Fisker AB, Ravn H, Rodrigues A, Østergaard MD, Bale C, Benn CS, Aaby P. 2013. Co-administration of live measles and yellow fever vaccines and inactivated pentavalent vaccines is associated with increased mortality compared with measles and yellow fever vaccines only. An observational study from Guinea-Bissau. Vaccine. 2014 Jan 23;32(5):598-605. doi: 10.1016/j.vaccine.2013.11.074. Epub 2013 Dec 8.


Studies from low-income countries indicate that co-administration of inactivated diphtheria-tetanus-pertussis (DTP) vaccine and live attenuated measles vaccine (MV) is associated with increased mortality compared with receiving MV only. Pentavalent (DTP-H. Influenza type B-Hepatitis B) vaccine is replacing DTP in many low-income countries and yellow fever vaccine (YF) has been introduced to be given together with MV. Pentavalent and YF vaccines were introduced in Guinea-Bissau in 2008. We investigated whether co-administration of pentavalent vaccine with MV and yellow fever vaccine has similar negative effects.


In 2007-2011, we conducted a randomised placebo-controlled trial of vitamin A at routine vaccination contacts among children aged 6-23 months in urban and rural Guinea-Bissau. In the present study, we included 2331 children randomised to placebo who received live vaccines only (MV or MV+YF) or a combination of live and inactivated vaccines (MV+DTP or MV+YF+pentavalent). Mortality was compared in Cox proportional hazards models stratified for urban/rural enrolment adjusted for age and unevenly distributed baseline factors.


While DTP was still used 685 children received MV only and 358 MV+DTP; following the change in programme, 940 received MV+YF only and 348 MV+YF+pentavalent. During 6 months of follow-up, the adjusted mortality rate ratio (MRR) for co-administered live and inactivated vaccines compared with live vaccines only was 3.24 (1.20-8.73). For MV+YF+pentavalent compared with MV+YF only, the adjusted MRR was 7.73 (1.79-33.4).


In line with previous studies of DTP, the present results indicate that pentavalent vaccine co-administered with MV and YF is associated with increased mortality.

Copyright © 2013 Elsevier Ltd. All rights reserved.


BCG, BHP, Bacillus Calmette–Guérin vaccine, Bandim Health Project, Child mortality, DTP, Diphtheria–tetanus–pertussis vaccine, EPI, Expanded Programme on Immunisations, HDSS, MRR, MV, Measles vaccine, OPV, Pentavalent vaccine, YF, Yellow fever vaccine, diphtheria–tetanus–pertussis vaccine, health and demographic surveillance system, measles vaccine, mortality rate ratio, oral polio vaccine, yellow fever vaccine

Last revised 26 February 2014