Vaccinia scars associated with improved survival among adults in rural Guinea-Bissau

Mette Lundsby Jensen, Sangeeta Dave, Maarten Schim van der Loeff, Carlos da Costa, Tim Vincent, Aleksandra Leligdowicz, Christine Stabell Benn, Adam Roth, Henrik Ravn, Ida Maria Lisse, Hilton Whittle, Peter Aaby, Mette Lundsby Jensen, Sangeeta Dave, Maarten Schim van der Loeff, Carlos da Costa, Tim Vincent, Aleksandra Leligdowicz, Christine Stabell Benn, Adam Roth, Henrik Ravn, Ida Maria Lisse, Hilton Whittle, Peter Aaby

Abstract

Background: In urban Guinea-Bissau, adults with a vaccinia scar had better survival but also a higher prevalence of HIV-2 infection. We therefore investigated the association between vaccinia scar and survival and HIV infection in a rural area of Guinea-Bissau.

Methodology/principal findings: In connection with a study of HIV in rural Guinea-Bissau, we assessed vaccinia and BCG scars in 193 HIV-1 or HIV-2 infected and 174 uninfected participants. Mortality was assessed after 2(1/2)-3 years of follow-up. The analyses were adjusted for age, sex, village, and HIV status. The prevalence of vaccinia scar was associated with age, village, and HIV-2 status but not with sex and schooling. Compared with individuals without any scar, individuals with a vaccinia scar had better survival (mortality rate ratio (MR) = 0.22 (95% CI 0.08-0.61)), the MR being 0.19 (95% CI 0.06-0.57) for women and 0.40 (95% CI 0.04-3.74) for men. Estimates were similar for HIV-2 infected and HIV-1 and HIV-2 uninfected individuals. The HIV-2 prevalence was higher among individuals with a vaccinia scar compared to individuals without a vaccinia scar (RR = 1.57 (95% CI 1.02-2.36)).

