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Providing it is not given after vitamin A or followed by DTP, measles vaccine reduces mortality from diseases other than measles by 45% (95% confidence interval [CI], 14%‐65%) when given at 4.5 months of age [9], and by 47% (95% CI, 23%‐63%) when given to girls at 9 to 10 months of age [1]. In this issue of the Journal ,A aby et al present further evidence, from Guinea-Bissau, that BCG has potent nonspecific effects on mortality [4]. Low-birth-weight neonates were randomized to receive BCG at birth or via the routine immunization program at an older age (median, 7.7 weeks). The biological effects of BCG are shown by the outcome during the first 4 weeks after randomization, before children in either group had been given DTP and when few children in the control group had received BCG. In this period, BCG reduced mortality by 45% (95% CI, 11%‐66%); there were fewer deaths from sepsis and acute respiratory infection, and no deaths from tuberculosis (which is a rare cause of death at this age). This spectacular reduction in mortality is consistent with the results of 6 controlled trials performed in 45,662 children in the United States and the United Kingdom in the 1940s and 1950s, in which BCG reduced mortality from causes other than tuberculosis by 25% (95% CI, 6%‐41%)

The Nonspecific Effects of Vaccines and the Expanded Program on Immunization