human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The female/male mortality ratio among unimmunized children and children vaccinated with st and ard 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 ( CI ) 0.75 - 1.19 ) , significantly different from the ratio of 0.64 ( 95 % CI 0.48 - 0.85 ) for recipients of the Schwarz st and ard 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 % CI 1.00 - 1.78 ) for recipients of high-titer Edmonston-Zagreb or Schwarz vaccines compared with 0.67 ( 95 % CI 0.42 - 1.07 ) for recipients of the Schwarz st and ard vaccine ( p = 0.013 ) . Hence , the Schwarz st and ard and high-titer measles vaccines have divergent sex-specific effects on mortality throughout childhood . Further studies of the underlying mechanisms are needed Objective To determine whether BCG revaccination at 19 months of age reduces overall child mortality . Design R and omised trial , with follow-up to age 5 . Setting A health project in Bissau , Guinea-Bissau , which maintains a health and demographic surveillance system in an urban area with 90 000 inhabitants . Participants 2871 children aged 19 months to 5 years with low or no reactivity to tuberculin and who were not severely sick on the day of enrolment . Intervention BCG vaccination or no vaccination ( control ) . Main outcome measure Hazard ratios for mortality . Results 77 children died during follow-up . Compared with controls , the BCG revaccinated children had a hazard ratio of 1.20 ( 95 % confidence interval 0.77 to 1.89 ) . Two hundred and fifty children were admitted to hospital for the first time between enrolment and the end of the study , with an incidence rate ratio for BCG revaccinated children versus controls of 1.04 ( 0.81 to 1.33 ) . The trial was stopped prematurely because of a cluster of deaths in the BCG arm of the study . This increase in mortality occurred at a time when many children had received missing vaccinations or vitamin A or iron supplementation ; the hazard ratio for BCG revaccinated children compared with controls was 2.69 ( 1.05 to 6.88 ) in the period after these campaigns . Throughout the trial , the effect of BCG revaccination on mortality was significantly different ( P=0.006 ) in children who had received diphtheria-tetanus-pertussis ( DTP ) booster vaccination before enrolment ( hazard ratio 0.36 , 0.13 to 0.99 ) and children who had not received the booster before enrolment ( 1.78 , 1.04 to 3.04 ) . Conclusions There was no overall beneficial effect of being revaccinated with BCG . The effect of BCG revaccination on mortality might depend on other health interventions . Trial registration Clinical Trials ICA4-CT-2002 - 10053-REVAC A total of 105 low – birth-weight children presenting for first vaccination were r and omized to receive bacillus Calmette-Guérin ( BCG ) immediately or later ( current practice ) . The mortality rate ratio for BCG was 0.17 ( 95 % CI = 0.02–1.35 ) within 3 days of enrollment , 0.28 ( 0.06–1.37 ) in the first month , and 0.27 ( 0.07–0.98 ) after 2 months of age . The mortality rate ratio was 0.41 ( 0.14–1.18 ) ( P = 0.098 ) in infancy . Administration of BCG vaccine at first contact may contribute to lower mortality Abstract Objective To study the effect of vaccination on  mortality before 2 years of age in a developing country . Design Prospect i ve cohort study . Setting Rural communities in Burkina Faso . Participants 9085 children born in the study area between 1985 and 1993 . Main outcome measure Child death rate . Results Mortality before 2 years of age was lower in children who had been vaccinated : those vaccinated with BCG only had significantly lower mortality ( risk ratio for vaccinated v unvaccinated children 0.37 , 95 % confidence interval 0.29 to 0.48 ) as did those vaccinated with diphtheria , tetanus , and pertussis only ( 0.24 , 0.13 to 0.43 ) . The second dose of diphtheria , tetanus , and pertussis was not associated with lower mortality ( 0.80 , 0.58 to 1.12 ) . Conclusion Vaccination with diphtheria , tetanus , and pertussis as well as BCG is associated with better survival of children up to 2 years of age In 2-dose trials , early measles vaccination at 4–6 months in presence of maternal measles antibody was associated with significantly better survival to age 5 years than vaccination in absence of measles antibody . Confounding factors did not explain the effect BACKGROUND Observational studies have suggested that BCG may have nonspecific beneficial effects on survival .  