VoICE : Search Immunization Evidence

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The VoICE tool is a compendium of the many direct and downstream impacts of vaccine-preventable disease and immunization. The database contains summary explanations of the link between immunization and each impact, as well as sources of evidence for each link. You can browse the VoICE tool by topic, or use the filters to find results based on topic, disease or vaccine, location and published year.

16 Key Concepts, 15 Sources
Key Concept

Key Evidence: A 2019 analysis of survey data from India, Ethiopia and Vietnam found that children vaccinated against measles scored better on cognitive tests of language development, math and reading than children who did not receive measles vaccines.

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Key Evidence: A small study from the Philippines, published in a Working Paper from Harvard University, found that children immunized with 6 basic vaccines scored better on three cognitive tests (verbal, mathematics and language) at age 11 compared to children who received none of these 6 vaccines.

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Key Concept

Key Evidence: The highly contagious varicella infections (chicken pox) cause children, on average, to miss 9 days of school. A highly effective varicella vaccine was introduced in the US in the mid-1990s.

From the VoICE editors: This study was conducted in 1987 in the US.

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Key Concept

Key Evidence: A review of gut infections and effects on physical growth and development found that for children living in impoverished areas of the world, episodes of diarrhea during the first two years of life not only negatively affected their physical growth, but could result in a 10 points lower IQ than average by age 7.

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Key Concept

Key Evidence: Among families participating in a study in Western Cape, South Africa, 35% of mothers who were previously employed stopped working to care for children who had survived tuberculosis meningitis with permanent disabilities. 19% of families reported experiencing financial loss as a result of caring for these disabled children.

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Key Concept

Key Evidence: In a study of immunization in the Philippines, children vaccinated against 6 diseases performed significantly better on verbal reasoning, math, and language tests than those who were unvaccinated. (note: Researchers did not find an association with physical growth.)

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Key Concept

Key Evidence: For every 6 children vaccinated against measles in a poor, largely rural community in South Africa, one additional grade of schooling was achieved.

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Key Evidence: In 1996, a follow-up study was conducted on a 1974 randomized trial of tetanus and cholera vaccine administered to mothers. At the time of follow up in 1996, there was a clear pattern of increased educational attainment among children whose mothers received tetanus vaccine during pregnancy. This pattern was significant for the group of children born to vaccinated mothers with very low levels of education.

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Key Concept

Key Evidence: Among families participating in a study in Western Cape, South Africa, 35% of mothers who were previously employed stopped working to care for children who had survived tuberculosis meningitis resulting in permanent disabilities. 19% of families reported experiencing financial loss as a result of caring for these disabled children.

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Key Concept

Key Evidence: A large longitudinal study in the Philippines found that children suffering bouts of diarrhea and respiratory infections were at a significantly increased risk of physical stunting which is associated with “poor functional outcomes such as impaired cognitive development.”

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Key Evidence: A study looking at the long term cognitive deficits faced by children in an urban Brazilian shantytown with high incidence of diarrhea in the first two years of life showed that this cohort scored significantly lower on 3/5 types of test measuring cognitive function at ages 6-10 compared to children who did not suffer recurrent bouts of early childhood diarrhea. In particular, the children who suffered from persistent early childhood diarrhea scored lower on tests assessing nonverbal intelligence (TONI) and IQ through assessing ability to match symbols to numbers (WISC-III Coding task) and short-term memory (WISC-III digit scan).

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Key Concept

Key Evidence: A study analyzing the long-term consequences of middle ear disease in children in an urban health center and a private practice in the United States found that time spent with middle ear effusion during the first 3 years of life was significantly associated with lower school performance and lower scores in cognitive ability, speech, and language.

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Key Concept

Key Evidence: The risk of mortality from tetanus is high for mothers and their newborns, and up to 50% of children who do survive neonatal tetanus may have long-term cognitive impairment, according to a 2007 review.

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Key Evidence: In The Gambia, 58% of children who survived pneumococcal meningitis had long lasting negative health outcomes. Half had major disabilities such as mental retardation, hearing loss, motor abnormalities, and seizures.

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Key Evidence: In a systematic literature review of studies in Africa, it was found that 25% of children who survived pneumococcal or Hib meningitis had neuropsychological deficits.

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Key Concept

Key Evidence: In a study of children in a Brazilian shantytown, researchers found that the greater the number of episodes of persistent diarrhea before age two, the more delayed a child was in terms of school readiness. Overall, each episode of diarrhea delayed a child’s starting school by 0.7 months. Likewise, 6-10 years later, increasing episodes of diarrhea before age two predicted delays in age-appropriate educational attainment.

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Key Concept

Key Evidence: Children in Western Cape, South Africa who were well enough to attend school after surviving tuberculosis meningitis, more than half had failed at least one school grade.

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Key Concept

Key Evidence: This study follows up on a 1974 randomized trial of tetanus and cholera vaccine administered to mothers in Bangladesh. At the time of follow up in 1996, there was a clear pattern of increased educational attainment among children whose mothers received tetanus vaccine during pregnancy. This pattern was significant for the group of children born to vaccinated mothers with very low levels of education.

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Key Concept

Key Evidence: A 2019 analysis of survey data from school aged children in Ethiopia, India and Vietnam shows that children vaccinated against measles achieved 0.2 – 0.3 years of additional schooling compared to children who did not receive the measles vaccine.

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Key Evidence: For every 6 children vaccinated against measles in a poor, largely rural community in South Africa, one additional grade of schooling was achieved.

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Key Evidence: A study of the staggered roll-out of measles vaccination in Matlab, Bangladesh, which started in the early 1980s, found that boys vaccinated before 12 months of age were 7.4% more likely to be enrolled in school than boys who were never vaccinated or vaccinated later in childhood, while measles vaccination had no effect on girls’ enrolment in school.

From the VoICE editors: This may suggest that poor health, resulting from complications of measles that can lead to deficits in physical and cognitive development, affected schooling decisions for boys in Bangladesh, but not for girls.

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Key Concept

Key Evidence: A large longitudinal study in the Philippines found that children suffering bouts of diarrhea and respiratory infections were at a significantly increased risk of physical stunting which is associated with “poor functional outcomes such as impaired cognitive development.”

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Key Concept

Key Evidence: In Gambia, 58% of children who survived a bout of pneumococcal meningitis “had clinical sequelae; half of them had major disability preventing normal adaptation to social life” (mental retardation, hearing loss, motor abnormalities, seizures).

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Key Evidence: A systematic literature review analyzing data from 21 African countries revealed that bacterial meningitis is associated with high case fatality and frequent neurophysiological sequelae. Pneumococcal and Hib meningitis contribute to one third of disease related mortality. They also cause clinically evident sequalae in 25% of survivors prior to hospital discharge. The three main causes of bacterial meningitis- Haemophilus influenzae type B; Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus) are vaccine preventable, routine use of conjugate vaccines have potential for significant health and economic benefits.

From the VoICE Editors: Neuropsychological sequelae includes hearing loss, vision loss, cognitive delay, speech/language disorder, behavioural problems, motor delays/impairment, and seizures. 

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