National immunisation campaigns with oral polio vaccine may reduce all-cause mortality: Analysis of 2004-2019 demographic surveillance data in rural Bangladesh.
Bangladesh
Campaigns
Child mortality
Eradication
Non-specific effects of vaccines
OPV
Oral polio vaccine
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
07
01
2021
revised:
19
04
2021
accepted:
20
04
2021
entrez:
27
5
2021
pubmed:
28
5
2021
medline:
28
5
2021
Statut:
epublish
Résumé
West African studies have suggested that national immunisation campaigns with oral polio vaccine (C-OPV) may non-specifically reduce all-cause child mortality rate by 15-25%. We investigated whether C-OPVs had similar non-specific effects in rural Bangladesh from 2004 to 2019. Chakaria, is a health and demographic surveillance system (HDSS) in Southern Bangladesh. From 2004-2011 the HDSS covered a random sample of households; from 2012 to 2019 it covered a random sample of villages. Using Cox proportional hazards models, we calculated hazard ratios (HR) comparing mortality for children under 3 years of age after C-OPV versus before C-OPV to assess the effect of receiving a C-OPV. We allowed for different baseline hazard function in the two periods (2004-2011, 2012-2019), with separate models for each period. There were 768 deaths (2.1%) amongst 36,176 children. The HR after C-OPV was 0.69 (95% confidence interval: 0.52-0.90). National campaigns providing vitamin A or measles vaccine did not have similar effects. Each additional dose of C-OPV was associated with a reduction in the mortality rate by 6% (-2 to 13%). The number needed to treat with C-OPV to save one life between 0 and 35 months of age was 88 (81-96). This is the fourth study to show that C-OPV has beneficial non-specific effects on child survival. All studies have shown a beneficial effect of C-OPV on child health. Stopping OPV as planned after polio eradication without any mitigation plan could have detrimental effects for overall child health in low-income countries. The Chakaria HDSS was funded by international sponsors. No sponsor had any influence on the preparation of the article.
Sections du résumé
BACKGROUND
BACKGROUND
West African studies have suggested that national immunisation campaigns with oral polio vaccine (C-OPV) may non-specifically reduce all-cause child mortality rate by 15-25%. We investigated whether C-OPVs had similar non-specific effects in rural Bangladesh from 2004 to 2019.
METHODS
METHODS
Chakaria, is a health and demographic surveillance system (HDSS) in Southern Bangladesh. From 2004-2011 the HDSS covered a random sample of households; from 2012 to 2019 it covered a random sample of villages. Using Cox proportional hazards models, we calculated hazard ratios (HR) comparing mortality for children under 3 years of age after C-OPV versus before C-OPV to assess the effect of receiving a C-OPV. We allowed for different baseline hazard function in the two periods (2004-2011, 2012-2019), with separate models for each period.
FINDINGS
RESULTS
There were 768 deaths (2.1%) amongst 36,176 children. The HR after C-OPV was 0.69 (95% confidence interval: 0.52-0.90). National campaigns providing vitamin A or measles vaccine did not have similar effects. Each additional dose of C-OPV was associated with a reduction in the mortality rate by 6% (-2 to 13%). The number needed to treat with C-OPV to save one life between 0 and 35 months of age was 88 (81-96).
INTERPRETATION
CONCLUSIONS
This is the fourth study to show that C-OPV has beneficial non-specific effects on child survival. All studies have shown a beneficial effect of C-OPV on child health. Stopping OPV as planned after polio eradication without any mitigation plan could have detrimental effects for overall child health in low-income countries.
FUNDING
BACKGROUND
The Chakaria HDSS was funded by international sponsors. No sponsor had any influence on the preparation of the article.
Identifiants
pubmed: 34041458
doi: 10.1016/j.eclinm.2021.100886
pii: S2589-5370(21)00166-8
pmc: PMC8144662
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100886Informations de copyright
© 2021 The Authors.
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Références
Bull Pan Am Health Organ. 1974;8(2):123-32
pubmed: 4369156
Clin Infect Dis. 2021 May 18;72(10):e596-e603
pubmed: 32949460
Prog Med Virol. 1989;36:191-202
pubmed: 2555836
Cell Host Microbe. 2018 Jan 10;23(1):89-100.e5
pubmed: 29324233
Clin Infect Dis. 2015 Nov 15;61(10):1504-11
pubmed: 26219694
Trends Immunol. 2013 Sep;34(9):431-9
pubmed: 23680130
BMJ. 2010 Nov 30;341:c6495
pubmed: 21118875
Vaccine. 2011 Nov 3;29(47):8615-8
pubmed: 21939720
Zh Mikrobiol Epidemiol Immunobiol. 1992;(11-12):37-40
pubmed: 1338742
EBioMedicine. 2017 Mar;17:192-198
pubmed: 28188123
Lancet Infect Dis. 2020 Oct;20(10):e274-e283
pubmed: 32645296
Trop Med Int Health. 2007 Jan;12(1):5-14
pubmed: 17207143
Vaccine. 2018 Apr 5;36(15):1965-1971
pubmed: 29523450
Int J Epidemiol. 2016 Dec 1;45(6):1866-1886
pubmed: 28108528
BMJ Open. 2019 Sep 5;9(9):e024893
pubmed: 31492774
J Infect Dis. 2020 Oct 30;:
pubmed: 33125458
Clin Infect Dis. 2021 Apr 26;72(8):1429-1436
pubmed: 32185375
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Hum Vaccin Immunother. 2021 Jan 2;17(1):197-204
pubmed: 32573310
Vaccine. 2017 Apr 25;35(18):2496-2503
pubmed: 28341115
Int J Epidemiol. 2017 Apr 1;46(2):695-705
pubmed: 27380797
J Innate Immun. 2014;6(2):152-8
pubmed: 24192057
Vaccine. 2015 Jan 1;33(1):18-21
pubmed: 25444792
Int J Epidemiol. 2011 Aug;40(4):955-63
pubmed: 21543446
BMJ Open. 2016 Dec 23;6(12):e013335
pubmed: 28011813
Wkly Epidemiol Rec. 2014 May 23;89(21):221-36
pubmed: 24864348
Open Forum Infect Dis. 2015 Dec 17;3(1):ofv204
pubmed: 26885538
Pediatr Infect Dis J. 2015 Dec;34(12):1369-76
pubmed: 26379164
Vaccine. 2017 Feb 22;35(8):1113-1116
pubmed: 28139347
Proc Natl Acad Sci U S A. 2012 Oct 23;109(43):17537-42
pubmed: 22988082
JAMA. 2019 Feb 26;321(8):798-799
pubmed: 30730545
Vaccine. 2005 Feb 25;23(14):1746-51
pubmed: 15705481
Vaccine. 2020 Jan 3;38(1):10-14
pubmed: 31648913
Vaccine. 2006 Jul 17;24(29-30):5718-25
pubmed: 16720061
BMJ Open. 2012 Nov 19;2(6):
pubmed: 23166127
Front Public Health. 2018 Feb 02;6:13
pubmed: 29456992
Clin Infect Dis. 2017 Aug 1;65(3):420-421
pubmed: 28407072