Low-birth-weight ( LBW ) children are not given BCG at birth in Guinea-Bissau ; we conducted a r and omized trial of BCG at birth ( early BCG ) vs delayed BCG . METHODS In the period 2004 - 2008 we recruited 2320 LBW children in Bissau . The children were visited at home at 2 , 6 , and 12 months of age . With a pretrial infant mortality of 250 per 1000 , we hypothesized a 25 % reduction in infant mortality for LBW children . RESULTS Infant mortality was only 101 per 1000 during the trial . In the primary analysis , infant mortality was reduced insignificantly by 17 % ( mortality rate ratio [ MRR ] = .83 [ .63 - 1.08 ] ) . In secondary analyses , early BCG vaccine was safe with an MRR of .49 ( .21 - 1.15 ) after 3 days and .55 ( .34-.89 ) after 4 weeks . The reduction in neonatal mortality was mainly due to fewer cases of neonatal sepsis , respiratory infection , and fever . The impact of early BCG on infant mortality was marked for children weighing < 1.5 kg ( MRR = .43 [ .21-.85 ] ) who had lower coverage for diphtheria-tetanus-pertussis vaccinations . CONCLUSIONS Though early BCG did not reduce infant mortality significantly , it may have a beneficial effect in the neonatal period . This could be important for public health because BCG is often delayed in low-income countries BACKGROUND Studies from Africa have suggested marked non-specific effects ( NSEs ) of routine vaccinations with effects on child survival . There have been few studies from Asia . We re-analyzed a study from Maharashtra , India , which had collected information on vaccinations during infancy and survival until 5 years of age . DESIGN 4138 children born between 1987 and 1989 were visited at home every three months to collect information on nutritional status and vaccinations . Since nutritional status was a determinant of time to vaccinations , we adjusted for nutritional status in the analyzes of the association between vaccinations and mortality . SETTING 45 contiguous villages in Shirur Administrative Block in Pune District . MAIN OUTCOME MEASURES Mortality rate ratios ( MRR ) for different vaccination status groups . RESULTS The study area has male preferential treatment , but the female-male mortality ratio varied between age groups with different pre-dominant vaccines ; it was high in the age group in which diphtheria-tetanus-pertussis ( DTP ) vaccine predominates and low in the age group in which measles vaccine ( MV ) is given . Children who followed the WHO recommended schedule of first BCG and then DTP vaccination were vaccinated earlier than other children ( p<0.01 ) . Two-thirds of the children had received BCG and DTP out-of-sequence , i.e. BCG and DTP simultaneously or BCG after DTP . Children who received BCG and DTP simultaneously or BCG as most recent vaccination had significantly lower mortality than children having DTP as the most recent vaccination , the mortality rate ratio being 0.15 ( 0.03 - 0.70 ) . CONCLUSIONS BCG out-of-sequence may be associated with lower mortality than DTP as the most recent vaccination . Given the public health implication s , this possibility should be tested in r and omized trials . Excess female mortality may also be related to vaccination policy Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES Studies from low-income countries have suggested that routine vaccinations may have non-specific effects on child mortality ;  measles vaccine ( MV ) is associated with lower mortality and diphtheria-tetanus-pertussis ( DTP ) with relatively higher mortality . We used data from Navrongo , Ghana , to examine the impact of vaccinations on  child mortality .  METHODS  Vaccination status was assessed at the initiation of a trial of vitamin A supplementation and after 12 and 24 months of follow-up . Within the placebo group , we compared the mortality over the first 4 months and the full 2 years of follow-up for different vaccination status groups with different likelihoods of additional vaccinations during follow-up . The frequency of additional vaccinations  was assessed among children whose vaccination card was seen at 12 and 24 months of follow-up . RESULTS Among children with a vaccination card , more than 75 % received missing DTP or MV  during the first 12 months of follow-up , whereas only 25 % received these vaccines among children with no vaccination card at enrollment . Children without a card at enrollment had a significant threefold higher mortality over the 2-year follow-up period than those fully vaccinated . The small group of children with DTP3 - 4 but no MV at enrollment had lower mortality than children without a card and had the same mortality as fully vaccinated children . In contrast , children with 1 - 2 DTP doses but no MV had a higher mortality during the first 4 months