Divergent Mortality for Male and Female Recipients of Low-Titer and High-Titer Measles Vaccines in Rural Senegal

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Abstract
The female/male mortality ratio among unimmunized children and children vaccinated with standard or high-titer measles vaccines was examined for all children born in the period 1985–1991 in a rural area of Senegal. The female/male mortality ratio from 9 months to 5 years of age for unvaccinated children was 0.94 (95% confidence interval (Cl) 0.75–1.19), significantly different from the ratio of 0.64 (95% Cl 0.48–0.85) for recipients of the Schwarz standard measles vaccine (p=0.040). In the 4-year period, where high-titer measles vaccines were used in the study area, the female/male mortality ratio was 1.33 (95% Cl 1.00–1.78) for recipients of high-titer Edmonston-Zagreb or Schwarz vaccines compared with 0.67 (95% Cl 0.42–1.07) for recipients of the Schwarz standard vaccine (p=0.013). Hence, the Schwarz standard and high-titer measles vaccines have divergent sex-specific effects on mortality throughout childhood. Further studies of the underlying mechanisms are needed.

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