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Meta-Analysis
. 2010 Apr;39 Suppl 1(Suppl 1):i48-55.
doi: 10.1093/ije/dyq021.

Effectiveness of measles vaccination and vitamin A treatment

Christopher R Sudfeld  1 , Ann Marie Navar, Neal A Halsey
Affiliations
Meta-Analysis

Effectiveness of measles vaccination and vitamin A treatment

Christopher R Sudfeld et al. Int J Epidemiol. 2010 Apr.

Abstract

Background: The current strategy utilized by WHO/United Nations Children's Fund (UNICEF) to reach the Global Immunization Vision and Strategy 2010 measles reduction goal includes increasing coverage of measles vaccine, vitamin A treatment and supplementation in addition to offering two doses of vaccine to all children.

Methods: We conducted a systematic review of published randomized controlled trials (RCTs) and quasi-experimental (QE) studies in order to determine effect estimates of measles vaccine and vitamin A treatment for the Lives Saved Tool (LiST). We utilized a standardized abstraction and grading format in order to determine effect estimates for measles mortality employing the standard Child Health Epidemiology Research Group Rules for Evidence Review.

Results: We identified three measles vaccine RCTs and two QE studies with data on prevention of measles disease. A meta-analysis of these studies found that vaccination was 85% [95% confidence interval (CI) 83-87] effective in preventing measles disease, which will be used as a proxy for measles mortality in LiST for countries vaccinating before one year of age. The literature also suggests that a conservative 95% effect estimate is reasonable to employ when vaccinating at 1 year or later and 98% for two doses of vaccine based on serology reviews. We included six high-quality RCTs in the meta-analysis of vitamin A treatment of measles which found no significant reduction in measles morality. However, when stratifying by vitamin A treatment dose, at least two doses were found to reduce measles mortality by 62% (95% CI 19-82).

Conclusion: Measles vaccine and vitamin A treatment are effective interventions to prevent measles mortality in children.

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Figures

Figure 1
Figure 1
Forest plot for the effect of one dose measles vaccine on measles disease (vaccinated compared with unvaccinated). Heterogeneity χ = 3.59 (df = 4); P = 0.464. I (variation in RR attributable to heterogeneity) = 0.0%. Test of RR = 1: z = 26.34; P < 0.01
Figure 2
Figure 2
Forest plot for the effect of vitamin A treatment on measles mortality for at least two doses of 200 000 IU for children and 100 000 IU for infants (treated vs untreated). Heterogeneity χ = 1.05 (df = 2); P = 0.592. I (variation in RR attributable to heterogeneity) = 0.0%. Test of RR = 1: z = 2.50; P = 0.01
Figure 3
Figure 3
Application of standard rules to measles interventions for LiST
See this image and copyright information in PMC

References

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