than children without a card [ MRR = 1.65 ( 0.95 , 2.87 ) ] ; compared with the fully vaccinated children , they had significantly higher mortality after 4 months [ MRR = 2.38 ( 1.07 , 5.30 ) ] and after 2 years [ MRR = 2.41 ( 1.41 , 4.15 ) ] . Children with 0 - 2 DTP doses at enrollment had higher mortality after 4 months ( MRR = 1.67 ( 0.82 , 3.43 ) and after 2 years [ MRR = 1.85 ( 1.16 , 2.95 ) ] than children who had all three doses of DTP at enrollment . CONCLUSIONS As hypothesised , DTP vaccination was associated with higher child mortality  than measles vaccination . To optimise vaccination policies , routine vaccinations need to be evaluated in r and omised trials measuring the impact on survival Background . Previous studies have suggested that st and ard measles vaccine may reduce mortality by more than the number of deaths thought to be caused by measles infection in areas with high mortality . However , these observations have not been based on r and omized trials . Methods . During the recent war in Guinea-Bissau , most children fled from the city of Bissau and immunization services in the country broke down for several months . We were performing a trial in which children were r and omized at 6 months of age to receive either measles vaccine or inactivated polio vaccine . Because of the war many children did not receive the dose of measles vaccine planned for 9 months of age . We were able to monitor mortality during the war and after . Results . Included in the study were 433 children 6 to 11 months of age . Fifteen children died ( 3.6 % ) during the first 3 months of the war before vaccination programs were resumed , 4 of 214 measles-vaccinated children and 11 of 219 children who had received inactivated polio vaccine . The effect of measles vaccine was marked for girls [ mortality rate ratio ( MR ) , 0.00 ; 95 % confidence limits , 0.0 to 0.37 ] , whereas there was no difference for boys ( MR = 1.02 ; 95 % confidence limits , 0.25 to 3.88 ) . In a combined analysis controlling for factors that differed between the two groups , the MR for measles-vaccinated children was 0.30 ( 95 % confidence limits , 0.08 to 0.87 ) . Prolonging the period of observation to the end of 1998 or including the prewar period did not modify the significant beneficial effect of measles 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The female/male mortality ratio among unimmunized children and children vaccinated with st and ard 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 ( CI ) 0.75 - 1.19 ) , significantly different from the ratio of 0.64 ( 95 % CI 0.48 - 0.85 ) for recipients of the Schwarz st and ard 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 % CI 1.00 - 1.78 ) for recipients of high-titer Edmonston-Zagreb or Schwarz vaccines compared with 0.67 ( 95 % CI 0.42 - 1.07 ) for recipients of the Schwarz st and ard vaccine ( p = 0.013 ) . Hence , the Schwarz st and ard and high-titer measles vaccines have divergent sex-specific effects on mortality throughout childhood . Further studies of the underlying mechanisms are needed Objective To determine whether BCG revaccination at 19 months of age reduces overall child mortality . Design R and omised trial , with follow-up to age 5 . Setting A health project in Bissau , Guinea-Bissau , which maintains a health and demographic surveillance system in an urban area with 90 000 inhabitants . Participants 2871 children aged 19 months to 5 years with low or no reactivity to tuberculin and who were not severely sick on the day of enrolment . Intervention BCG vaccination or no vaccination ( control ) . Main outcome measure Hazard ratios for mortality . Results 77 children died during follow-up . Compared with controls , the BCG revaccinated children had a hazard ratio of 1.20 ( 95 % confidence interval 0.77 to 1.89 ) . Two hundred and fifty children were admitted to hospital for the first time between enrolment and the end of the study , with an incidence rate ratio for BCG revaccinated children versus controls of 1.04 ( 0.81 to 1.33 ) . The trial was stopped prematurely because of a cluster of deaths in the BCG arm of the study . This increase in mortality occurred at a time when many children had received missing vaccinations or vitamin A or iron supplementation ; the hazard ratio for BCG revaccinated children compared with controls was 2.69 ( 1.05 to 6.88 ) in the period after these campaigns . Throughout the trial , the effect of BCG revaccination on mortality was significantly different ( P=0.006 ) in children who had received diphtheria-tetanus-pertussis ( DTP ) booster vaccination before enrolment ( hazard