effect of 2 doses versus 1 dose of MV on mortality in Guinea-Bissau, we investigated the effect on hospital admissions.Methods: Children were randomly assigned 1:2 to receive MV at 4.5 and 9 months of age or the currently recommended dose at 9 months. We compared hospital admission rates among children between 9 and 18 months of age in a Cox regression model with age as the underlying time scale. Half of the children had received neonatal vitamin A supplementation (NVAS) in another trial. The beneficial effect of MV at 4.5 and 9 months on mortality was limited to children who had not received NVAS; therefore, we investigated the interaction of MV with NVAS on admission rates.Results: Among 5626 children (2 doses of MV, 1960 children; 1 dose of MV, 3666), we identified 311 hospital admissions of children between 9 and 18 months of age. Overall, compared to 1 dose of MV, 2 doses reduced the risk of hospital admission for children who had not received NVAS (hazard ratio [HR], 0.66 [95% confidence interval (CI), 0.47-0.93]), but we found no effect among NVAS recipients (HR, 1.16 [95% CI, 0.82-1.63]) (P = .02 for interaction).Conclusions: The benefit of 2 doses of MV was limited to children who had not received NVAS. NVAS is not generally recommended; hence, an early 2-dose measles vaccination policy might reduce hospital admissions more than the current policy of providing the first MV at 9 months of age.Trial registration: ClinicalTrials.gov identifier NCT00168558.

AB - Background: Two doses of measles vaccine (MV) might reduce the nonmeasles mortality rate more than 1 dose of MV does. The effect of 2 versus 1 dose on morbidity has not been examined. Within a randomized trial of the effect of 2 doses versus 1 dose of MV on mortality in Guinea-Bissau, we investigated the effect on hospital admissions.Methods: Children were randomly assigned 1:2 to receive MV at 4.5 and 9 months of age or the currently recommended dose at 9 months. We compared hospital admission rates among children between 9 and 18 months of age in a Cox regression model with age as the underlying time scale. Half of the children had received neonatal vitamin A supplementation (NVAS) in another trial. The beneficial effect of MV at 4.5 and 9 months on mortality was limited to children who had not received NVAS; therefore, we investigated the interaction of MV with NVAS on admission rates.Results: Among 5626 children (2 doses of MV, 1960 children; 1 dose of MV, 3666), we identified 311 hospital admissions of children between 9 and 18 months of age. Overall, compared to 1 dose of MV, 2 doses reduced the risk of hospital admission for children who had not received NVAS (hazard ratio [HR], 0.66 [95% confidence interval (CI), 0.47-0.93]), but we found no effect among NVAS recipients (HR, 1.16 [95% CI, 0.82-1.63]) (P = .02 for interaction).Conclusions: The benefit of 2 doses of MV was limited to children who had not received NVAS. NVAS is not generally recommended; hence, an early 2-dose measles vaccination policy might reduce hospital admissions more than the current policy of providing the first MV at 9 months of age.Trial registration: ClinicalTrials.gov identifier NCT00168558.

KW - Dietary Supplements

KW - Drug Administration Schedule

KW - Female

KW - Guinea-Bissau/epidemiology

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Immunization Schedule

KW - Infant

KW - Male

KW - Measles Vaccine/administration & dosage

KW - Measles/mortality

KW - Proportional Hazards Models

KW - Vitamin A/administration & dosage

KW - Vitamins/administration & dosage

U2 - 10.1093/jpids/pix042

DO - 10.1093/jpids/pix042

M3 - Journal article

C2 - 28992261

VL - 7

SP - 226

EP - 233

JO - Pediatric Infectious Diseases Society. Journal

JF - Pediatric Infectious Diseases Society. Journal

SN - 2048-7193

IS - 3

ER -