Uptake of neonatal BCG vaccination in England: performance of the current policy recommendations: Table 1

Nguipdop-Djomo, Patrick; Mangtani, Punam; Pedrazzoli, Debora; Rodrigues, Laura C.; Abubakar, Ibrahim

doi:10.1136/thoraxjnl-2013-203931

Cited by 10 publications

(7 citation statements)

References 3 publications

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“…Bacille Calmette–Guerin (BCG) vaccination has limited efficacy in preventing pulmonary TB but can effectively reduce the risk of severe disseminated forms of TB and their sequelae in children [ 81 , 82 ]. However, the risk–benefit ratio of BCG vaccination becomes increasingly unfavourable with decreasing TB transmission rate [ 83 – 85 ].…”

Section: Adapting the Global Strategy To The Special Challenges For Tmentioning

confidence: 99%

Towards tuberculosis elimination: an action framework for low-incidence countries

et al. 2015

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This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards “pre-elimination” (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.

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Section: Adapting the Global Strategy To The Special Challenges For Tmentioning

confidence: 99%

Towards tuberculosis elimination: an action framework for low-incidence countries

et al. 2015

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“…Our findings may support this view as we observed only a small decrease in incidence rates in UK born neonates after the introduction of the targeted neonatal vaccination programme. Alternatively, the effectiveness of the BCG in neonates, in England, may be lower than previously thought as we only observed a small decrease in incidence rates, while a previous study estimated BCG coverage at 68% (95%CI: 65% to 71%) among those eligible for the targeted neonatal vaccination programme [28].…”

Section: Discussionmentioning

confidence: 61%

Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015

et al. 2019

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BackgroundIn 2005 in England, universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates.AimEstimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England.MethodsWe conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both the universal and targeted vaccination between 1 January 2000 and 31 December 2010. We then estimated incidence rates over a 5-year follow-up period and used regression modelling to estimate the impact of the change in policy on TB.ResultsIn the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR): 0.74; 95% credible interval (CrI): 0.61 to 0.88 and neonatal IRR: 0.62; 95%CrI: 0.44 to 0.88). We found some evidence that the change in policy was associated with an increase in incidence rates in the UK born school-age population (IRR: 1.08; 95%CrI: 0.97 to 1.19) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96; 95%CrI: 0.82 to 1.14). Overall, we found that the change in policy was associated with directly preventing 385 (95%CrI: −105 to 881) cases.ConclusionsWithdrawing universal vaccination at school age and targeting vaccination towards high-risk neonates was associated with reduced incidence of TB. This was largely driven by reductions in the non-UK born with cases increasing in the UK born.

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“…Alternatively, the effectiveness of the BCG in neonates, in England, may be lower than previously thought as we only observed a small decrease in incidence rates, whilst a previous study estimated BCG coverage at 68% (95%CI 65%, 71%) amongst those eligible for the targeted neonatal vaccination programme. (29) This study indicates that the change in England's BCG vaccination policy was associated with a modest increase in incidence in the UK born that were relevant to the school-age vaccination programme, and with a small reduction in incidence in the UK born that were relevant to the high-risk neonatal vaccination programme, although both these estimates had wide credible intervals. We found stronger evidence of an association between the change in policy and a decrease in incidence rates in the non-UK born populations relevant to both programmes.…”

Section: Discussionmentioning

confidence: 77%

Estimating the effect of the 2005 change in BCG policy in England: A retrospective cohort study

Abbott

Christensen²,

Welton³

et al. 2019

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BackgroundIn 2005, England changed from universal Bacillus Calmette-Guérin (BCG) vaccination of school-age children to targeted BCG vaccination of high-risk children at birth. MethodsWe combined notification data from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts of individuals in England relevant to both the universal, and targeted vaccination programmes between Jan 1, 2000 and Dec 31, 2010. For each cohort, we estimated incidence rates over a 5 year follow-up period and used Poisson and Negative Binomial regression models in order to estimate the impact of the change in policy on TB. ResultsIn the non-UK born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age IRR: 0.74 (95%CI 0.61, 0.88), neonatal IRR: 0.62 (95%CI 0.44, 0.88)). We found some evidence that the change in BCG policy was associated with a increase in incidence rates in the UK born school-age population (IRR: 1.08 (95%CI 0.97, 1.19)) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96 (95%CI 0.82, 1.14)). Overall, we found that the change in BCG policy was associated with directly preventing 385 (95% CI -105, 881) TB cases. ConclusionsWithdrawing universal vaccination at school-age and targeting BCG vaccination towards high-risk neonates was associated with reduced incidence of TB in England. This was largely driven by reductions in the non-UK born. There was a slight increase in UK born school-age cases. Key Messages •There is little existing literature on the impact of withdrawing universal school-age BCG vaccination and introducing high-risk neonatal BCG vaccination on TB incidence rates in the populations directly affected by the vaccination programmes.

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Uptake of neonatal BCG vaccination in England: performance of the current policy recommendations: Table 1

Cited by 10 publications

References 3 publications

Towards tuberculosis elimination: an action framework for low-incidence countries

Towards tuberculosis elimination: an action framework for low-incidence countries

Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015

Estimating the effect of the 2005 change in BCG policy in England: A retrospective cohort study

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