Live vaccine against measles, mumps, and rubella and the risk of hospital admissions for nontargeted infections

Signe Sørup, Christine Stabell Benn, Anja Poulsen, Tyra G Krause, Peter Aaby, Henrik Ravn

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

IMPORTANCE: In low-income countries, live measles vaccine reduces mortality from causes other than measles infection. Such nonspecific effects of vaccines might also be important for the health of children in high-income settings.

OBJECTIVE: To examine whether the live vaccine against measles, mumps, and rubella (MMR) is associated with lower rates of hospital admissions for infections among children in Denmark.

DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study of Danish children born 1997-2006 and followed up from ages 11 months to 2 years (last follow-up, August 31, 2008). Nationwide Danish registers provided data on vaccinations and hospital admissions. The recommended vaccination schedule was inactivated vaccine against diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) administered at ages 3, 5, and 12 months and MMR at age 15 months.

MAIN OUTCOMES AND MEASURES: Incidence rate ratios (IRRs) of hospital admissions for any infection, comparing receipt of MMR vs DTaP-IPV-Hib as the most recent vaccine. Risks, risk difference, and number needed to vaccinate were calculated for receiving MMR on time.

RESULTS: The study included 495,987 children contributing with 56,889 hospital admissions for any type of infection during 509,427 person-years (rate, 11.2 per 100 person-years). For the 456,043 children who followed the recommended schedule and received MMR after the third dose of DTaP-IPV-Hib, MMR (rate, 8.9 per 100 person-years) vs the third dose of DTaP-IPV-Hib (rate, 12.4 per 100 person-years) as the most recent vaccine was associated with an adjusted IRR of 0.86 (95% CI, 0.84-0.88) for any admission for infection. There were 19,219 children immunized out of sequence. The adjusted IRR was 0.87 (95% CI, 0.80-0.95) for those receiving MMR (rate, 9.9 per 100 person-years) after the second dose of DTaP-IPV-Hib (rate, 15.1 per 100 person-years). However, in the 1981 children who subsequently received the third dose of DTaP-IPV-Hib (rate, 12.8 per 100 person-years) after MMR, the IRR for hospital admissions for infection was significantly greater (adjusted IRR, 1.62 [95% CI, 1.28-2.05]). The risk of admission for an infection between ages 16 months and 24 months was 4.6% (95% CI, 4.5%-4.7%) for receiving MMR on time and 5.1% (95% CI, 5.0%-5.2%) for not receiving MMR on time. The risk difference was 0.5 percentage point (95% CI, 0.4-0.6), and the number needed to vaccinate with MMR before age 16 months to prevent 1 admission for any infection was 201 (95% CI, 159-272).

CONCLUSIONS AND RELEVANCE: In a cohort of Danish children, receipt of live MMR vs inactivated DTaP-IPV-Hib as the most recent vaccine was associated with a lower rate of hospital admissions for any infections. These findings require replication in other high-income populations.

Original languageEnglish
JournalJ A M A: The Journal of the American Medical Association
Volume311
Issue number8
Pages (from-to)826-835
Number of pages10
ISSN0098-7484
DOIs
Publication statusPublished - 26. Feb 2014

Keywords

  • Child, Preschool
  • Cohort Studies
  • Denmark
  • Diphtheria-Tetanus-acellular Pertussis Vaccines
  • Female
  • Haemophilus Vaccines
  • Hospitalization
  • Humans
  • Incidence
  • Infant
  • Infection
  • Male
  • Measles-Mumps-Rubella Vaccine
  • Poliovirus Vaccines
  • Registries
  • Risk
  • Socioeconomic Factors
  • Vaccines, Attenuated

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