Six years' experience with the discontinuation of BCG vaccination

Trnka, L; Danková, D; Svandová, E

doi:10.1016/0962-8479(94)90080-9

Cited by 74 publications

(33 citation statements)

References 7 publications

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“…According to the eligibility criteria, only 13 studies were selected as they focused on the economic evaluations of BCG vaccination or on the use of a new TB vaccine. Of these, 11 studies focused on country-specific BCG vaccination [13][14][15][16][17][18][19][20][21][22][23], while two studies expanded economic assessment on region-specific BCG vaccination worldwide [5,24]. Two studies took place in America [16,17]; two studies focused on Asia [19,20]; six studies were performed for European countries [13][14][15]18,21,22]; and only one study was carried out for Africa [23].…”

Section: Generalmentioning

confidence: 99%

“…Of these, 11 studies focused on country-specific BCG vaccination [13][14][15][16][17][18][19][20][21][22][23], while two studies expanded economic assessment on region-specific BCG vaccination worldwide [5,24]. Two studies took place in America [16,17]; two studies focused on Asia [19,20]; six studies were performed for European countries [13][14][15]18,21,22]; and only one study was carried out for Africa [23]. Among countryspecific studies, there was only one study focusing on the economic impacts of BCG vaccination in the developing world [23], while the remaining studies focused on the BCG vaccination in the developed world [13][14][15][16][17][18][19][20][21][22].…”

Section: Generalmentioning

confidence: 99%

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A review of the literature on the economics of vaccination against TB

Rozenbaum

et al. 2012

Expert Review of Vaccines

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The BCG vaccine was introduced in 1921 and remains the only licensed vaccine for the prevention of TB worldwide. Despite its extensive use, the BCG vaccine lacks the ability to fully control the TB-endemic and -pandemic situations. The BCG vaccine is most effective in preventing pediatric TB, in particular, miliary TB and tuberculous meningitis. However, it has a limited effect in preventing pulmonary TB, which occurs more frequently in adults. BCG vaccination has now been implemented in more than 157 countries worldwide. For various countries, the benefits of vaccination are only limited and potentially not cost effective. The International Union Against Tuberculosis and Lung Diseases had set the criteria for discontinuation of BCG vaccination in 1994. This decision, however, was not based on economic considerations. Many developed countries have met the criteria set by the International Union Against Tuberculosis and Lung Disease and stopped universal BCG vaccination. For developing countries, the BCG vaccine is still an effective intervention in protecting young children from TB infection. A lot of effort has been spent on R&D of new TB vaccines, the first of which are expected to be available within 5-7 years from now. Novel TB vaccines are expected to be better and more effective than the current BCG vaccine and should provide a viable strategy in controlling TB morbidity and mortality. In this review, the aim is to explore economic evaluations that have been carried out for vaccination against TB worldwide. In addition to epidemiological evidence, economic evidence can play a crucial role in supporting the governments of countries in making proper public health decisions on BCG vaccination policies, in particular, to implement, continue, or discontinue.

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Section: Generalmentioning

confidence: 99%

Section: Generalmentioning

confidence: 99%

A review of the literature on the economics of vaccination against TB

Rozenbaum

et al. 2012

Expert Review of Vaccines

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“…Los factores de riesgo presentes en todos los pacientes fueron similares a los reportados en la literatura: adultos jóvenes, conteo de CD4 <50 cel/μL, y ausencia de TAR (2,4) . El cuadro clínico de infección por MAC se presentó antes del uso de TAR en todos los casos.…”

Section: Discussionunclassified

“…En países de mediano y bajo ingreso la prevalencia ha sido poco estudiada (3) . La infección por MAC en pacientes con inmunosupresión severa por VIH/SIDA se manifiesta, principalmente, de forma diseminada; en otras enfermedades que también comprometen la inmunidad celular, su presentación es más frecuente en el pulmón, piel y tejido blando (4) .…”

Section: Introductionunclassified

Infección por el complejo Mycobacterium aviumintracellulare en pacientes con VIH/SIDA en un hospital peruano: una serie de casos

