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Varma A, Thysen SM, Martins JSD, Nanque LM, Jensen AKG, Fisker AB. Overall effect of a campaign with measles vaccine on the composite outcome mortality or hospital admission: A cluster-randomized trial among children aged 9-59 months in rural Guinea-Bissau. Int J Infect Dis 2023; 134:23-30. [PMID: 37182547 DOI: 10.1016/j.ijid.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES Campaigns with measles vaccine (C-MV) are conducted to eradicate measles, but prior studies indicate that MV reduces non-measles mortality and hospital admissions too. We hypothesized that C-MV reduces death/hospital admission by 30%. METHODS Between 2016-2019, we conducted a non-blinded cluster-randomized trial randomizing village clusters in rural Guinea-Bissau to a C-MV targeting children aged 9-59 months. In Cox proportional hazards models, we assessed the effect of C-MV, obtaining hazard ratios (HR) for the composite outcome (death/hospital admission). We also examined potential effect modifiers. RESULTS Among 18,411 children (9636 in 111 intervention clusters/8775 in 110 control clusters), 379 events occurred (208 intervention/171 control) during a median follow-up period of 22 months. C-MV did not reduce the composite outcome (HR 1.12, 95% confidence interval 0.88-1.41). Mortality among enrolled children (5.3 intervention and 4.6 control, per 1000 person-years) was approximately half the pre-trial mortality rate (11.1 intervention and 8.9 control, per 1000 person-years). Neither planned nor explorative analyses of potential effect modifiers explained the contrasting results to prior studies. CONCLUSION C-MV did not reduce overall mortality or hospital admission. This might be explained by changes in disease patterns, baseline differences in health status, and/or modifying effects of other campaigns during follow-up.
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Affiliation(s)
- Anshu Varma
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sanne M Thysen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Line M Nanque
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Aksel K G Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ane B Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Medeiros MM, Ingham AC, Nanque LM, Correia C, Stegger M, Andersen PS, Fisker AB, Benn CS, Lanaspa M, Silveira H, Abrantes P. Oral polio revaccination is associated with changes in gut and upper respiratory microbiomes of infants. Front Microbiol 2022; 13:1016220. [PMID: 36386704 PMCID: PMC9649904 DOI: 10.3389/fmicb.2022.1016220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
After the eradication of polio infection, the plan is to phase-out the live-attenuated oral polio vaccine (OPV). Considering the protective non-specific effects (NSE) of OPV on unrelated pathogens, the withdrawal may impact child health negatively. Within a cluster-randomized trial, we carried out 16S rRNA deep sequencing analysis of fecal and nasopharyngeal microbial content of Bissau–Guinean infants aged 4–8 months, before and after 2 months of OPV revaccination (revaccinated infants = 47) vs. no OPV revaccination (control infants = 47). The aim was to address changes in the gut and upper respiratory bacterial microbiotas due to revaccination. Alpha-diversity for both microbiotas increased similarly over time in OPV-revaccinated infants and controls, whereas greater changes over time in the bacterial composition of gut (padjusted < 0.001) and upper respiratory microbiotas (padjusted = 0.018) were observed in the former. Taxonomic analysis of gut bacterial microbiota revealed a decrease over time in the median proportion of Bifidobacterium longum for all infants (25–14.3%, p = 0.0006 in OPV-revaccinated infants and 25.3–11.6%, p = 0.01 in controls), compatible with the reported weaning. Also, it showed a restricted increase in the median proportion of Prevotella_9 genus in controls (1.4–7.1%, p = 0.02), whereas in OPV revaccinated infants an increase over time in Prevotellaceae family (7.2–17.4%, p = 0.005) together with a reduction in median proportion of potentially pathogenic/opportunistic genera such as Escherichia/Shigella (5.8–3.4%, p = 0.01) were observed. Taxonomic analysis of upper respiratory bacterial microbiota revealed an increase over time in median proportions of potentially pathogenic/opportunistic genera in controls, such as Streptococcus (2.9–11.8%, p = 0.001 and Hemophilus (11.3–20.5%, p = 0.03), not observed in OPV revaccinated infants. In conclusion, OPV revaccination was associated with a healthier microbiome composition 2 months after revaccination, based on a more abundant and diversified bacterial community of Prevotellaceae and fewer pathogenic/opportunistic organisms. Further information on species-level differentiation and functional analysis of microbiome content are warranted to elucidate the impact of OPV-associated changes in bacterial microbiota on child health.
