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More Intervention Effect Estimate Summaries

Effectiveness of Measles Vaccination and Vitamin A TreatmentEffectiveness of Measles Vaccination and Vitamin A Treatment

Reference
Sudfeld CR, Navar AM, Halsey NA.Effectiveness of Measles Vaccination and Vitamin A Treatment. Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i48-i55.


Background

  • WHO recommends a first dose of measles-containing vaccine at 9 months of age in countries where measles transmission is high, whereas 12 months of age is preferable in countries with low transmission. A second opportunity for measles vaccination is recommended for all children. (1-2) 
  • WHO recommends vitamin A treatment of measles consisting of two doses of: 
    • 50 000 IU for infants < 6 months of age, 
    • 100 000 IU for those 6 months to 1 year of age, and 
    • 200 000 IU for individuals > 1 year of age.(3)


Intervention Effects

Measles Vaccination on Measles Disease and All-cause Mortality

  • 43% (95% CI: 29-54) reduction in all-cause mortality from measles vaccine [Low Quality of Evidence – not included in LiST]
  • 85% (95% CI: 83-87) reduction in measles disease from measles vaccine [High Quality of Evidence]– this effect size will be used in the LiST tool as a proxy for prevention of measles mortality
  • Assuming 85% efficacy for single dose measles vaccine, and extrapolating 99.6% efficacy for two dose measles vaccination from serology data studies looking at effectiveness of two dose vs. one-dose measles vaccination, the authors produce a conservative estimate of the efficacy of two dose measles vaccine at 98%.

Vitamin A Treatment and Measles-specific Mortality

  • Meta-analysis of 6 vitamin A treatment RCTs with measles-specific mortality data [High Quality of Evidence]
  • No significant reduction in measles mortality including all doses and frequency of vitamin A treatment [RR 0.63; 95% CI 0.37-1.08], but…
  • 62% reduction in measles mortality [RR 0.38; 95% CI 0.18-0.81] with > 2 doses of 200 000 IU for children > 1 year of age and 100 000 IU for infants for treatment of measles.


Intervention Recommendation:  STRONG

  • Measles vaccine and vitamin A treatment are effective interventions to reduce measles mortality in children.


References from Sudfeld Paper Cited Here

  1. Cutts FT, Henderson RH, Clements CJ et al.  Principles of measles control.  Bull World Health Organ 1991; 69:1-7.
  2. World Health Organization, United Nations Children’s Fund. Measles Mortality Reduction and Regional Elimination Strategic Plan 2001-2005. Geneva, Switzerland: World Health Organization, 2001.
  3. WHO/UNICEF/IVAGG Task Force. Vitamin A Supplements – A Guide to Their Use in the Treatment and Prevention of Vitamin A Deficiency and Xerophthalmia.  Geneva: WHO, 1997.

 

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