TY - JOUR

T1 - Can earlier BCG-Japan and OPV vaccination reduce early infant mortality?

T2 - A cluster-randomised trial in Guinea-Bissau

AU - Thysen, Sanne Marie

AU - da Silva Borges, Igualdino

AU - Martins, Jailson

AU - Stjernholm, Alexander Dahl

AU - Hansen, Jesper Sloth

AU - da Silva, Leontino Manuel Vieira

AU - Martins, Justiniano Sebastião Durga

AU - Jensen, Aksel

AU - Rodrigues, Amabelia

AU - Aaby, Peter

AU - Stabell Benn, Christine

AU - Fisker, Ane Baerent

N1 - © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2024

Y1 - 2024

N2 - OBJECTIVE: To assess the effect of providing BCG and oral polio vaccine (OPV) at an early home visit after delivery.DESIGN: Cluster-randomised trial, randomising 92 geographically defined clusters 1:1 to intervention/control arms.SETTING: Bandim Health Project Health and Demographic Surveillance System, Guinea-Bissau.PARTICIPANTS: 2226 newborns enrolled between July 2016 and August 2019.INTERVENTIONS: In both arms, newborns received a home visit within 72 hours after birth. In intervention clusters (n=46), BCG and OPV were provided at the home visit.MAIN OUTCOME MEASURE: Rates of non-accidental mortality were compared in Cox proportional hazards models from (last of) day 1 or enrolment, until (first of) day 60 or registration of non-trial vaccines.RESULTS: A total of 35 deaths (intervention: 7, control: 28) were registered during the trial. Providing BCG and OPV reduced non-accidental early infant mortality by 59% (8-82%). The intervention also reduced non-accidental hospital admissions. The intervention had little impact on growth and BCG scarring and tended to increase the risk of consultations.CONCLUSIONS: The trial was stopped early due to lower-than-expected enrolment and event rates when 33% of the planned number of newborns had been enrolled. Despite the small size of the trial, the results support that early BCG and OPV vaccinations are beneficial and reduce early child mortality and morbidity.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT02504203).

AB - OBJECTIVE: To assess the effect of providing BCG and oral polio vaccine (OPV) at an early home visit after delivery.DESIGN: Cluster-randomised trial, randomising 92 geographically defined clusters 1:1 to intervention/control arms.SETTING: Bandim Health Project Health and Demographic Surveillance System, Guinea-Bissau.PARTICIPANTS: 2226 newborns enrolled between July 2016 and August 2019.INTERVENTIONS: In both arms, newborns received a home visit within 72 hours after birth. In intervention clusters (n=46), BCG and OPV were provided at the home visit.MAIN OUTCOME MEASURE: Rates of non-accidental mortality were compared in Cox proportional hazards models from (last of) day 1 or enrolment, until (first of) day 60 or registration of non-trial vaccines.RESULTS: A total of 35 deaths (intervention: 7, control: 28) were registered during the trial. Providing BCG and OPV reduced non-accidental early infant mortality by 59% (8-82%). The intervention also reduced non-accidental hospital admissions. The intervention had little impact on growth and BCG scarring and tended to increase the risk of consultations.CONCLUSIONS: The trial was stopped early due to lower-than-expected enrolment and event rates when 33% of the planned number of newborns had been enrolled. Despite the small size of the trial, the results support that early BCG and OPV vaccinations are beneficial and reduce early child mortality and morbidity.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT02504203).

KW - Infant

KW - Child

KW - Humans

KW - Infant, Newborn

KW - BCG Vaccine

KW - Guinea-Bissau/epidemiology

KW - Japan

KW - Infant Mortality

KW - Vaccination

KW - Poliovirus Vaccine, Oral

U2 - 10.1136/bmjgh-2023-014044

DO - 10.1136/bmjgh-2023-014044

M3 - Journal article

C2 - 38350670

VL - 9

JO - BMJ Global Health

JF - BMJ Global Health

SN - 2059-7908

IS - 2

ER -