A Case-Control Study of BCG and Childhood Tuberculosis in Cali, Colombia

Shapiro, Craig N.; Cook, Nancy R.; Evans, Denis A.; Willett, Walter C.; Fajardo, Ileana; Koch-Eser, Dieter; Bergonzoli, Gustavo; Bolaños, Óscar; Guerrero, Rodrigo; Hennekens, Charles H.

doi:10.1093/ije/14.3.441

Cited by 41 publications

(12 citation statements)

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“…Analysis of the 8 case-control studies involving populations vaccinated as infants [18][19][20][21][22][23][24][25] showed a combined OR of 0.45 (95% Cl, 0.34-0.59), for a protective effect of 55% against tuberculosis. When the 10 case-control studies [18][19][20][21][22][23][24][25][26][27] with 1414 cases of predominantly pulmonary tuberculosis were combined (table 2), BCG vaccination had a 50% protective effect compared with no vaccination (95% CI for the OR, 0.39-0.64). The protective effect of BCG was stronger (83%) when the analysis was limited to patients in case-control studies [19,24,25] in which the diagnosis of tuberculosis was established by a positive culture or histology (95% CI for OR, 0.07-0.42).…”

Section: Resultsmentioning

confidence: 99%

Preventing Tuberculosis with Bacillus Calmette-Guérin Vaccine: A Meta-Analysis of the Literature

Brewer

2000

Clinical Infectious Diseases

241

145

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This article reviews a previously published meta-analysis of 1264 titles or abstracts and 70 selected studies for evaluation of the efficacy of bacillus Calmette-Guérin (BCG) vaccine in preventing tuberculosis. Following review, data from 26 studies were included in the analysis. These 26 studies reveal that vaccination with BCG significantly reduces the risk of tuberculosis by an average of 50%. This level of protection persists across a number of subgroups defined by age at vaccination and study design. Vaccination with BCG was significantly associated with a reduction in the incidence of pulmonary tuberculosis and extrapulmonary disease. In general, the results of this meta-analysis lend weight and confidence to arguments favoring the use of BCG vaccine.

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Section: Resultsmentioning

confidence: 99%

Preventing Tuberculosis with Bacillus Calmette-Guérin Vaccine: A Meta-Analysis of the Literature

Brewer

2000

Clinical Infectious Diseases

241

145

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“…Millions of people around the world have been vaccinated with BCG, but even so, the efficacy of the vaccine is uncertain. There are ample data indicating that BCG vaccine protects against disseminated tuberculosis and meningitis in children (146). However, the protection afforded by BCG against pulmonary disease in both children and adults is not proven (147).…”

Section: F Previous Vaccination With Bcgmentioning

confidence: 99%

Diagnostic Standards and Classification of Tuberculosis in Adults and Children

2000

Am J Respir Crit Care Med

1,247

396

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“…Published case-control studies have yielded widely disparate measures of protection from different BCG vaccines, ranging from no reduction [13] to an 83% reduction [14] in TB incidence. In 1994, George Comstock proposed using a controlled methodology to measure relative vaccine efficacy changes in geographic areas in which the BCG vaccine had been recently changed [15], noting that “…countries that have a need for vaccination and that vaccinate at birth could be recruited to use their own vaccine in even years and a different vaccine in odd years without making any other changes in their vaccination programs.…”

Section: Discussionmentioning

confidence: 99%

Comparative Tuberculosis (TB) Prevention Effectiveness in Children of Bacillus Calmette-Guérin (BCG) Vaccines from Different Sources, Kazakhstan

et al. 2012

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BackgroundExcept during a 1-year period when BCG vaccine was not routinely administered, annual coverage of infants with Bacillus Calmette-Guérin (BCG) in Kazakhstan since 2002 has exceeded 95%. BCG preparations from different sources (Japan, Serbia, and Russia) or none were used exclusively in comparable 7-month time-frames, September through March, in 4 successive years beginning in 2002. Our objective was to assess relative effectiveness of BCG immunization.Methods/FindingsWe compared outcomes of birth cohorts from the 4 time-frames retrospectively. Three cohorts received vaccine from one of three manufacturers exclusively, and one cohort was not vaccinated. Cohorts were followed for 3 years for notifications of clinical TB and of culture-confirmed TB, and for 21 months for TB meningitis notifications. Prevention effectiveness based on relative risk of TB incidence was calculated for each vaccinated cohort compared to the non-vaccinated cohort.Although there were differences in prevention effectiveness observed among the three BCG vaccines, all were protective. The Japanese vaccine (currently used in Kazakhstan), the Serbian vaccine, and the Russian vaccine respectively were 69%, 43%, and 22% effective with respect to clinical TB notifications, and 92%, 82%, and 51% effective with respect to culture confirmed TB. All three vaccines were >70% effective with respect to TB meningitis.LimitationsPotential limitations included considerations that 1) the methodology used was retrospective, 2) multiple risk factors could have varied between cohorts and affected prevention effectiveness measures, 3) most cases were clinically diagnosed, and TB culture-positive case numbers and TB meningitis case numbers were sparse, and 4) small variations in reported population TB burden could have affected relative risk of exposure for cohorts.Conclusions/SignificanceAll three BCG vaccines evaluated were protective against TB, and prevention effectiveness varied by manufacturer. When setting national immunization policy, consideration should be given to prevention effectiveness of BCG preparations.

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A Case-Control Study of BCG and Childhood Tuberculosis in Cali, Colombia

Cited by 41 publications

References 0 publications

Preventing Tuberculosis with Bacillus Calmette-Guérin Vaccine: A Meta-Analysis of the Literature

Preventing Tuberculosis with Bacillus Calmette-Guérin Vaccine: A Meta-Analysis of the Literature

Diagnostic Standards and Classification of Tuberculosis in Adults and Children

Comparative Tuberculosis (TB) Prevention Effectiveness in Children of Bacillus Calmette-Guérin (BCG) Vaccines from Different Sources, Kazakhstan

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