Conclusion: The present study supports the hypothesis that vaccinia vaccination may have a non-specific beneficial effect on adult survival.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Mercer A. Disease mortality and population in transition. Leicester: Leicester University Press; 1990. p. 262 p.
    1. Henderson DA, Moss B. Smallpox and vaccinia. In: Plotkin SA, Orenstein WA, editors. Vaccines, Philadelphia: W.B.Saunders Company; 1999. pp. 74–97.
    1. Aaby P, Samb B, Simondon F, Seck AM, Knudsen K, et al. Non-specific beneficial effect of measles immunisation: analysis of mortality studies from developing countries. BMJ. 1995;311:481–485.
    1. Kristensen I, Aaby P, Jensen H. Routine vaccinations and child survival: follow up study in Guinea-Bissau, West Africa. BMJ. 2000;321:1435–1438.
    1. Velema JP, Alihonou EM, Gandaho T, Hounye FH. Childhood mortality among users and non-users of primary health care in a rural west African community. Int J Epidemiol. 1991;20:474–479.
    1. Garly ML, Martins CL, Bale C, Balde MA, Hedegaard KL, et al. BCG scar and positive tuberculin reaction associated with reduced child mortality in West Africa. A non-specific beneficial effect of BCG? Vaccine. 2003;21:2782–2790.
    1. Knudsen KM, Aaby P, Whittle H, Rowe M, Samb B, et al. Child mortality following standard, medium or high titre measles immunization in West Africa. Int J Epidemiol. 1996;25:665–673.
    1. Aaby P, Samb B, Simondon F, Knudsen K, Coll Seck AM, et al. Divergent mortality for male and female recipients of lowtitre and hightitre measles vaccines in rural Senegal. Am J Epidemiol. 1993;138:746–755.
    1. Ashorn P, Maleta K, Espo M, Kulmala T. Male biased mortality among 1–2 year old children in rural Malawi. Arch Dis Child. 2002;87:386–387.
    1. Aaby P, Gustafson P, Roth A, Rodrigues A, Fernandes M, et al. Vaccinia scars associated with better survival for adults. An observational study from Guinea-Bissau. Vaccine. 2006;24:5718–5725.
    1. Wilkins A, Ricard D, Todd J, Whittle H, Dias F, et al. The epidemiology of HIV infection in a rural area of Guinea-Bissau. AIDS. 1993;7:1119–1122.
    1. Ricard D, Wilkins A, ŃGum PT, Hayes R, Morgan G, et al. The effects of HIV-2 infection in a rural area of Guinea-Bissau. AIDS. 1994;8:977–982.
    1. Ariyoshi K, Berry N, Wilkins A, Ricard D, Aaby P, et al. A community-based study of HIV-2 provirus load in a rural village in West Africa. JID. 1996;173:245–248.
    1. Aaby P, Ariyoshi K, Buckner M, Jensen H, Berry N, et al. Age of wife as a major determinant of male-to-female transmission of HIV-2 infection. A community study from rural West Africa. AIDS. 1996;10:1585–1590.
    1. Schim van der Loeff MF, Aaby P, Aryioshi K, Vincent T, Awasana AA, et al. HIV-2 does not protect against HIV-1 infection in a rural community in Guinea-Bissau. AIDS. 2001;15:2303–2310.
    1. Berry N, Jaffar S, Schim van der Loeff M, Ariyoshi K, Harding E, et al. Low level viraemia and prolonged survival of HIV-2 infected villagers in rural Guinea-Bissau. AIDS Res Hum Retrovirol. 2002;18:1167–1173.
    1. Ariyoshi K, Berry N, Cham F, Jaffar S, Schim van der Loeff M, et al. Quantification of Human T-Lymphotropic Virus Type (HTLV-1) proviral load in rural West Africa population: no enhancement of Human Immunodeficiency Virus Type-2 pathogenesis but HTLV-1 proviral load relates to mortality. JID. 2003;188:1648–1651.
    1. Jaffar S, Schim van der Loeff M, Eugen-Olsen J, Vincent T, Sarje-Njie R, et al. Immunological predictors of survival in HIV type 2-infected rural villagers in Guinea-Bissau. Aids Res Hum Retrovirol. 2005;21:560–564.
    1. Cox DR, Oakes D. Analysis of survival data. London: Chapman & Hall; 1984. p. 208 p.
    1. Frey SE, Newman FK, Cruz J, Shelton WB, Tennant JM, et al. Dose-related effects of smallpox vaccine. N Engl J Med. 2002;346:1275–1280.
    1. Fine PEM, Ponninghaus JM, Maine N. The distribution and implications of BCG scars in northern Malawi. Bull WHO. 1989;67:35–42.
    1. Poulsen AG, Aaby P, Jensen H, Dias F. Risk factors for HIV-2 seropositivity among older people in Guinea-Bissau. A search for the early history of HIV-2 infection. Scand J Infect Dis. 2000;32:169–175.
    1. Bager P, Westergaard T, Rostgaard K, Nielsen NM, Melbye M, et al. Smallpox vaccination and risk of allergy and asthma. J Allergy Clin Immunol. 2003;111:1227–1231.
    1. Kölmel KF, Gefeller O, Haferkamp B. Febrile infections and malignant melanoma: results of a case-control study. Melanoma Res. 1992;2:207–211.
    1. Pfahlberg A, Kolmel KF, Grange JM, Mastrangelo G, Krone B, et al. Inverse association between melanoma and previous vaccinations against tuberculosis and smallpox: results of the FEBIM study. J Invest Dermatol. 2002;119:570–575.
    1. Grufferman S, Wang HH, DeLong ER, Kimm SY, Delzell ES, et al. Environmental factors in the etiology of rhabdomyosarcoma in childhood. J Natl Cancer Inst. 1982;68:107–113.
    1. Gilat T, Hacohen D, Lilos P, Langman MJ. Childhood factors in ulcerative colitis and Crohn's disease. An international cooperative study. Scan J Gastroenterol. 1987;22:1009–1024.
    1. Kurtzke JF, Hyllested K, Arbuckle JD, Brønnum-Hansen H, Wallin MT, et al. Multiple sclerosis in the Faroe Islands. 7. Results of a case control questionnaire with multiple controls. Acta Neurol Scand. 1997;96:149–157.
    1. Kolmel KF, Grange JM, Krone B, Mastrangelo G, Rossi CR, et al. Prior immunisation of patients with malignant melanoma with vaccinia or BCG is associated with better survival. An European Organization for Research and Treatment of Cancer cohort study on 542 patients. Eur J Cancer. 2005;41:118–125.
    1. Demkowicz WE, Jr, Littaua RA, Wang J, Ennis FA. Human cytotoxic T-cell memory: long-lived responses to vaccinia virus. J Virol. 1996;70:2627–2631.
    1. Demkowicz WE, Jr, Ennis FA. Vaccinia virus-specific CD8+ cytotoxic T lymphocytes in humans. J Virol. 1993;66:1538–1544.
    1. Moore ZS, Seward JF, Lane JM. Smallpox. Lancet. 2006;367:425–435.
    1. Shann F. Heterologous immunity and the nonspecific effects of vaccines. A major medical advance? PIDJ. 2004;23:555–558.
    1. Welsh RM, Sein LK. No one is naïve: the significance of heterologous T-cell immunity. Nat Rev Immunol. 2002;2:417–426.

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