Maternal Priming: Bacillus Calmette-Guerin (BCG) Vaccine Scarring in Mothers Enhances the Survival of Their Child With a BCG Vaccine Scar
Maternal Priming: Bacillus Calmette-Guerin (BCG) Vaccine Scarring in Mothers Enhances the Survival of Their Child With a BCG Vaccine Scar
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DOI：
10.1093/jpids/piy142
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发表时间：
2020-06-01
影响因子：
3.2
通讯作者：
Aaby, Peter
中科院分区：
文献类型：
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作者：
Berendsen, Mike L. T.;Oland, Christian Bjerregard;Aaby, Peter
背景和假设。母亲启动可能会增强麻疹活疫苗（MV）的有益非特异性效应（NSE）。有卡介苗（BCG）疫苗疤痕的儿童死亡率低于没有疤痕的儿童，这不能解释为对结核病的保护。我们检验了这样一个假设，即如果母亲也有卡介苗疤痕，卡介苗疤痕对孩子的影响会更大。在一项4.5月龄儿童早期MV的随机对照试验（RCT）中，在4.5月龄时登记了儿童及其母亲的BCG瘢痕状况。这些孩子被随访到36个月大。使用考克斯比例风险模型，我们比较了在调整卡介苗接种地点（国立医院或其他地方）后，根据母亲和儿童卡介苗疤痕状况的死亡率比。我们审查了其他对儿童生存有免疫调节作用的干预措施，包括新生儿维生素A补充和早期MV。共有2213名儿童没有接受新生儿维生素A补充和早期MV; 83%的这些儿童和44%的母亲有卡介苗疤痕。母亲有BCG疤痕的儿童并不比母亲没有BCG疤痕的儿童更容易有BCG疤痕（风险比，1.01 [95%置信区间（CI），0.98-1.05]）。在这些儿童中，在4.5至36个月之间，有卡介苗疤痕与41%（95% CI，5%-64%）的死亡率降低相关。如果母亲也有卡介苗疤痕，死亡率降低66%（95%CI，33%-83%），但如果母亲没有卡介苗疤痕，死亡率仅降低8%（95%CI，-83%至53%）（相互作用检验，P = 0.04）。母亲的卡介苗预激可能是重要的卡介苗接种对儿童生存的影响。确保母亲和儿童更好地接种卡介苗，可对儿童死亡率产生相当大的影响。
Background and Hypothesis. Maternal priming might enhance the beneficial nonspecific effects (NSEs) of live measles vaccination (MV). Children with a bacillus Calmette-Guerin (BCG) vaccine scar have a lower mortality rate than those without a scar that is not explained by protection against tuberculosis. We examined the hypothesis that BCG scarring would have a stronger effect on a child if the mother also had a BCG scar.Methods. In a randomized controlled trial (RCT) of early MV in children aged 4.5 months, the BCG-scar status of the children and their mother were registered at enrollment at 4.5 months of age. The children were followed up until they were 36 months of age. Using a Cox proportional hazards model, we compared mortality rate ratios according to maternal and child BCG-scar status after adjusting for where the BCG vaccine was given (the national hospital or elsewhere). We censored for other interventions that have immunomodulating effects on child survival, including neonatal vitamin A supplementation and early MV.Results. A total of 2213 children had not received neonatal vitamin A supplementation and early MV; 83% of these children and 44% of the mothers had a BCG scar. Children whose mother had a BCG scar were not more likely to have a BCG scar than those whose mother did not have a BCG scar (risk ratio, 1.01 [95% confidence interval (CI), 0.98-1.05]). Among the children, having a BCG scar was associated with a 41% (95% CI, 5%-64%) lower mortality between the ages of 4.5 and 36 months. The reduction in mortality was 66% (95% CI, 33%-83%) if the mother also had a BCG scar but only 8% (95% CI, -83% to 53%) if the mother had no BCG scar (test of interaction, P = .04).Conclusions. Maternal BCG priming might be important for the effect of BCG vaccination on child survival. Ensuring better BCG vaccine scarring among mothers and children could have a considerable effect on child mortality levels.