THE PROTECTIVE EFFECT OF BCG VACCINATION OF THE NEWBORN AGAINST CHILDHOOD TUBERCULOSIS IN AN AFRICAN COMMUNITY
THE PROTECTIVE EFFECT OF BCG VACCINATION OF THE NEWBORN AGAINST CHILDHOOD TUBERCULOSIS IN AN AFRICAN COMMUNITY
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DOI：
10.1016/0041-3879(86)90016-4
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发表时间：
1986-12-01
期刊：
影响因子：
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通讯作者：
TENDAM, HG
中科院分区：
文献类型：
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作者：
TIDJANI, O;AMEDOME, A;TENDAM, HG
印度南部最新的卡介苗接种对照试验显示，两种疫苗未能提供对肺结核的保护。这一结果令人严重怀疑在发展中国家广泛应用的新生儿卡介苗接种的有效性。因此，世卫组织发起了一项全球研究研究，以评估发展中国家目前的方案。这项研究的一部分是在多哥洛美进行的，对新发现患者的儿童接触者进行了临床和放射学检查。所有观察结果均根据评分系统进行记录。同时进行观察，以验证接种疫苗和未接种疫苗的儿童的可比性。在352例儿童接触者中，有1421人完成了检查。最终分数的分布使得能够区分175名可能患有结核病的儿童：546名未接种疫苗的儿童中有113名，875名接种过疫苗的儿童中有62名。在暴露强度方面观察到显著的不可比性：如果父母是指示病例或儿童与指示病例共用卧室(这往往是重合的)，则疫苗接种覆盖率相对较低，疾病风险相对较高。其他被研究的变量，包括年龄和性别，被证明在可比性方面实际上是无关的。对所有类型结核病的综合预防效果的估计为61.5%，略低于原始数据(66%)。然而，这种保护作用似乎随着疾病的严重程度而显著增加。在5岁及以上的儿童中，这一比例低于年龄较小的儿童。结核菌素试验未能显示卡介苗在接种儿童中引起的任何敏感性。结核菌素反应的分布与其他诊断结果的相关性较差。健康儿童的小反应仅比患病儿童略多一些；只有非常大的反应才与更高的患病风险相关。这证实了结核菌素试验在幼儿中的诊断价值非常有限。
The latest controlled trial of BCG vaccination in southern India showed that two vaccines failed to confer protection against pulmonary tuberculosis. This result cast serious doubt on the effectiveness of BCG vaccination of the newborn, which is widely applied in developing countries. Therefore, WHO initiated a global research study to evaluate current programmes in developing countries. Part of this study was carried out in Lome, Togo, in which child contacts of newly detected patients were followed up with clinical and radiological examinations. All observations were recorded according to a scoring system. Concomitant observations were made to verify the comparability of the vaccinated and unvaccinated children. Of the child contacts of 352 index cases, 1421 completed the examinations. The distribution of the final score made it possible to distinguish 175 children likely to suffer from tuberculosis: 113 among the 546 unvaccinated and 62 among the 875 vaccinated children. Significant incomparability was observed in respect of intensity of exposure: the vaccination coverage was relatively low, and the risk of disease relatively high, if a parent was the index case or the child shared the bedroom of the index case (which very often coincided). The other variables studied, including age and sex, turned out to be practically irrelevant as regards comparability. The estimate of the protective effect against all types of tuberculosis combined is 61.5%, which is slightly lower than suggested by the raw data (66%). The protective effect, however, appeared to increase considerably with severity of disease. In children of 5 years and older it was lower than in the younger children. Tuberculin testing failed to reveal any sensitivity induced by BCG in the vaccinated children. The distribution of the tuberculin reactions correlated poorly with the other diagnostic findings. Small reactions were only slightly more frequent in healthy than in sick children; only the very large reactions were associated with a higher risk of disease. This confirms that the tuberculin test is of very limited diagnostic value in young children.