Abstract
BackgroundSudden infant death syndrome (SIDS) continues to be one of the main causes of infant mortality in the United States. The objective of this study was to analyse the association between diphtheria-tetanus-pertussis (DTP) immunisation and SIDS over time.MethodsThe Centers for Disease Control and Prevention provided the number of cases of SIDS and live births per year (1968–2009), allowing the calculation of SIDS mortality rates. Immunisation coverage was based on (1) the United States Immunization Survey (1968–1985), (2) the National Health Interview Survey (1991–1993), and (3) the National Immunization Survey (1994–2009). We used sleep position data from the National Infant Sleep Position Survey. To determine the time points at which significant changes occurred and to estimate the annual percentage change in mortality rates, we performed joinpoint regression analyses. We fitted a Poisson regression model to determine the association between SIDS mortality rates and DTP immunisation coverage (1975–2009).ResultsSIDS mortality rates increased significantly from 1968 to 1971 (+27% annually), from 1971 to 1974 (+47%), and from 1974 to 1979 (+3%). They decreased from 1979 to 1991 (−1%) and from 1991 to 2001 (−8%). After 2001, mortality rates remained constant. DTP immunisation coverage was inversely associated with SIDS mortality rates. We observed an incidence rate ratio of 0.92 (95% confidence interval: 0.87 to 0.97) per 10% increase in DTP immunisation coverage after adjusting for infant sleep position.ConclusionsIncreased DTP immunisation coverage is associated with decreased SIDS mortality. Current recommendations on timely DTP immunisation should be emphasised to prevent not only specific infectious diseases but also potentially SIDS.
Highlights
Sudden infant death syndrome (SIDS) continues to be one of the main causes of infant mortality in the United States
In 1991, the Institute of Medicine published a report that showed no increase in neurological complications associated with pertussis immunisation [10]
The objective of the current study was to analyse the ecological association between DTP immunisation coverage and SIDS incidence in the United States over several decades
Summary
Sudden infant death syndrome (SIDS) continues to be one of the main causes of infant mortality in the United States. Despite a major decrease in mortality since the early 1990s, sudden infant death syndrome (SIDS) continues to be one of the main causes of infant death worldwide [1]. Many Western countries experienced a continuous increase in SIDS mortality during the 1970s - most likely due to a shift in diagnostic coding -, followed by a peak or plateau during the 1980s and a sharp decline at the beginning of the 1990s [1,3,4,5]. During the 1970s and 1980s, reports of neurological complications led to a dramatic decrease in immunisation coverage in many countries [7,8]. In 1991, the Institute of Medicine published a report that showed no increase in neurological complications associated with pertussis immunisation [10]. Pertussis immunisation, which is Müller-Nordhorn et al BMC Pediatrics (2015) 15:1 typically given in combination with diphtheria and tetanus vaccines (diphtheria-pertussis-tetanus, or DTP), quickly recovered beginning in 1991 [9]
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