Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: a retrospective population-based cohort study
Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: a retrospective population-based cohort study
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DOI：
10.1016/s1473-3099(15)00400-4
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发表时间：
2016-02-01
影响因子：
56.3
通讯作者：
Mangtani, Punam
中科院分区：
文献类型：
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作者：
Nguipdop-Djomo, Patrick;Heldal, Einar;Mangtani, Punam
关于卡介苗能预防结核病多久，人们知之甚少。我们评估了挪威出生个体的长期疫苗有效性（VE）。方法在这项基于人群的回顾性队列研究中，我们研究了出生于挪威的12-50岁的个体，他们结核菌素皮肤试验（TST）阴性，符合卡介苗接种条件，作为挪威最后一轮强制性大规模结核病筛查和卡介苗接种计划的一部分，从1962年到1975年。我们排除了在筛查前或筛查当年患有结核病的个体以及TST和BCG状态未知的个体。我们获得了TST和BCG信息，并将其与国家结核病登记册、人口和住房普查以及移民和死亡人口登记册联系起来。我们对这些个体进行随访，直到他们首次结核病发作、移民、死亡或2011年12月31日。我们使用Cox回归来估计接种疫苗以来所有结核病和仅肺结核的VE，并根据年龄、时间、县级结核病率以及人口和社会经济指标进行调整。83 421名未接种bcg疫苗的患者中位随访时间为41年（IQR 32-49）， 297 905名接种疫苗的患者中位随访时间为44年（41-46），其中260例结核病发作。未接种疫苗者结核病发病率为每10万人年3.3例，接种疫苗者为每10万人年1.3例。40年随访期间调整后的平均VE为49% (95% CI 26-65)，尽管20年后，VE并不显著（9年VE[不包括前2年的结核病发作]为61% [95% CI 24-80]， 10-19年为58%[27-76]，20-29年为38%[-32至71]，30-40年为42%[-24至73]）。9年（不包括前2年的结核病发作）的VE为67% (95% CI 27-85)， 10-19年为63%(32-80)，20-29年为50%(19 - 79)，30-40年为40%（-46 - 76）。研究结果与卡介苗的持久保护一致，但VE随着时间的推移而减弱。这种疫苗的成本效益可能比以前估计的要高
Background Little is known about how long the BCG vaccine protects against tuberculosis. We assessed the long-term vaccine effectiveness (VE) in Norwegian-born individuals.Methods In this retrospective population-based cohort study, we studied Norwegian-born individuals aged 12-50 years who were tuberculin skin test (TST) negative and eligible for BCG vaccination as part of the last round of Norway's mandatory mass tuberculosis screening and BCG vaccination programme between 1962 and 1975. We excluded individuals who had tuberculosis before or in the year of screening and those with unknown TST and BCG status. We obtained TST and BCG information and linked it to the National Tuberculosis Register, population and housing censuses, and the population register for emigrations and deaths. We followed individuals up to their first tuberculosis episode, emigration, death, or Dec 31, 2011. We used Cox regressions to estimate VE against all tuberculosis and just pulmonary tuberculosis by time since vaccination, adjusted for age, time, county-level tuberculosis rates, and demographic and socioeconomic indicators.Findings Median follow-up was 41 years (IQR 32-49) for 83 421 BCG-unvaccinated and 44 years (41-46) for 297 905 vaccinated individuals, with 260 tuberculosis episodes. Tuberculosis rates were 3.3 per 100 000 person-years in unvaccinated and 1.3 per 100 000 person-years in vaccinated individuals. The adjusted average VE during 40 year follow-up was 49% (95% CI 26-65), although after 20 years, the VE was not significant (up to 9 years VE [excluding tuberculosis episodes in the first 2 years] 61% [95% CI 24-80]; 10-19 years 58% [27-76]; 20-29 years 38% [-32 to 71]; 30-40 years 42% [-24 to 73]). VE against pulmonary tuberculosis up to 9 years (excluding tuberculosis episodes in the first 2 years) was 67% (95% CI 27-85), 10-19 years was 63% (32-80), 20-29 years was 50% (-19 to 79), and 30-40 years was 40% (-46 to 76).Interpretation Findings are consistent with long-lasting BCG protection, but waning of VE with time. The vaccine could be more cost effective than has been previously estimated