SynthesisTransactions of the Royal Society of Tropical Medicine and Hygiene2016
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.
Synthesis in Transactions of the Royal Society of Tropical Medicine and Hygiene, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 72 citations in OpenAlex.
- Neonatal Bacillus Calmette-Guérin Vaccination to Prevent Early-Life Eczema: A Systematic Review and Meta-analysis.Dermatitis : contact, atopic, occupational, drugPooled it
- Non-specific effects of BCG and DTP vaccination on infant mortality: An analysis of birth cohorts in Ghana and Tanzania.Vaccine · 2022Trial
- Innovations, Challenges, and Future Prospects for Combination Vaccines Against Human Infections.Vaccines · 2025Review
- Long-term effects of influenza and Bacille Calmette-Guérin vaccination on systemic inflammation.Clinical & translational immunology · 2025Article
- Sex differences in symptoms following the administration of BNT162b2 mRNA COVID-19 vaccine in children below 5 years of age in Germany (CoVacU5): a retrospective cohort study.Biology of sex differences · 2024Article
- Non-specific protection against severe COVID-19 associated to typhoid fever and DTP vaccination.Heliyon · 2024Article
- Low-doseFrontiers in immunology · 2024Article
- Do Pentavalent (DTwP-Hib-HBV) vaccines have sex-differential nonspecific effects? An observational study.Human vaccines & immunotherapeutics · 2023Observational
- Implications of Non-Specific Effects for Testing, Approving, and Regulating Vaccines.Drug safety · 2023Article
- Sex-Differential and Non-specific Effects of Vaccines Over the Life Course.Current topics in microbiology and immunology · 2023Review
- Sex-differential non-specific effects of adjuvanted and non-adjuvanted rabies vaccines versus placebo on all-cause mortality in dogs (NERVE-Dog study): a study protocol for a randomized controlled trial with a nested case-control study.BMC veterinary research · 2022Article
- Immunisation with the BCG and DTPw vaccines induces different programs of trained immunity in mice.Vaccine · 2022Article
- BCG-induced trained immunity enhances acellular pertussis vaccination responses in an explorative randomized clinical trial.NPJ vaccines · 2022Article
- Review
- Quadrivalent human papillomavirus vaccination and non-targeted infectious disease hospitalisation: Population-based self-controlled case series analysis.The Lancet regional health. Europe · 2021Article
- Are maternal and child health initiatives helping to reduce under-five mortality in Ghana? Results of a quasi-experimental study using coarsened exact matching.BMC pediatrics · 2021Article
- Parental Bacillus Calmette-Guérin vaccine scars decrease infant mortality in the first six weeks of life: A retrospective cohort study.EClinicalMedicine · 2021Article
- The Effects of Trained Innate Immunity on T Cell Responses; Clinical Implications and Knowledge Gaps for Future Research.Frontiers in immunology · 2021Review
- BCG vaccination in humans inhibits systemic inflammation in a sex-dependent manner.The Journal of clinical investigation · 2020Article
- Rabies Vaccination of 6-Week-Old Puppies Born to Immunized Mothers: A Randomized Controlled Trial in a High-Mortality Population of Owned, Free-Roaming Dogs.Tropical medicine and infectious disease · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTen years ago, we formulated two hypotheses about whole-cell diphtheria-tetanus-pertussis (DTP) vaccination: first, when given after BCG, 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.
methodsWe used previous DTP reviews as well as the recent WHO review for assessing the hypotheses. As pre-specified we excluded studies with survival or frailty bias; if children had received BCG and DTP simultaneously; and if the children had received neonatal vitamin A.
resultsIn seven studies of BCG-vaccinated children, DTP vaccination was associated with a 2.54 (95% CI 1.68-3.86) increase in mortality in girls (with no increase in boys [ratio 0.96, 0.55-1.68]). In 10 studies of BCG-vaccinated children, the female-to-male mortality ratio was 2.45 (1.48-4.06) times higher after DTP than before DTP. In 15 studies of children who had received DTP after previous BCG vaccination, mortality was 1.53 (1.21-1.93) times higher in girls than boys. The findings were similar in studies conducted before and after formulation of the hypotheses.
conclusionsThe two hypotheses were confirmed in the studies that fulfilled pre-specified criteria.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.