IJE Advance Access originally published online on July 23, 2007
International Journal of Epidemiology 2007 36(5):1022-1029; doi:10.1093/ije/dym142
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Non-specific effects of diphtheria–tetanus–pertussis vaccination on child mortality in Cebu, The Philippines
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
2Population and Family Health Sciences Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
4Harvard Medical School, Boston MA, 02115, USA.
*Corresponding author. Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe Street, E8527, Baltimore, MD 21205, USA. E-mail: gchan{at}jhsph.edu
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Abstract |
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Background To determine the non-specific effects of diphtheria, tetanus and pertussis (DTP) vaccination and sex on mortality before 30 months of age among those who received Bacille Calmette Guerin (BCG) vaccine in a high mortality area.
Methods This analysis used a longitudinal study of child survival monitoring the use of primary care services, morbidity and mortality in Metro Cebu, The Philippines. Participants included 14 537 children under 30 months of age who received a BCG vaccination from July 1988 to January 1991. The main outcome measure was all-cause mortality.
Results Mortality before 30 months of age was 57% lower among BCG-vaccinated children who received DTP vaccination than BCG-vaccinated children who did not receive DTP vaccination {hazard ratio (HR) for vaccinated vs unvaccinated 0.43 [95% confidence interval (CI) 0.21–0.88]}. Females had lower mortality rates [HR = 0.19 (0.04–0.86), P = 0.03] than males among DTP-unvaccinated children. The protective effect of DTP vaccination was more pronounced in males [HR 0.32 (0.14–0.73)] than in females [HR 0.86 (0.18–4.23)]. DTP vaccination increased (interaction term P = 0.08) the female-to-male mortality ratio to 0.76 (0.52–1.12).
Conclusions Among BCG-vaccinated children under 30 months of age, DTP vaccination is associated with improved survival. The increased female–male mortality ratio is associated with reduced mortality among males following DTP vaccination rather than increased mortality among female children.
Keywords Non-specific vaccine effects, sex differences, DTP vaccine, child survival
Accepted 13 June 2007
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  P. Aaby, C. S. Benn, J. Nielsen, and H. Ravn Sex-differential non-specific effects of BCG and DTP in Cebu, The Philippines Int. J. Epidemiol., February 14, 2008; (2008) dyn005v1. [Full Text] [PDF]
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