ratio 0.36 , 0.13 to 0.99 ) and children who had not received the booster before enrolment ( 1.78 , 1.04 to 3.04 ) . Conclusions There was no overall beneficial effect of being revaccinated with BCG . The effect of BCG revaccination on mortality might depend on other health interventions . Trial registration Clinical Trials ICA4-CT-2002 - 10053-REVAC A total of 105 low – birth-weight children presenting for first vaccination were r and omized to receive bacillus Calmette-Guérin ( BCG ) immediately or later ( current practice ) . The mortality rate ratio for BCG was 0.17 ( 95 % CI = 0.02–1.35 ) within 3 days of enrollment , 0.28 ( 0.06–1.37 ) in the first month , and 0.27 ( 0.07–0.98 ) after 2 months of age . The mortality rate ratio was 0.41 ( 0.14–1.18 ) ( P = 0.098 ) in infancy . Administration of BCG vaccine at first contact may contribute to lower mortality Abstract Objective To study the effect of vaccination on  mortality before 2 years of age in a developing country . Design Prospect i ve cohort study . Setting Rural communities in Burkina Faso . Participants 9085 children born in the study area between 1985 and 1993 . Main outcome measure Child death rate . Results Mortality before 2 years of age was lower in children who had been vaccinated : those vaccinated with BCG only had significantly lower mortality ( risk ratio for vaccinated v unvaccinated children 0.37 , 95 % confidence interval 0.29 to 0.48 ) as did those vaccinated with diphtheria , tetanus , and pertussis only ( 0.24 , 0.13 to 0.43 ) . The second dose of diphtheria , tetanus , and pertussis was not associated with lower mortality ( 0.80 , 0.58 to 1.12 ) . Conclusion Vaccination with diphtheria , tetanus , and pertussis as well as BCG is associated with better survival of children up to 2 years of age In 2-dose trials , early measles vaccination at 4–6 months in presence of maternal measles antibody was associated with significantly better survival to age 5 years than vaccination in absence of measles antibody . Confounding factors did not explain the effect BACKGROUND Observational studies have suggested that BCG may have nonspecific beneficial effects on survival .  Low-birth-weight ( LBW ) children are not given BCG at birth in Guinea-Bissau ; we conducted a r and omized trial of BCG at birth ( early BCG ) vs delayed BCG . METHODS In the period 2004 - 2008 we recruited 2320 LBW children in Bissau . The children were visited at home at 2 , 6 , and 12 months of age . With a pretrial infant mortality of 250 per 1000 , we hypothesized a 25 % reduction in infant mortality for LBW children . RESULTS Infant mortality was only 101 per 1000 during the trial . In the primary analysis , infant mortality was reduced insignificantly by 17 % ( mortality rate ratio [ MRR ] = .83 [ .63 - 1.08 ] ) . In secondary analyses , early BCG vaccine was safe with an MRR of .49 ( .21 - 1.15 ) after 3 days and .55 ( .34-.89 ) after 4 weeks . The reduction in neonatal mortality was mainly due to fewer cases of neonatal sepsis , respiratory infection , and fever . The impact of early BCG on infant mortality was marked for children weighing < 1.5 kg ( MRR = .43 [ .21-.85 ] ) who had lower coverage for diphtheria-tetanus-pertussis vaccinations . CONCLUSIONS Though early BCG did not reduce infant mortality significantly , it may have a beneficial effect in the neonatal period . This could be important for public health because BCG is often delayed in low-income countries BACKGROUND Studies from Africa have suggested marked non-specific effects ( NSEs ) of routine vaccinations with effects on child survival . There have been few studies from Asia . We re-analyzed a study from Maharashtra , India , which had collected information on vaccinations during infancy and survival until 5 years of age . DESIGN 4138 children born between 1987 and 1989 were visited at home every three months to collect information on nutritional status and vaccinations . Since nutritional status was a determinant of time to vaccinations , we adjusted for nutritional status in the analyzes of the association between vaccinations and mortality . SETTING 45 contiguous villages in Shirur Administrative Block in Pune District . MAIN OUTCOME MEASURES Mortality rate ratios ( MRR ) for different vaccination status groups . RESULTS The study area has male preferential treatment , but the female-male mortality ratio varied between age groups with different pre-dominant vaccines ; it was high in the age group in which diphtheria-tetanus-pertussis ( DTP ) vaccine predominates and low in the age group in which measles vaccine ( MV ) is given . Children who followed the