DTP with or after measles vaccination is associated with increased in-hospital mortality in Guinea-Bissau

BackgroundThe sequence of routine immunisations may be important for childhood mortality. Three doses of diphtheria–tetanus–pertussis vaccine (DTP) should be given at 6, 10, and 14 weeks and measles vaccine (MV) at 9 months of age. The sequence is not always respected. We examined in-hospital mortality of children having received DTP with or after measles vaccine.SettingThe only paediatric ward in Bissau, Guinea-Bissau.ParticipantsChildren hospitalised during two periods in 1990–1996 and 2001–2002 who had received MV prior to hospitalisation.Main outcome measureThe all-cause case fatality at the hospital for children aged 6–17 months.ResultThe case fatality was increased for children who had received DTP with or after measles vaccine compared with children who had received measles vaccine as the most recent vaccine, the ratio being 2.53 (1.37–4.67) and 1.77 (0.92–3.41) in the two periods, respectively. The combined estimate was 2.10 (1.34–3.28). These results were not explained by differences in nutritional status, number of doses of DTP or discharge policy.ConclusionAdministration of DTP with, or after MV, may reduce the beneficial effect of MV.