The effect of early measles vaccination at 4.5 months of age on growth at 9 and 24 months of age in a randomized trial in Guinea-Bissau

S M Rasmussen, S Biering-Sørensen, S Byberg, A Andersen, M Bjerregaard-Andersen, A Rodrigues, C S Benn, C L Martins, P Aaby, S M Rasmussen, S Biering-Sørensen, S Byberg, A Andersen, M Bjerregaard-Andersen, A Rodrigues, C S Benn, C L Martins, P Aaby

Abstract

Background: Providing an early, additional measles vaccine (MV) at 4.5 months of age has been shown to reduce child mortality in low-income countries. We studied the effects on growth at 9 and 24 months of age.

Methods: A randomized controlled trial was conducted in Guinea-Bissau from 2003-2007 including 6,648 children. Children were randomized 1:1:1 to receive Edmonston-Zagreb measles vaccine at 4.5 and 9 months of age (group A), no vaccine at 4.5 months and Edmonston-Zagreb measles vaccine at 9 months (group B), or no vaccine at 4.5 months and Schwarz measles vaccine at 9 months (group C) Data on anthropometrics were obtained at enrolment at 4.5 months of age and again at 9 and 24 months of age. Analyses were stratified by sex, season of enrolment, and neonatal vitamin A supplementation (NVAS) status, as all these factors have been shown to modify the effect of early MV on mortality.

Results: Overall there was no effect of early MV on anthropometry at 9 months. At 24 months children who had received early MV had a significantly larger mid-upper-arm-circumference (MUAC/in cm) (Difference = 0.08; 95% CI (0.02;0.14)) compared with children in the control group; this effect was most pronounced among girls (0.12 (0.03;0.20)). The effect of early MV on MUAC remained significant in the dry season and in girls who received placebo rather than NVAS.

Conclusion: Early MV was associated with a larger MUAC particularly in girls. These results indicate that a two-dose measles vaccination schedule might not only reduce child mortality but also improve growth.

Trial registration: ClinicalTrials.gov NCT00168558 . Registered September 9, 2005, retrospectively registered.

Keywords: Early measles vaccination; Growth; Neonatal vitamin A supplementation; Non-specific effects; Season; Sex-differential effects.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
Effect of an early MV on anthropometric measures stratified by season (a) and NVAS (b) at 24 months2. 2) Statistical test was linear regression comparing early MV/No early MV controlled for weight/length and MUAC at inclusion. Horizontal lines defines the 95% confidence interval. *Marks significant effect of early MV (p < 0.05). bMUAC (mid upper arm circumference). # Significant (p < 0.05) after controlling for multiple testing using the permutation test

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