Abstract | BACKGROUND: The current strategy utilized by WHO/United Nations Children's Fund (UNICEF) to reach the Global Immunization Vision and Strategy 2010 measles reduction goal includes increasing coverage of measles vaccine, vitamin A treatment and supplementation in addition to offering two doses of vaccine to all children. METHODS: We conducted a systematic review of published randomized controlled trials (RCTs) and quasi-experimental (QE) studies in order to determine effect estimates of measles vaccine and vitamin A treatment for the Lives Saved Tool (LiST). We utilized a standardized abstraction and grading format in order to determine effect estimates for measles mortality employing the standard Child Health Epidemiology Research Group Rules for Evidence Review. RESULTS: We identified three measles vaccine RCTs and two QE studies with data on prevention of measles disease. A meta-analysis of these studies found that vaccination was 85% [95% confidence interval (CI) 83-87] effective in preventing measles disease, which will be used as a proxy for measles mortality in LiST for countries vaccinating before one year of age. The literature also suggests that a conservative 95% effect estimate is reasonable to employ when vaccinating at 1 year or later and 98% for two doses of vaccine based on serology reviews. We included six high-quality RCTs in the meta-analysis of vitamin A treatment of measles which found no significant reduction in measles morality. However, when stratifying by vitamin A treatment dose, at least two doses were found to reduce measles mortality by 62% (95% CI 19-82). CONCLUSION:
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Authors | Christopher R Sudfeld, Ann Marie Navar, Neal A Halsey |
Journal | International journal of epidemiology
(Int J Epidemiol)
Vol. 39 Suppl 1
Pg. i48-55
(Apr 2010)
ISSN: 1464-3685 [Electronic] England |
PMID | 20348126
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
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Chemical References |
- Measles Vaccine
- Vitamin A
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Topics |
- Age Factors
- Child, Preschool
- Dose-Response Relationship, Drug
- Dose-Response Relationship, Immunologic
- Female
- Humans
- Immunization Schedule
- Infant
- Male
- Measles
(drug therapy, mortality, prevention & control)
- Measles Vaccine
(administration & dosage)
- Randomized Controlled Trials as Topic
- Treatment Outcome
- Vitamin A
(administration & dosage, therapeutic use)
- Vitamin A Deficiency
(complications, drug therapy)
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