Huaroto¹,

Astocondor-Salazar²,

Montenegro-Idrogo³

et al. 2017

Rev Peru Med Exp Salud Publica

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RESUMENExiste poca información sobre la presencia del complejo Mycobacterium avium-intracellulare (MAC) en el Perú. Se describen cinco casos de infección por MAC en pacientes con VIH/SIDA del Hospital Nacional Dos de Mayo, Lima-Perú. Los pacientes presentaron, principalmente, fiebre persistente, diarrea crónica, síndrome consuntivo, pancitopenia y citofagocitosis. En todos ellos se identificó bacilos acido-alcohol resistentes en heces, por lo que recibieron tratamiento antituberculoso. El cultivo de heces fue negativo para Mycobacterium tuberculosis y, posteriormente, en todos se identificó a MAC mediante una prueba molecular (Genotype) en el cultivo de heces. Tres pacientes recibieron tratamiento para MAC luego de la identificación; sin embargo, todos fallecieron. Ante presentaciones similares a lo reportado, se sugiere el uso de métodos de mayor rendimiento (hemocultivo, mielocultivo, pruebas moleculares), así como asociar tempranamente drogas con actividad para MAC al esquema antituberculoso con la intención de mejorar el pronóstico de este grupo de pacientes. Palabras clave: Complejo Mycobacterium avium; VIH-1; Síndrome de inmunodeficiencia adquirida (fuente: DeCS BIREME). INFECTION BY THE Mycobacterium avium-intracellulare COMPLEX IN PATIENTS WITH HIV/AIDS IN A PERUVIAN HOSPITAL: A SERIES OF CASES ABSTRACTThere is little information on the presence of the Mycobacterium avium-Intracellulare (MAC) complex in Peru. Five cases of MAC infection are described in patients with HIV/AIDS at the National Hospital Dos de Mayo, Lima -Peru. The patients presented, mainly, persistent fever, chronic diarrhea, consumptive syndrome, pancytopenia and citofagocitosis. In all of them, resistant acid-alcohol bacilli were identified in feces, so they received antituberculous treatment. The culture of feces was negative for Mycobacterium tuberculosis and, later, in all cases MAC was identified using a molecular test (genotype) in the culture of feces. Three patients received treatment for MAC right after identification; however, they all died. Before presentations similar to the reported, we suggest the use of higher performance methods (blood culture, myeloculture, molecular tests), as well as early associating drugs with activity for MAC to antitubercular scheme with the intention of improving the prognosis of this group of patients. Key words: Mycobacterium avium complex; HIV-1; Acquired immunodeficiency syndrome (source: MeSH NLM).1 Servicio de Medicina en Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo. Lima, Perú. INTRODUCCIÓN Elcomplejo Mycobacterium avium-intracellulare (MAC) está comprendido por las especies M. avium y M. intracellulare. Dichas especies están distribuidas ampliamente en el medioambiente -principalmente en el agua y el suelo-, siendo la inhalación y/o ingesta sus probables mecanismos de transmisión (1) . En el paciente VIH coinfectado por MAC se observa una alta frecuencia de colonización y compromiso gastrointestinal, por lo que se postula que sería la mucosa intestinal la vía pr...

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“…Les résultats suédois, allemands et tchèques sont convergents. Dans ces 3 pays, une augmentation, certes limitée, de l'incidence de la tuberculose de l'enfant a été observée [17][18][19]. L'expérience suédoise est la mieux documentée.…”

Section: Calendrier Vaccinal Du Bcg Jusqu'en 2004unclassified

BCG: attitudes actuelles

Lévy-Brühl¹

2006

La Presse Médicale

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■ Key points BCG: current features Up to recently, the French BCG vaccination policy was consisting of a mandatory BCG vaccination before entry into day-care centres or school, and of re-vaccination of tuberulino-negative children.A re-assessment of this policy has been undertaken in the last years. It has lead to the discontinuation of all revaccinations and post-vaccination tuberculin tests except, for the latter, those performed as part of a diagnosis of tuberculosis infection or of the followup of health or social workers for which BCG vaccination remains mandatory.Based on an estimation of the epidemiological impact of either selective vaccination of high risk children or discontinuation of all BCG vaccination, and taking into account the risks-benefits balance that can be made of the respective two options, the French Infectious Diseases Advisory Board has recommended, in principle, a switch towards selective vaccination.However, the committee has proposed to the Ministry of Health, as a pre-requisite to the implementation of this strategy, the strengthening of others control measures aiming at decreasing the risk of infections for children.This reflexion is made more complex by the disappearance, since early 2006, of the multipuncture technique, used in France in more than 90% of BCG primo-vaccinations. ■ Points essentielsLa politique française de vaccination BCG reposait, jusqu'à récemment, sur la primovaccination des enfants, obligatoire avant l'entrée en collectivité, et la revaccination des enfants tuberculinonégatifs. Une révision de cette politique a été entreprise en France depuis quelques années. Elle s'est concrétisée par la suppression, en 2004, de toutes les revaccinations ainsi que des tests tuberculiniques postvaccinaux de routine effectués en dehors du diagnostic d'une tuberculose ou de la surveillance des professionnels des secteurs sanitaires et sociaux soumis à l'obligation vaccinale. Sur la base d'une évaluation de l'impact épidémiologique qu'auraient d'une part le ciblage de la vaccination sur les enfants les plus à risque et d'autre part la suppression totale de la vaccination BCG, ainsi que sur l'appréciation de la balance bénéfice/risque de ces 2 options, le Conseil supérieur d'hygiène publique de France s'est prononcé en faveur du principe de la vaccination ciblée des enfants. Cependant, il a posé comme préalable à l'application de cette stratégie le renforcement de la mise en oeuvre des autres mesures de lutte contre la tuberculose susceptibles d'avoir un impact sur le risque de transmission à l'enfant. Cette réflexion est rendue plus complexe par la disparition, début 2006, de la multipuncture, technique utilisée en France pour plus de 90 % des primovaccinations par le BCG. Cette réflexion est rendue plus complexe par la disparition, depuis début 2006, de la multipuncture, technique qui était utilisée en France pour plus de 90 % des primovaccinations par le BCG.

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Six years' experience with the discontinuation of BCG vaccination

Cited by 74 publications

References 7 publications

A review of the literature on the economics of vaccination against TB

A review of the literature on the economics of vaccination against TB

Infección por el complejo Mycobacterium aviumintracellulare en pacientes con VIH/SIDA en un hospital peruano: una serie de casos

BCG: attitudes actuelles

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