WHO recommended schedule of first BCG and then DTP vaccination were vaccinated earlier than other children ( p<0.01 ) . Two-thirds of the children had received BCG and DTP out-of-sequence , i.e. BCG and DTP simultaneously or BCG after DTP . Children who received BCG and DTP simultaneously or BCG as most recent vaccination had significantly lower mortality than children having DTP as the most recent vaccination , the mortality rate ratio being 0.15 ( 0.03 - 0.70 ) . CONCLUSIONS BCG out-of-sequence may be associated with lower mortality than DTP as the most recent vaccination . Given the public health implication s , this possibility should be tested in r and omized trials . Excess female mortality may also be related to vaccination policy Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES Studies from low-income countries have suggested that routine vaccinations may have non-specific effects on child mortality ;  measles vaccine ( MV ) is associated with lower mortality and diphtheria-tetanus-pertussis ( DTP ) with relatively higher mortality . We used data from Navrongo , Ghana , to examine the impact of vaccinations on  child mortality .  METHODS  Vaccination status was assessed at the initiation of a trial of vitamin A supplementation and after 12 and 24 months of follow-up . Within the placebo group , we compared the mortality over the first 4 months and the full 2 years of follow-up for different vaccination status groups with different likelihoods of additional vaccinations during follow-up . The frequency of additional vaccinations  was assessed among children whose vaccination card was seen at 12 and 24 months of follow-up . RESULTS Among children with a vaccination card , more than 75 % received missing DTP or MV  during the first 12 months of follow-up , whereas only 25 % received these vaccines among children with no vaccination card at enrollment . Children without a card at enrollment had a significant threefold higher mortality over the 2-year follow-up period than those fully vaccinated . The small group of children with DTP3 - 4 but no MV at enrollment had lower mortality than children without a card and had the same mortality as fully vaccinated children . In contrast , children with 1 - 2 DTP doses but no MV had a higher mortality during the first 4 months than children without a card [ MRR = 1.65 ( 0.95 , 2.87 ) ] ; compared with the fully vaccinated children , they had significantly higher mortality after 4 months [ MRR = 2.38 ( 1.07 , 5.30 ) ] and after 2 years [ MRR = 2.41 ( 1.41 , 4.15 ) ] . Children with 0 - 2 DTP doses at enrollment had higher mortality after 4 months ( MRR = 1.67 ( 0.82 , 3.43 ) and after 2 years [ MRR = 1.85 ( 1.16 , 2.95 ) ] than children who had all three doses of DTP at enrollment . CONCLUSIONS As hypothesised , DTP vaccination was associated with higher child mortality  than measles vaccination . To optimise vaccination policies , routine vaccinations need to be evaluated in r and omised trials measuring the impact on survival Background . Previous studies have suggested that st and ard measles vaccine may reduce mortality by more than the number of deaths thought to be caused by measles infection in areas with high mortality . However , these observations have not been based on r and omized trials . Methods . During the recent war in Guinea-Bissau , most children fled from the city of Bissau and immunization services in the country broke down for several months . We were performing a trial in which children were r and omized at 6 months of age to receive either measles vaccine or inactivated polio vaccine . Because of the war many children did not receive the dose of measles vaccine planned for 9 months of age . We were able to monitor mortality during the war and after . Results . Included in the study were 433 children 6 to 11 months of age . Fifteen children died ( 3.6 % ) during the first 3 months of the war before vaccination programs were resumed , 4 of 214 measles-vaccinated children and 11 of 219 children who had received inactivated polio vaccine . The effect of measles vaccine was marked for girls [ mortality rate ratio ( MR ) , 0.00 ; 95 % confidence limits , 0.0 to 0.37 ] , whereas there was no difference for boys ( MR = 1.02 ; 95 % confidence limits , 0.25 to 3.88 ) . In a combined analysis controlling for factors that differed between the two groups , the MR for measles-vaccinated children was 0.30 ( 95 % confidence limits , 0.08 to 0.87 ) . Prolonging the period of observation to the end of 1998 or including the prewar period did not modify the significant beneficial effect of measles 
    Output:
    