PHLS inquiry into current BCG vaccination policy.

Miller, C.; Morris, J. Glenn; Pollock, T.M.

doi:10.1136/bmj.288.6416.564

Cited by 20 publications

(13 citation statements)

References 1 publication

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“…Details of the survey are published as a peer-reviewed paper. 26 We also obtained the source data (original questionnaires/tables) from previous BCG policy surveys 16,27 from the investigators to complement information on historical infant vaccination policies.…”

Section: Methodsmentioning

confidence: 99%

“…27 The 1992 survey reported that, of the 184 health districts surveyed, five had a universal infant BCG programme and 148 had a selective infant BCG programme (including 14 of the 15 districts where vaccination of schoolchildren had been discontinued). 16 The main groups targeted in areas with selective policies were infants from ethnic minority groups (all 148 districts) and recent immigrants from high TB burden countries (120 districts), as well as infants from families with a history of TB (40 districts).…”

Section: Infant Bacillus Calmette-guérin Vaccination Pre 2005mentioning

confidence: 99%

“…All (100%) PCTs that vaccinated primarily on postnatal wards did so during the infants' first month of life, whereas only 13 out of 37 (35%) PCTs that mainly vaccinated in community clinics did so in the infants' first month of life (p < 0.001). 27 By 1992, at least 15 health authorities in England and Wales had stopped their routine BCG vaccination programme for schoolchildren, mostly in areas with very low TB notification rates. 16 This later survey also found that 18 health authorities offered BCG vaccination to selected groups at school entry, mostly recent immigrants, although this was offered in only two of the 15 districts that had discontinued BCG vaccination for schoolchildren.…”

Section: Current Bacillus Calmette-guérin Vaccination Policymentioning

confidence: 99%

“…Two districts used the multipuncture method. 27 By 1992, 163 out of 169 (96%) health districts still implemented routine vaccination of schoolchildren using a needle and syringe, with three using the multipuncture method and one using a jet injector. All districts offering infant BCG administered it using a syringe and needle.…”

Section: Bacillus Calmette-guérin Vaccine Administrationmentioning

confidence: 99%

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Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Mangtani

Nguipdop-Djomo

Keogh

et al. 2017

Health Technol Assess

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Background Until recently, evidence that protection from the bacillus Calmette–Guérin (BCG) vaccination lasted beyond 10 years was limited. In the past few years, studies in Brazil and the USA (in Native Americans) have suggested that protection from BCG vaccination against tuberculosis (TB) in childhood can last for several decades. The UK’s universal school-age BCG vaccination programme was stopped in 2005 and the programme of selective vaccination of high-risk (usually ethnic minority) infants was enhanced. Objectives To assess the duration of protection of infant and school-age BCG vaccination against TB in the UK. Methods Two case–control studies of the duration of protection of BCG vaccination were conducted, the first on minority ethnic groups who were eligible for infant BCG vaccination 0–19 years earlier and the second on white subjects eligible for school-age BCG vaccination 10–29 years earlier. TB cases were selected from notifications to the UK national Enhanced Tuberculosis Surveillance system from 2003 to 2012. Population-based control subjects, frequency matched for age, were recruited. BCG vaccination status was established from BCG records, scar reading and BCG history. Information on potential confounders was collected using computer-assisted interviews. Vaccine effectiveness was estimated as a function of time since vaccination, using a case–cohort analysis based on Cox regression. Results In the infant BCG study, vaccination status was determined using vaccination records as recall was poor and concordance between records and scar reading was limited. A protective effect was seen up to 10 years following infant vaccination [< 5 years since vaccination: vaccine effectiveness (VE) 66%, 95% confidence interval (CI) 17% to 86%; 5–10 years since vaccination: VE 75%, 95% CI 43% to 89%], but there was weak evidence of an effect 10–15 years after vaccination (VE 36%, 95% CI negative to 77%; p = 0.396). The analyses of the protective effect of infant BCG vaccination were adjusted for confounders, including birth cohort and ethnicity. For school-aged BCG vaccination, VE was 51% (95% CI 21% to 69%) 10–15 years after vaccination and 57% (95% CI 33% to 72%) 15–20 years after vaccination, beyond which time protection appeared to wane. Ascertainment of vaccination status was based on self-reported history and scar reading. Limitations The difficulty in examining vaccination sites in older women in the high-risk minority ethnic study population and the sparsity of vaccine record data in the later time periods precluded robust assessment of protection from infant BCG vaccination > 10 years after vaccination. Conclusions Infant BCG vaccination in a population at high risk for TB was shown to provide protection for at least 10 years, whereas in the white population school-age vaccination was shown to provide protection for at least 20 years. This evidence may inform TB vaccination programmes (e.g. the timing of administration of improved TB vaccines, if they become available) and cost-effectiveness studies. Methods to deal with missing record data in the infant study could be explored, including the use of scar reading. Funding The National Institute for Health Research Health Technology Assessment programme. During the conduct of the study, Jonathan Sterne, Ibrahim Abubakar and Laura C Rodrigues received other funding from NIHR; Ibrahim Abubakar and Laura C Rodrigues have also received funding from the Medical Research Council. Punam Mangtani received funding from the Biotechnology and Biological Sciences Research Council.

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Section: Methodsmentioning

confidence: 99%

Section: Infant Bacillus Calmette-guérin Vaccination Pre 2005mentioning

confidence: 99%

Section: Current Bacillus Calmette-guérin Vaccination Policymentioning

confidence: 99%

Section: Bacillus Calmette-guérin Vaccine Administrationmentioning

confidence: 99%

See 2 more Smart Citations

Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Mangtani

Nguipdop-Djomo

Keogh

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…4 In 1983 a survey of BCG immunisation policies for schoolchildren and neonates in health districts of England and Wales revealed that five health authorities had discontinued their schools programme and a further 10 had their policy under review. 5 The national survey of notifications of tuberculosis, also in 1983, confirmed the continuing fall in notification rates in the white population.6 Similar rates of decline were also seen in people originating from the Indian subcontinent, but the rates in this group were still 20-30 times higher than those in the indigenous population. After reviewing these data in 1985 the Joint Committee on Vaccination and Immunisation recommended the continuation of the schools programme, with the intention of stopping by 1990 provided that a further notification survey showed that the downward trend in notifications was maintained.7 Despite a continuing decline in the age and sex specific incidence of tuberculosis up to 1987, small increases in the total number of notifications were observed in 1988 and 1989.8 In 1990 the committee reviewed the situation and, largely because of uncertainties about the effect of the interaction between HIV and tuberculosis, recommended that the schools BCG programme be continued for at least another five years, when the results of a further notification survey in 1993 would be available.9…”

Section: Introductionmentioning

confidence: 86%