Lower prevalence of tuberculosis infection in BCG vaccinees: a cross-sectional study in adult prison inmates

Chan, Pei-Chun; Yang, Chin-Hui; Chang, Luan‐Yin; Wang, Kwei-Feng; Kuo, Yi-Chen; Lin, Chou-Jui; Lee, Shih‐Wei; Hsueh, Po-Ren; Fang, Chi-Tai; Huang, Li‐Min

doi:10.1136/thoraxjnl-2012-202208

Cited by 35 publications

(35 citation statements)

References 24 publications

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“…The study might focus on efficacy in individuals only (excluding transmission effects) and rely on routine case reports (cheaper than individual follow-up) to assess the effect on incidence. Another option would be to use the incidence of infection rather than the incidence of disease as an endpoint, because there are many more infections than cases, and there is some evidence that BCG can prevent infection [16–19]. Such a trial is already being planned in Cape Town (A. Ginsberg & W. Hanekom 2013, personal communication).…”

Section: Discussionmentioning

confidence: 99%

“…Under some circumstances, BCG vaccination prevents mycobacterial infection (probably M. tuberculosis ) in addition to active disease [16–18], and so does revaccination [19]. Thus, in a prison population in Taiwan, there were fewer infections (measured as positive responses on a QuantiFERON TB gold test) among inmates who had greater than or equal to two BCG scars, when compared with those who had one scar or no scar [19].…”

Section: Introductionmentioning

confidence: 99%

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Making wider use of the world's most widely used vaccine: Bacille Calmette–Guérin revaccination reconsidered

Dye

2013

J. R. Soc. Interface.

103

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Approximately 100 million newborn children receive Bacille Calmette–Guérin (BCG) annually, because vaccination is consistently protective against childhood tuberculous meningitis and miliary TB. By contrast, BCG efficacy against pulmonary TB in children and adults is highly variable, ranging from 0% to 80%, though it tends to be higher in individuals who have no detectable prior exposure to mycobacterial infections, as judged by the absence of delayed-type hypersensitivity response (a negative tuberculin skin test, TST). The duration of protection against pulmonary TB is also variable, but lasts about 10 years on average. These observations raise the possibility that BCG revaccination, following primary vaccination in infancy, could be efficacious among TST-negative adolescents as they move into adulthood, the period of highest risk for pulmonary disease. To inform continuing debate about revaccination, this paper assesses the effectiveness and cost-effectiveness of revaccinating adolescents in a setting with intense transmission—Cape Town, South Africa. For a cost of revaccination in the range US$1–10 per person, and vaccine efficacy between 10% and 80% with protection for 10 years, the incremental cost per year of healthy life recovered (disability-adjusted life years, DALY) in the vaccinated population lies between US$116 and US$9237. The intervention is about twice as cost-effective when allowing for the extra benefits of preventing transmission, with costs per DALY recovered in the range US$52–$4540. At 80% efficacy, revaccination averted 17% of cases. Under the scenarios investigated, BCG revaccination is cost-effective against international benchmarks, though not highly effective. Cost-effectiveness ratios would be more favourable if we also allow for TB cases averted by preventing transmission to HIV-positive people, for the protection of HIV-negative people who later acquire HIV infection, for the possible non-specific benefits of BCG, for the fact that some adolescents would receive BCG for the first time, and for cost sharing when BCG is integrated into an adolescent immunization programme. These findings suggest, subject to further evaluation, that BCG revaccination could be cost-effective in some settings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Making wider use of the world's most widely used vaccine: Bacille Calmette–Guérin revaccination reconsidered

Dye

2013

J. R. Soc. Interface.

103

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“…Revaccination of children and adults in Karonga District of Malawi induced no protection against TB [30] and no protection against TB was observed following revaccination of 6–9 year old children in Hong Kong [31]. In contrast, there were fewer infections (measured as positive responses on a Quanti-FERON TB gold test) among prison inmates in Taiwan who had greater than or equal to two BCG scars, when compared with those who had one scar or no scar [32]. Studies in cattle support the hypothesis that revaccination should be effective when immunity has waned and concur with the idea that revaccination of humans may be effective in locations where human populations do not respond in the tuberculin intradermal test [9].…”

Section: Discussionmentioning

confidence: 99%

Revaccination of Cattle with Bacille Calmette-Guérin Two Years after First Vaccination when Immunity Has Waned, Boosted Protection against Challenge with Mycobacterium bovis

et al. 2014

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In both humans and animals, controversy exists concerning the duration of protection induced by BCG vaccine against tuberculosis (TB) and whether revaccination enhances protection. A long-term study was undertaken to determine whether BCG-vaccinated calves would be protected against challenge with Mycobacterium bovis 2½ years after vaccination and to determine the effect of revaccination after 2 years. Seventy–nine calves were divided into five groups (n = 15–17 calves/group) with four of the groups vaccinated subcutaneously with 105 CFU of BCG Danish at 2–4 weeks of age and the fifth group serving as non-vaccinated controls. Three of the four BCG-vaccinated groups were revaccinated 2 years after the initial vaccination. One BCG-vaccinated group was revaccinated with BCG. A second group was vaccinated subcutaneously with a TB protein vaccine consisting of biopolyester particles (Biobeads) displaying two mycobacterial proteins, ESAT-6 and Antigen 85A, mixed with an adjuvant. A third group was vaccinated with TB proteins from M. bovis culture filtrate, mixed with an adjuvant. Twenty-three weeks after the BCG revaccination, all animals were challenged endotracheally with virulent M. bovis and a further 13 weeks later, animals were killed and necropsied to determine protection against TB. The BCG-vaccinated animals produced positive tuberculin caudal fold intradermal (15 of 62 animals) and IFN-γ TB test responses (six of 62 animals) at 6 months after vaccination, but not at subsequent time-points compared to the non-vaccinated animals. Calves receiving a single vaccination with BCG vaccine 2½ years prior to challenge were not protected against TB, while those revaccinated with BCG 2 years after the initial vaccination displayed significant reductions in lung and pulmonary lymph node lesion scores compared to the non-vaccinated animals. In contrast, no reduction in lesion scores was observed in the animals revaccinated with the TB protein vaccines with their immune responses biased towards induction of antibody.

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“…An adult mouse model is used because the effect of BCG immunisation on M. tuberculosis has been detected in adults [27,33] and spleen cell samples obtainable for interferon gamma release assay will be big enough to detect specific reactive T-effector cells.…”

Section: The Infection Modelmentioning

confidence: 99%

Reduction of Mycobacterium tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity

Eisenhut

2015

Medical Hypotheses

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Lower prevalence of tuberculosis infection in BCG vaccinees: a cross-sectional study in adult prison inmates

Cited by 35 publications

References 24 publications

Making wider use of the world's most widely used vaccine: Bacille Calmette–Guérin revaccination reconsidered

Making wider use of the world's most widely used vaccine: Bacille Calmette–Guérin revaccination reconsidered

Revaccination of Cattle with Bacille Calmette-Guérin Two Years after First Vaccination when Immunity Has Waned, Boosted Protection against Challenge with Mycobacterium bovis

Reduction of Mycobacterium tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity

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