Diphtheria-Tetanus-Pertussis - DTP
Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine.
SYNOPSIS
In seven studies of BCG-vaccinated children, DTP vaccination was associated with a 2.54 (95% Cl 1.68- 3.86) increase in mortality in girls (with no increase in boys [ratio 0.96, 0.55-1.68]). The ways in which the female and the male immune systems may respond differently to vaccinations in infants are only beginning to be studied.
CITATION
Peter Aaby, Henrik Ravn, Ane B. Fisker, Amabelia Rodrigues, and Christine S. Benn; Transactions of the Royal Society of Tropical Medicine and Hygiene. 2016 Dec; 110(10): 570–581.doi: 10.1093/trstmh/trw073.
SUMMARY
Ten years ago, we formulated two hypotheses about whole-cell diphtheria-tetanus-pertussis (DTP) vaccination: first, when given after BCG (bacille Calmette-Guerin, is a vaccine for tuberculosis), DTP increases mortality in girls and, second, following DTP there is an increase in the female/male mortality rate ratio (MRR). A recent review by WHO found no convincing evidence that DTP increases mortality in females. Now, ten years later, we have tested the two hypotheses using studies from before, but also those published since formulation of the hypotheses. All studies published after the formulation of the hypotheses of the association of DTP with increased mortality.
Early diphtheria-tetanus-pertussis vaccination associated with higher female mortality and no difference in male mortality in a cohort of low birthweight children: an observational study within a randomised trial.
SYNOPSIS
Surprisingly, even though the children with the best nutritional status were vaccinated early, early DTP vaccination was associated with increased mortality.
CITATION
Aaby P, Ravn H, Roth A, Rodrigues A, Lisse IM, Diness BR, Lausch KR, Lund N, Rasmussen J, Biering-Sorensen S, Whittle H, Benn CS. Archives of Disease in Childhood. 2012 Aug;97(8):685-91. doi: 10.1136/archdischild-2011-300646. Epub 2012 Feb 13.
SUMMARY
Studies from low-income countries have suggested that diphtheria-tetanus-pertussis (DTP) vaccine provided after Bacille Calmette-Guerin (BCG) vaccination may have a negative effect on female survival. The authors examined the effect of DTP in a cohort of low birthweight (LBW) infants and found, surprisingly, even though the children with the best nutritional status were vaccinated early, early DTP vaccination was associated with increased mortality for girls.
Post-vaccination encephalomyelitis: Literature review and illustrative case
SYNOPSIS
Australian scientists describe the role of vaccines in triggering acute disseminated encephalomyelitis (“ADEM”).
CITATION
William Huynh, Dennis J. Cordato, Elias Kehdi, Lynette T. Masters, Chris Dedousis. Journal of Clinical Neuroscience, 15 (2008) 1315–1322.
SUMMARY
“Post-infectious and post-immunization encephalomyelitis make up about three-quarters of cases, where the timing of a febrile event is associated with the onset of neurological disease. Post-vaccination Acute disseminated encephalomyelitis has been associated with several vaccines such as rabies, diphtheria-tetanus-polio, smallpox, measles, mumps, rubella, Japanese B encephalitis, pertussis, influenza, hepatitis B, and the Hog vaccine. We review ADEM with particular emphasis on vaccination as the precipitating factor.”
Delay in diphtheria, pertussis, tetanus vaccination is associated with a reduced risk of childhood asthma?
SYNOPSIS
Children who delayed the timing of the DPT vaccine had lower rates of asthma.
CITATION
McDonald KL, Huq SI. Journal of the American Academy of Allergy, Asthma and Immunology. 2008;121:626-631.
SUMMARY
“Early childhood immunizations have been viewed as promoters of asthma development by stimulating a T(H)2-type immune response or decreasing microbial pressure, which shifts the balance between T(H)1 and T(H)2 immunity. Among 11, 531 children who received at least 4 doses of DPT, the risk of asthma was reduced to (1/2) in children whose first dose of DPT was delayed by more than 2 months.”
Evaluation of non-specific effects of infant immunization on early infant mortality in southern Indian population.
SYNOPSIS
Among girls, those who received both BCG and DTP experienced higher mortality than those who received only one of the two vaccines (hazards ratio 2.4; 95% confidence interval 1.2-5.0).
CITATION
Moulton LH, Rahmathullah L, Halsey NA, Thulasiraj RD, Katz J, Tielsch JM. Tropical Medicine and International Health, 2005 Oct;10(10):947-55.
SUMMARY
In a study of children under 2 years of age in Guinea-Bissau, Kristensen et al. (2000) found immunization with Bacille Calmette Guerin (BCG) vaccine to be associated with lower mortality, but stated that oral polio vaccine (OPV) and diphtheria, tetanus, polio (DTP) vaccines were associated with higher mortality. More recently, it has been suggested that this effect may be gender-specific, existing primarily among girls. This evaluation, focused on relating timing of BCG and DTP vaccine receipt to mortality from 1 week to 6 months of age, with emphasis on gender differentials found that girls that received both BCG and DTP experienced higher mortality than those who received only one of the two vaccines.
