The major interventions in childhood, in particular vaccinations and micronutrient supplementation, in low-income countries are implemented to prevent specific infections or deficiencies. These interventions have been evaluated exclusively for their expected effect. However, we have documented several times that interventions may have additional beneficial or negative effects because they also stimulate the immune system in unforeseen ways. These non-specific effects (NSE) often differ for boys and girls. Some examples: BCG vaccine reduces non-TB mortality for girls. High-titre measles vaccine increased female mortality two-fold when followed by inactivated vaccines but had no effect for boys. Vitamin A supplementation (VAS) administered with vaccines as recommendede by the WHO may increase mortality for girls. Hence, though we believe that our interventions are good and effective, we may totally misjudge the total effect. The only way to prevent this is to monitor the impact of our current and future specific interventions in a context where the total impact on mortality can be assessed. We therefore intend to create a consortium of health demographic surveillance sites (HDSS) interested in such monitoring and in testing possible modifications in current practice. Few sites apart from the Bandim Health Project (BHP) have such experience and it will therefore be necessary to standardize data collection procedures. To reinforce these issues we intend to establish a research agenda for NSE and to train a series of young scientists through developing PhD programs. We have already conducted several field visits, made several data sharing agreements, and a workshop on NSEs of vaccines is planned at LSHTM in April 2008. The present proposal seek funding for additional site visits and a meeting to discuss common data collection procedures and research projects in order to submit a cross-site ENRECA proposal in 2009.
September 27, 2008
January 1, 2011