Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015
Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015
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DOI：
10.2807/1560-7917.es.2019.24.49.1900220
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发表时间：
2019-12-05
期刊：
影响因子：
19
通讯作者：
Brooks-Pollock, Ellen
中科院分区：
文献类型：
--
作者：
Abbott, Sam;Christensen, Hannah;Brooks-Pollock, Ellen
背景：2005年，英国对学龄儿童普遍接种卡介苗（BCG），取而代之的是对高危新生儿进行针对性的卡介苗接种。目标：估计 2005 年 BCG 政策变化对英格兰结核病 (TB) 发病率的影响。方法：我们进行了一项观察性研究，将加强结核病监测系统的通知与劳动力调查的人口数据相结合，构建了2000年1月1日至2010年12月31日期间与普遍疫苗接种和定向疫苗接种相关的回顾性队列。然后，我们估计了5年随访期内的发病率，并使用回归模型来估计结核病政策变化的影响。结果：在非英国 (UK) 出生的儿童中，我们发现了发病率降低与 BCG 政策变化之间存在关联的证据（学龄发病率比 (IRR)：0.74；95% 可信区间 (CrI)：0.61 至 0.88，新生儿 IRR：0.62；95%CrI：0.44 至 0.88）。我们发现一些证据表明政策的变化与英国出生的学龄人口发病率的增加有关（IRR：1.08；95%CrI：0.97至1.19），而与英国出生的新生儿发病率降低的相关证据较弱（IRR：0.96；95%CrI：0.82至1.14）。总体而言，我们发现政策变化与直接预防 385 例（95%CrI：-105 至 881）例病例相关。结论：取消学龄期全民疫苗接种并针对高危新生儿进行疫苗接种与降低结核病发病率相关。这主要是由于非英国出生的病例减少而英国出生的病例增加所致。
Background: In 2005 in England, universal Bacillus Calmette-Guerin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates. Aim: Estimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England. Methods: We conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both the universal and targeted vaccination between 1 January 2000 and 31 December 2010. We then estimated incidence rates over a 5-year follow-up period and used regression modelling to estimate the impact of the change in policy on TB. Results: In the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR): 0.74; 95% credible interval (CrI): 0.61 to 0.88 and neonatal IRR: 0.62; 95%CrI: 0.44 to 0.88). We found some evidence that the change in policy was associated with an increase in incidence rates in the UK born school-age population (IRR: 1.08; 95%CrI: 0.97 to 1.19) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96; 95%CrI: 0.82 to 1.14). Overall, we found that the change in policy was associated with directly preventing 385 (95%CrI: -105 to 881) cases. Conclusions: Withdrawing universal vaccination at school age and targeting vaccination towards high-risk neonates was associated with reduced incidence of TB. This was largely driven by reductions in the non-UK born with cases increasing in the UK born.