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Affiliation(s)
- Márcia Melo Medeiros
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
- *Correspondence: Márcia Melo Medeiros,
| | - Anna Cäcilia Ingham
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Line Møller Nanque
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Odense Patient Data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
| | | | - Marc Stegger
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Paal Skyt Andersen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Ane Baerent Fisker
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Odense Patient Data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
| | - Christine Stabell Benn
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Odense Patient Data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Miguel Lanaspa
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
| | - Henrique Silveira
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
| | - Patrícia Abrantes
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
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Byberg S, Aaby P, Rodrigues A, Stabell Benn C, Fisker AB. The mortality effects of disregarding the strategy to save doses of measles vaccine: a cluster-randomised trial in Guinea-Bissau. BMJ Glob Health 2021; 6:e004328. [PMID: 33941513 PMCID: PMC8098964 DOI: 10.1136/bmjgh-2020-004328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Measles vaccine (MV) may improve health beyond measles protection. To avoid wastage from multi-dose vials, children in Guinea-Bissau are only measles vaccinated when aged 9-11 months and when six or more children are present. We assessed health impacts of providing MV to all measles-unvaccinated children 9-35 months. METHODS We cluster-randomised 182 village clusters under demographic surveillance in rural Guinea-Bissau to an 'MV-for-all-policy' arm where we offered MV regardless of age and number of children present at our bi-annual village visits, or a 'Restrictive-MV-policy' arm where we followed national policy. Measles-unvaccinated children aged 9-35 months were eligible for enrolment and followed to 5 years of age. In intention-to-treat analyses, we compared mortality using Cox regression analyses with age as underlying timescale. The primary analysis was for children aged 12-35 months at eligibility assessment. Interactions with several background factors were explored. RESULTS Between 2011 and 2016, we followed 2778 children in the primary analysis. MV coverage by 3 years was 97% among children eligible for enrolment under the MV-for-all-policy, and 48% under the Restrictive-MV-policy. Mortality was 59% lower than anticipated and did not differ by trial arm (MV-for-all-policy: 45/1405: Restrictive-MV-policy: 44/1373; HR: 0.95 (95% CI 0.64 to 1.43)). The effect of MV-for-all changed over time: The HR was 0.53 (95% CI 0.27 to 1.07) during the first 1½ years of enrolment but 1.47 (95% CI 0.87 to 2.50) later (p=0.02, test of interaction). Explorative analyses indicated that the temporal change may be related to interactions with other childhood interventions. CONCLUSION The MV-for-all-policy increased MV coverage but had no overall effect on overall mortality. TRIAL REGISTRATION NUMBER NCT01306006.
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Affiliation(s)
- Stine Byberg
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | | | - Christine Stabell Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Ane Baerent Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
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Varma A, Aaby P, Thysen SM, Jensen AKG, Fisker AB. Reduction in Short-term Outpatient Consultations After a Campaign With Measles Vaccine in Children Aged 9-59 Months: Substudy Within a Cluster-Randomized Trial. J Pediatric Infect Dis Soc 2020; 9:535-543. [PMID: 32897359 DOI: 10.1093/jpids/piaa091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND We assessed a measles vaccination campaign's potential short-term adverse events. METHODS In a cluster-randomized trial assessing a measles vaccination campaign's effect on all-cause mortality and hospital admission among children aged 9-59 months in Guinea-Bissau, children received a measles vaccination (intervention) or a health check-up (control). One month to 2 months later, we visited a subgroup of children to ask mothers/guardians about outpatient consultations since enrollment. In log-binomial models, we estimated the relative risk (RR) of nonaccidental outpatient consultations. RESULTS Among 8319 children (4437 intervention/3882 control), 652 nonaccidental outpatient consultations occurred (322 intervention/330 control). The measles vaccination campaign tended to reduce nonaccidental outpatient consultations by 16% (RR, 0.84 [95% confidence interval {CI}, .65-1.11]), especially if caused by respiratory symptoms (RR, 0.68 [95% CI, .42-1.11]). The reduction tended to be larger in children who prior to trial enrollment had a pentavalent vaccination (diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b) as the most recent vaccination (RR, 0.61 [95% CI, .42-.89]) than in children who prior to trial enrollment had a routine measles vaccination as the most recent vaccination (RR, 0.93 [95% CI, .68-1.26]) (P = .04 for interaction). CONCLUSIONS In the short term, a measles vaccination campaign seems not to increase nonaccidental outpatient consultations but may reduce them. CLINICAL TRIALS REGISTRATION NCT03460002.
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Affiliation(s)
- Anshu Varma
- OPEN, University of Southern Denmark, Odense, Denmark.,Indepth Network, Bandim Health Project, Bissau, Guinea-Bissau.,Research Center of Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Peter Aaby
- OPEN, University of Southern Denmark, Odense, Denmark.,Indepth Network, Bandim Health Project, Bissau, Guinea-Bissau.,Research Center of Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Sanne Marie Thysen
- OPEN, University of Southern Denmark, Odense, Denmark.,Indepth Network, Bandim Health Project, Bissau, Guinea-Bissau.,Research Center of Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Aksel Karl Georg Jensen
- OPEN, University of Southern Denmark, Odense, Denmark.,Research Center of Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark.,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Ane Bærent Fisker
- OPEN, University of Southern Denmark, Odense, Denmark.,Indepth Network, Bandim Health Project, Bissau, Guinea-Bissau.,Research Center of Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
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