Assessing the impact of different BCG vaccination strategies on severe childhood TB in low-intermediate prevalence settings

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作者：Davide Manissero ; Pier Luigi Lopalco ; Daniel Levy-Bruhl ; Marta Luisa Ciofi degli Atti ; Johan Giesecke
关键词：BCG ; Selective vaccination ; Tuberculosis
刊名：Vaccine
出版年：2008
期刊代码：89_0264410x
类别：imm
出版时间：24 April 2008
卷：26
期：18
页码：2253-2259
文件大小：226 K

摘要

We calculated the number of tuberculous meningitis and miliary tuberculosis cases that have been and will be prevented in all children born in 2002, by combining estimates of the annual risk of tuberculosis infection, the proportion of infections that lead to either of these diseases in unvaccinated children, the number of children vaccinated, and BCG efficacy.

ass="h4">Findings

We estimated that the 100·5 million BCG vaccinations given to infants in 2002 will have prevented 29 729 cases of tuberculous meningitis (5th–95th centiles, 24 063–36 192) in children during their first 5 years of life, or one case for every 3435 vaccinations (2771–4177), and 11 486 cases of miliary tuberculosis (7304–16 280), or one case for every 9314 vaccinations (6172–13 729). The numbers of cases prevented would be highest in South East Asia (46%), sub-Saharan Africa (27%), the western Pacific region (15%), and where the risk of tuberculosis infection and vaccine coverage are also highest. At US$2–3 per dose, BCG vaccination costs US$206 (150–272) per year of healthy life gained.

ass="h4">Interpretation

BCG vaccination is a highly cost-effective intervention against severe childhood tuberculosis; it should be retained in high-incidence countries as a strategy to supplement the chemotherapy of active tuberculosis.

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Tuberclea>

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Tubercle, Volume 40, Issue 6, December 1959, Pages 432-442
V.H. Springett

Abstract

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ass="h3">Summary

BCG vaccination of Birmingham school children has reduced their tuberculosis notification rates by something between 0·5 and 0·7 per thousand per annum.

Statistically, the evidence is of such a nature that it cannot be taken as establishing the value of BCG vaccination. Practically, and taken in conjunction with the strictly controlled Medical Research Council Trial, the evidence fully justifies the use of BCG in children about to leave school in Birmingham and similar communities.

Financially, the cost BCG vaccination in Birmingham is less (and probably much less) than the estimated cost of dealing with the cases prevented.

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The Lancet, Volume 367, Issue 9517, 8 April 2006-14 April 2006, Pages 1122-1124
Vas Novelli

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Assessing the impact of different BCG vaccination strategies on severe childhood TB in low-intermediate prevalence settings