Reply to Thysen et al.
Reply to Thysen et al.
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回复蒂森等人。
DOI：
10.1093/infdis/jiv199
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Jaspan,HeatherB
中科院分区：
文献类型：
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作者：
Tchakoute,ChristopheToukam;Hesseling,AnnekeC;Blakney,AnnaK;Jaspan,HeatherB
致编辑-我们感谢Thysen等人对卡介苗疫苗接种政策变化的谨慎看法。尽管我们发现，与出生时接种疫苗的婴儿相比，8周龄时接种的人类免疫缺陷病毒（HIV）暴露婴儿的BCG疫苗免疫原性有所改善[1]，但我们不建议根据这些数据改变疫苗接种服务。尽管如此，我们的研究提供了有价值的数据，表明BCG疫苗接种的免疫原性不会受到延迟给药至8周龄的负面影响，这在新的结核病疫苗接种策略正在进行临床评估的HIV高流行地区非常需要[2]。以前的试验表明，卡介苗接种可以改善西非儿童的全因死亡率[3，4]，在某些情况下，可以改善对无关抗原的先天和适应性免疫[5，6]。然而，重要的是要注意这些研究进行的背景。冈比亚和几内亚比绍的医疗基础设施较差，婴儿死亡率高[7]，艾滋病毒感染和结核病发病率比我们进行试验的南非低得多。在这种情况下，早期接种卡介苗的好处可能超过对艾滋病毒感染婴儿造成的任何风险，推迟接种卡介苗可能不利于儿童生存。在常规婴儿疫苗接种服务、预防和治疗结核病的计划以及预防艾滋病毒母婴传播的服务得到良好整合的情况下，基础设施可以支持艾滋病毒暴露婴儿选择性延迟卡介苗接种，延迟卡介苗接种的风险将降低。需要考虑的其他要点是，在几内亚比绍的先前研究中，卡介苗接种与其他干预措施相结合，包括给予维生素A，而随机试验仅研究了低出生体重婴儿的延迟卡介苗接种，这些婴儿死亡率高，免疫力不成熟
TO THE EDITOR—We thank Thysen et al for their cautionary perspective on BCG vaccination policy changes. Although we found improved immunogenicity of BCG vaccine in human immunodeficiency virus (HIV)–exposed infants vaccinated at 8 weeks of age, compared with immunogenicity among those vaccinated at birth [1], we do not recommend changes to vaccine-delivery services on the basis of these data. Nonetheless, our study contributes valuable data indicating that the immunogenicity of BCG vaccination is not negatively affected by delaying administration until 8 weeks of age, which is much needed in regions of high HIV prevalence where new tuberculosis vaccination strategies are undergoing clinical evaluation [2].As highlighted by Thysen et al, previous trials have shown that BCG vaccination can improve all-cause mortality in West African children [3, 4], and in some cases, can improve innate and adaptive immunity to unrelated antigens [5, 6]. However, it is important to note the context in which these studies were performed. Gambia and Guinea-Bissau have poor healthcare infrastructures, high infant mortality [7], and considerably lower HIV infection and tuberculosis incidences than South Africa, where our trial was conducted. In such settings, the benefits associated with early BCG vaccination could outweigh any risks posed to HIV-infected infants, and delaying BCG vaccination could be detrimental to child survival. In settings with good integration of routine infant vaccination services, programs to prevent and treat tuberculosis, and services to prevent mother-to-child transmission of HIV, where infrastructure could support selectively delayed BCG vaccination for HIV-exposed infants, the risks due to delaying BCG vaccination would be lower. Additional points to consider are that in the prior studies from Guinea-Bissau, BCG vaccination was combined with other interventions, including vitamin A administration, and the randomized trials studied delayed BCG vaccination in lowbirth-weight infants only, in whom mortality is high and immunity less mature