The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices

Since their discovery in patients with autosomal dominant (AD) chronic mucocutaneous candidiasis (CMC) in 2011, heterozygous STAT1 gain-of-function (GOF) mutations have increasingly been identified worldwide. The clinical spectrum associated with them needed to be delineated. We enrolled 274 patients from 167 kindreds originating from 40 countries from 5 continents. Demographic data, clinical features, immunological parameters, treatment, and outcome were recorded. The median age of the 274 patients was 22 years (range, 1-71 years); 98% of them had CMC, with a median age at onset of 1 year (range, 0-24 years). Patients often displayed bacterial (74%) infections, mostly because of Staphylococcus aureus (36%), including the respiratory tract and the skin in 47% and 28% of patients, respectively, and viral (38%) infections, mostly because of Herpesviridae (83%) and affecting the skin in 32% of patients. Invasive fungal infections (10%), mostly caused by Candida spp. (29%), and mycobacterial disease (6%) caused by Mycobacterium tuberculosis, environmental mycobacteria, or Bacille Calmette-GuÃ©rin vaccines were less common. Many patients had autoimmune manifestations (37%), including hypothyroidism (22%), type 1 diabetes (4%), blood cytopenia (4%), and systemic lupus erythematosus (2%). Invasive infections (25%), cerebral aneurysms (6%), and cancers (6%) were the strongest predictors of poor outcome. CMC persisted in 39% of the 202 patients receiving prolonged antifungal treatment. Circulating interleukin-17A-producing T-cell count was low for most (82%) but not all of the patients tested. STAT1 GOF mutations underlie AD CMC, as well as an unexpectedly wide range of other clinical features, including not only a variety of infectious and autoimmune diseases, but also cerebral aneurysms and carcinomas that confer a poor prognosis

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“…Two thirds of the patients were presumed to be vaccinated with BCG during childhood according to the global BCG vaccination policies. 61 …”

Section: Bacterial Infectionsmentioning

confidence: 99%

Heterozygous STAT1 gain-of-function mutations underlie an unexpectedly broad clinical phenotype

Toubiana

Okada

Hiller

et al. 2016

Blood

473

649

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“…In Pakistan, infants are vaccinated with Bacille Calmette-Guerin (BCG) to protect from tuberculosis disease in children (36). Danish BCG strain 1331 (Copenhagen, State Serum Institute) was used up until year 2007 in Pakistan (37). However, in-spite of vaccination, tuberculosis remains a considerable public health issue in Pakistan.…”

Section: Discussionmentioning

confidence: 99%

Smear Positive Pulmonary Tuberculosis (TB) Patients Suspected to Have Drug Resistant TB in Programmatic Management of Drug Resistant TB Unit in Khyber Pakhtunkhwa, Pakistan

Javaid

Ullah

Ali

et al. 2017

Jundishapur J Microbiol

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“…BCG vaccination history is not collected in the TB registry. To infer BCG vaccination status, information regarding current BCG policies was abstracted from the BCG World Atlas 14,15 (http://www. bcgatlas.org/) for each country in which a California pediatric TB case patient was born.…”

Section: What This Study Addsmentioning

confidence: 99%

Risk Factors for Central Nervous System Tuberculosis

et al. 2015

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OBJECTIVES: To describe the epidemiology and factors associated with pediatric central nervous system (CNS) tuberculosis (TB) in California from 1993 to 2011. METHODS:We analyzed California TB registry data for persons aged #18 years, comparing CNS TB cases versus non-CNS TB cases reported from 1993 to 2011. Factors associated with CNS TB and TB deaths were identified by using multivariate logistic regression.RESULTS: A total of 200 CNS TB cases were reported. Compared with non-CNS TB case patients, CNS TB case patients were more likely to be aged ,5 years (72.0% vs 43.6%; odds ratio [OR] CONCLUSIONS: Subsets of children are at increased risk for CNS TB in California and may benefit from additional prevention efforts. WHAT'S KNOWN ON THIS SUBJECT:Central nervous system (CNS) tuberculosis has high morbidity and mortality, and it frequently affects children aged ,5 years. WHAT THIS STUDY ADDS:In California, children who were US-born, Hispanic, and aged ,5 years were at increased risk of CNS tuberculosis. Children with CNS tuberculosis were more likely to die. Specific populations of US-born infants might benefit from additional prevention measures. Dr Duque-Silva was involved in research design, performed the data analysis and interpretation, and drafted and revised the manuscript; Ms Robsky was involved in research design and assisted with data analysis and interpretation; and Dr Flood assisted in research design and data interpretation, and reviewed and revised the manuscript. Dr Barry conceptualized the study; supervised the research design, data analysis, and interpretation; and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted. 2,3 It is most commonly diagnosed in children aged ,5 years and may affect the same groups at high risk for pediatric TB in the United States such as immigrants, racial and ethnic minorities, and children who traveled to a country with high prevalence of TB or who had contact with a household visitor from a high-prevalence country. [4][5][6] In children, CNS TB is often the result of recently acquired infection after close contact with an infectious TB case in an adult. Risk of dissemination to the CNS after TB exposure is influenced by age and immune status, 7 including BCG vaccination. In most countries outside the United States, BCG vaccination is recommended in early childhood to decrease the risk of disseminated forms of TB such as miliary and CNS TB in children. 8 BCG vaccination has not routinely been used in the United States. 9 California is the state that reports the most pediatric TB cases 10 and has the largest foreign-born population in the United States. 11 It is therefore an excellent population in which to examine the epidemiology of pediatric CNS TB. To inform ongoing CNS TB prevention activities, our goal was to describe the epidemiology of pediatric CNS TB in California from 1993 to 2011 and to identify factors associated with the development of pediatric CNS TB as well as factors associated with pedia...

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The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices

Abstract: Madhu Pai and colleagues introduce the BCG World Atlas, an open access, user friendly Web site for TB clinicians to discern global BCG vaccination policies and practices and improve the care of their patients.

Cited by 524 publications

References 21 publications

Heterozygous STAT1 gain-of-function mutations underlie an unexpectedly broad clinical phenotype

Heterozygous STAT1 gain-of-function mutations underlie an unexpectedly broad clinical phenotype

Smear Positive Pulmonary Tuberculosis (TB) Patients Suspected to Have Drug Resistant TB in Programmatic Management of Drug Resistant TB Unit in Khyber Pakhtunkhwa, Pakistan

Risk Factors for Central Nervous System Tuberculosis

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