BCG scar and positive tuberculin reaction associated with reduced child mortality in West Africa -: A non-specific beneficial effect of BCG?
BCG scar and positive tuberculin reaction associated with reduced child mortality in West Africa -: A non-specific beneficial effect of BCG?
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DOI：
10.1016/s0264-410x(03)00181-6
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发表时间：
2003-06-20
期刊：
影响因子：
5.5
通讯作者：
Aaby, P
中科院分区：
文献类型：
--
作者：
Garly, ML;Martins, CL;Aaby, P
以前的研究表明，卡介苗(BCG)可能对高死亡率地区的儿童生存有非特异性的有益影响。我们研究了接种卡介苗的有卡痕或结核菌素反应阳性的儿童是否比没有这种反应的儿童有更好的存活率。作为正在进行的两剂麻疹疫苗试验的一部分，我们在6个月大的时候招募了儿童，检查了1813名6个月大的儿童是否有卡介苗疤痕，并对813名接种了卡介苗的儿童进行了对结核菌素、破伤风和白喉的迟发性超敏反应皮肤测试。我们发现卡介苗接种后有卡痕的儿童的死亡率明显低于卡痕阴性儿童，随访前12个月的死亡率比为0.41(0.25-0.67)。与结核菌素试验阴性的儿童相比，接种卡介苗的结核菌素试验阳性儿童的死亡率为0.45(0.24-0.85)。通过控制潜在的混杂因素或使用不同的结核菌素阳性反应截断点，这些结果没有变化。排除感染艾滋病毒抗体的死亡儿童并没有改变估计(死亡率(MR)=0.46(0.23-0.94))。在对家庭中的结核病暴露进行审查后，有疤痕和结核菌素阳性的死亡率分别为0.46(0.27-0.79)或0.42(0.21-0.84)。在皮试中对破伤风或白喉呈阳性的儿童的死亡率与对这些疫苗相关抗原无反应的儿童相同。因此，在一个死亡率较高的地区，卡痕和结核菌素阳性反应与儿童早期存活率较高有关。由于对白喉-破伤风-百日咳(DTP)疫苗的应答者没有发现类似的情况，而且这种效果不能用预防结核病来解释，卡介苗的效果可能是由于非特异性免疫刺激对其他感染的保护。(C)2003爱思唯尔科学有限公司。保留所有权利。
Previous studies have suggested that the bacille Calmette-Guerin (BCG) vaccine may have a non-specific beneficial effect on childhood survival in areas with high mortality. We examined whether BCG-vaccinated children with a BCG scar or a positive tuberculin reaction had better survival than children without such reactions. As part of an ongoing two-dose measles vaccine trial for which children were recruited at 6 months of age, we examined 1813 children for BCG scar at 6 months of age and 813 BCG-vaccinated children were skin-tested for delayed hypersensitivity to tuberculin, tetanus and diphtheria. We found that BCG-vaccinated children with a BCG scar had significantly lower mortality compared with BCG scar-negative children, the mortality ratio in the first 12 months of follow-up being 0.41 (0.25-0.67). BCG-vaccinated children with a positive tuberculin test had a mortality ratio of 0.45 (0.24-0.85) compared with tuberculin negative children. These results were unchanged by control for potential confounders or using different cut-off points for a tuberculin-positive response. Exclusion of dead children who had HIV antibodies did not modify the estimate (mortality rate (MR) = 0.46 (0.23-0.94)). After censoring for tuberculosis (TB) exposure at home, the mortality ratios for having a scar and being tuberculin-positive were 0.46 (0.27-0.79) or 0.42 (0.21-0.84), respectively. Children positive to tetanus or diphtheria in the skin test had the same mortality as children not responding to these vaccine-related antigens. Thus, BCG scar and a positive tuberculin reaction were associated with better survival in early childhood in an area with high mortality. Since nothing similar was found for responders to diphtheria-tetanus-pertussis (DTP) vaccine, and the effect could not be explained by protection against tuberculosis, the effect of BCG vaccination could be due to non-specific immune-stimulation protecting against other infections. (C) 2003 Elsevier Science Ltd. All rights reserved.