Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study

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  • Sanne M Thysen, Syddansk Universitet, Bandim Health Project, Statens Serum Institut
  • ,
  • Christine Stabell Benn, Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
  • ,
  • Victor Francisco Gomes, Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; National Public Health Laboratory, Bissau, Guinea-Bissau.
  • ,
  • Frauke Rudolf, Bandim Health Project
  • ,
  • Christian Wejse
  • Adam Roth, Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Lund, Sweden.
  • ,
  • Per Kallestrup
  • Peter Aaby, Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
  • ,
  • Ane Fisker, Bandim Health Project, Guinea-Bissau, Statens Serum Institut

OBJECTIVES: To assess the association between neonatal BCG vaccination and mortality between 28 days and 3 years of age among tuberculosis (TB)-exposed and TB-unexposed children.

DESIGN: Prospective cohort study.

SETTING: Bandim Health Project runs an urban Health and Demographic Surveillance site in Guinea-Bissau with registration of mortality, vaccination status and TB cases.

PARTICIPANTS: Children entered the analysis when their vaccination card was inspected after 28 days of age and remained under surveillance to 3 years of age. Children residing in the same house as a TB case were classified as TB-exposed from 3 months prior to case registration to the end of follow-up.

METHODS: Using Cox-proportional hazards models with age as underlying time scale, we compared mortality of children with and without neonatal BCG between October 2003 and September 2017.

MAIN OUTCOME MEASURE: HR for neonatal BCG compared with no neonatal BCG by TB-exposure status.

RESULTS: Among the 39 421 children who entered the analyses, 3022 (8%) had observation time as TB-exposed. In total, 84% of children received neonatal BCG. Children with neonatal BCG had lower mortality both in TB-exposed (adjusted HR: 0.57 (0.26 to 1.27)) and in TB-unexposed children (HR: 0.57 (95% CI 0.47 to 0.69)) than children without neonatal BCG. Children exposed to TB had higher mortality than TB-unexposed children if they had not received neonatal BCG.

CONCLUSION: Neonatal BCG vaccination was associated with lower mortality among both TB-exposed and TB-unexposed children, consistent with neonatal BCG vaccination having beneficial non-specific effects. Interventions to increase timely BCG vaccination are urgently warranted.

TidsskriftBMJ Open
Antal sider10
StatusUdgivet - 2020

Bibliografisk note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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