The introduction of diphtheria-tetanus-pertussis vaccine and child mortality in rural GuineaBissau: an observational study.
SYNOPSIS
The MR (mortality rate) was 1.81 (95% Cl: 0.95, 3.45) for the first dose of DTP and 4.36 (95% Cl: 1.28, 14.9) for the second and third dose
CITATION
Aaby P, Jensen H, Gomes J, Fernandes M, Lisse IM. International Journal of Epidemiology. 2004 Apr;33(2):374-80.
SUMMARY
Prior to the introduction of vaccines, children who were absent at a village examination had the same mortality as children who were present. During 1984-1987, children receiving DTP at 2-8 months of age had higher mortality over the next 6 months, the mortality rate ratio (MR) being 1.92 (95% CI: 1.04, 3.52) compared with DTP-unvaccinated children, adjusting for age, sex, season, period, BCG, and region. The MR was 1.81 (95% CI: 0.95, 3.45) for the first dose of DTP and 4.36 (95% CI: 1.28, 14.9) for the second and third dose. BCG was associated with slightly lower mortality (MR = 0.63, 95% CI: 0.30, 1.33), the MR for DTP and BCG being significantly inversed. Researchers found in low-income countries with high mortality, DTP as the last vaccine received may be associated with slightly increased mortality. Since the pattern was inversed for BCG, the effect is unlikely to be due to higher-risk children having received vaccination. The role of DTP in high mortality areas needs to be clarified.
Routine vaccinations and child survival: follow up study in Guinea Bissau, West Africa.
SYNOPSIS
One dose of diphtheria, tetanus, and pertussis vaccine was associated with a mortality ratio of 1.84 (1.10 to 3.10) and two to three doses with a ratio of 1.38 (0.73 to 2.61) compared with children who had received no dose of these vaccines.”
CITATION
Kristensen I, Aaby P, Jensen H. British Medical Journal. 2000 Dec 9;321(7274):1435-8.
SUMMARY
Research on vaccines in developing countries recommended by the World Health Organization has emphasised serological responses and protection against specific diseases. The aim of the research has been to optimise vaccine schedules for control, elimination, or eradication of disease. In modelling exercises, vaccination against diphtheria, pertussis, tetanus, and polio has been assumed to save 1.52.0% of the children in areas with high infant mortality. However, these assumptions are not supported by data. Mortality was lower in the group vaccinated with any vaccine compared with those not vaccinated, however, recipients of one dose of diphtheria, tetanus, and pertussis or polio vaccines had higher mortality than children who had received none of these vaccines.
Effects of Diphtheria-Tetanus-Pertussis or Tetanus Vaccination on Allergies and Allergy-Related Respiratory Symptoms Among Children and Adolescents in the United States
SYNOPSIS
UCLA researchers find the DTP vaccine is causing asthma.
CITATION
Eric L. Hurwitz, DC, PhD, and Hal Morgenstern, PhD. Journal of Manipulative and Physiological Therapeutics, Volume 23, Number 2, February 2000.
SUMMARY
“Asthma and other allergic hypersensitivity reactions and related symptoms may be caused, in part, by the delayed effects of DTP or tetanus vaccination. Because the proportion of US children who have received at least 1 dose of DTP vaccine approaches 100%, the number of allergies and allergy-related conditions attributable to DTP or tetanus vaccination in the United States may be very high. For example, assuming that the estimated vaccination effect is unbiased, 50% of diagnosed asthma cases (2.93 million) in US children and adolescents would be prevented if the DTP or tetanus vaccination was not administered.”
The timing of pediatric immunizations and the risk of Insulin-Dependent diabetes mellitus
SYNOPSIS
Addition of the Hepatitis B Vaccine in 1988 Increased the Rate of Type 1 Diabetes 1.62X in Children in New Zealand. The incidence of type I diabetes in person 0-19 years old living in Christchurch rose from 11.2 cases per 100,000 children annually in the years before the immunization program, 1982-1987, to 18.1 cases per 100,000 children annually ( P = .0008) in the years following the immunization, 1989-1991.
CITATION
Classen David C.; Classen, John Barthelow; Infectious Diseases in Clinical Practice: September-October 1997 – Volume 6 – Issue 7 – ppg 449-454.
SUMMARY
Insulin-dependent diabetes mellitus (IDDM) is believed to be an autoimmune disease induced by a variety of environmental stimuli. Vaccines and infectious agents have been suggested to have an influence, but most of this research has been centered on the ability of these agents to infect the pancreatic islet cells or contain antigens that mimic autoantigens. Classen found that administration of the diphtheria-tetanus-pertussis (DTP) and anthrax vaccines to mice and rats at birth prevented the development of diabetes, whereas administration of the DTP vaccine starting at 8 weeks was associated with an increased incidence of diabetes.