Reduced Mortality After Oral Polio Vaccination and Increased Mortality After Diphtheria-tetanus-pertussis Vaccination in Children in a Low-income Setting

Abstract

Purpose: The diphtheria-tetanus-pertussis vaccine (DTP) and oral polio vaccine (OPV) were introduced in children 3 of 5 months of age in 1981e1983 in Bandim, in the capital of Guinea-Bissau. Because DTP has been linked to deleterious nonspecific effects (NSEs) and OPV to beneficial NSEs, we followed up this cohort to 3 years of age and examined the effects of DTP with OPV on all-cause mortality and the interactions of DTP and OPV with the measles vaccine (MV). Methods: DTP and OPV were offered at 3 monthly community weighing sessions. Vaccination groups were defined by the last vaccine received. We compared overall mortality for different groups in Cox proportional hazards regression models, reporting hazards ratios (HRs) with 95% CIs. Findings: The study cohort included 1491 children born in Bandim from December 1980 to December 1983. From 3 to 35 months of age, with censoring for MV, children vaccinated with DTP and/or OPV had higher mortality than both unvaccinated children (HR ¼ l.66; 95% CI, 1.03e2.69) and OPV-only vaccinated children (HR ¼ 2.81; 95% CI, 1.02e7.69); DTP-only vaccinated children had higher mortality than OPV-only vaccinated children (HR ¼ 3.38; 95% CI, 1.15-e9.93). In the age group of 3e8 months, before MV is administered, DTPonly vaccination was associated with a higher mortality than DTP with OPV (HR ¼ 3.38; 95% CI, 1.59e7.20). Between 9 and 35 months of age, when MV is given, DTP-vaccinated and MV-unvaccinated children had higher mortality (HR ¼ 2.76; 95% CI, 1.36e5.59) than children who had received MV after DTP, and among children who received DTP with MV or after MV, DTP-only vaccination was associated with a higher mortality than DTP with OPV (HR ¼ 6.25; 95% CI, 2.55e15.37). Implications: Because the 2 vaccines had differential effects and the healthiest children were vaccinated first, selection biases are unlikely to explain the estimated impact on child survival. OPV had beneficial NSEs, and administration of OPV with DTP may have reduced the negative effects of DTP.

Stopping Oral Polio Vaccine (OPV) After Defeating Poliomyelitis in Low- and Middle-Income Countries: Harmful Unintended Consequences? Review of the Nonspecific Effects of OPV

“…Routine OPV could be assessed in 3 studies in which children received OPV-only because DTP was missing ( Table 1 ). OPV-only recipients had 3-fold lower all-cause mortality than recipients of DTP + OPV (relative risk [RR], 0.33 [95% CI, 0.14–0.75]) [ 17–20 ] in 2 studies when DTP and OPV were introduced in Guinea-Bissau in the 1980s. Twenty years later, DTP was missing for several months; the all-cause case fatality ratio (CFR) was 3-fold lower for hospitalized children who had received OPV1 only and not the recommended DTP1 + OPV1 [ 19 ].…”

“… a OPV in these periods would have been trivalent OPV. b Mogensen et al [ 21 ] overlaps with reference [ 17 ] as it covers the same cohort but only in the age group 3–5 months, where the study was a natural experiment with limited selection bias. c Reported, directly or inversed, in the original publication.…”

“… b Mogensen et al [ 21 ] overlaps with reference [ 17 ] as it covers the same cohort but only in the age group 3–5 months, where the study was a natural experiment with limited selection bias. …”

“… b Children followed in the age group 3–8 months, before measles vaccination. c Reference [ 17 ] provided data to both estimate the effect of DTP-only and DTP + OPV indirectly via comparison with children who received no DTP (first section) and directly (second section). It will be seen that the 2 estimates were essentially the same.…”

Vaccination With Oral Polio Vaccine Reduces COVID-19 Incidence

“…This was shown for Bacillus Calmette-Guerin (BCG, vaccine against tuberculosis) ( 8 , 9 ), live vaccine against measles ( 10 ), Oral Poliovirus Vaccine (OPV) ( 11 ), and some other vaccines ( 12 ). Their introduction was found to reduce the all-cause mortality in low-income countries ( 13 , 14 ) and infectious disease-related hospitalizations in high-income countries ( 15 ). A prospective clinical study conducted in the Soviet Union in the late 1960s demonstrated that OPV could reduce the incidence of influenza and other acute respiratory diseases ( 16 , 17 ).…”