The duration of protection of school-aged BCG vaccination in England: a population-based case-control study
The duration of protection of school-aged BCG vaccination in England: a population-based case-control study
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DOI：
10.1093/ije/dyx141
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发表时间：
2018-02-01
影响因子：
7.7
通讯作者：
Rodrigues, Laura C.
中科院分区：
文献类型：
--
作者：
Mangtani, Punam;Nguipdop-Djomo, Patrick;Rodrigues, Laura C.
工作背景：儿童期接种卡介苗（BCG）预防结核病（TB）的证据对于结核病控制和资源分配具有重要意义。方法：采用病例对照研究方法，对12-13岁儿童接种BCG预防结核病的效果进行了研究。我们招募了英国出生的白色结核病患者，并随机抽取了白色社区对照。风险比和95%置信区间（CI）采用病例队列考克斯回归估计，调整潜在的混杂因素，包括社会经济地位，吸烟，吸毒，监狱和无家可归。疫苗的有效性（VE = 1 -风险比）进行了评估，在连续的时间间隔超过10年后vaccination.Results：我们获得了677例和1170对照后，在两组的反应率为65%。接种疫苗后10-20年，受剥夺、教育和生活方式因素的干扰轻微，20年后更为明显。接种疫苗后10-15年的VE为51%（95% CI 21，69%），15-20年为57%（CI 33，72%）。随后，BCG保护似乎减弱; 20-25年VE = 25%（CI-14%，51%）和25-29年VE = 1%（CI-84%，47%）。基于缺失数据的多重插补（在17%的受试者中），接种后相同时间间隔内估计的VE相似[56%（置信区间33，72%），57%（置信区间36，71%），25%（-10，48%）、21%（-39，55%）]。学龄卡介苗接种提供了至少20年的结核病适度保护，这比以前认为的要长。这对评估卡介苗接种的成本效益和评估新的结核病疫苗具有意义。
Background: Evidence of protection from childhood Bacillus Calmette-Guerin (BCG) against tuberculosis (TB) in adulthood, when most transmission occurs, is important for TB control and resource allocation.Methods: We conducted a population-based case-control study of protection by BCG given to children aged 12-13 years against tuberculosis occurring 10-29 years later. We recruited UK-born White subjects with tuberculosis and randomly sampled White community controls. Hazard ratios and 95% confidence intervals (CIs) were estimated using case-cohort Cox regression, adjusting for potential confounding factors, including socioeconomic status, smoking, drug use, prison and homelessness. Vaccine effectiveness (VE = 1 - hazard ratio) was assessed at successive intervals more than 10 years following vaccination.Results: We obtained 677 cases and 1170 controls after a 65% response rate in both groups. Confounding by deprivation, education and lifestyle factors was slight 10-20 years after vaccination, and more evident after 20 years. VE 10-15 years after vaccination was 51% (95% CI 21, 69%) and 57% (CI 33, 72%) at 15-20 years. Subsequently, BCG protection appeared to wane; 20-25 years VE = 25% (CI -14%, 51%) and 25-29 years VE = 1% (CI -84%, 47%). Based on multiple imputation of missing data (in 17% subjects), VE estimated in the same intervals after vaccination were similar [56% (CI 33, 72%), 57% (CI 36, 71%), 25% (-10, 48%), 21% (-39, 55%)].Conclusions: School-aged BCG vaccination offered moderate protection against tuberculosis for at least 20 years, which is longer than previously thought. This has implications for assessing the cost-effectiveness of BCG vaccination and when evaluating new TB vaccines.