367名新生儿卡介苗接种效果评价

目的客观评价宝鸡市2007年新生儿接种卡介苗效果,为进一步提高接种质量,有效预防结核病提供科学依据。方法观察367名接种卡介苗后满12周儿童卡痕形成情况,并对其纯蛋白衍生物试验阳转结果进行分析。结果卡介苗疤痕率97.82%,卡介苗免疫成功率94.28%。不同性别儿童疤痕率及免疫成功率差异无统计学意义。BCG接种时间越早,BCG-PPD试验阳性率越高。结论宝鸡市新生儿卡介苗接种效果良好。     

大学新生卡介苗接种免疫效果的对照研究

目的为防止结核病在大学生中流行,探讨了对大学新生进行卡介苗接种的免疫效果。方法对结核菌素试验阴性的新入学大学生进行卡介苗接种,并与对照组在校期间的结核病患病情况进行对照研究。结果卡介苗接种组的结核病患病率为3.8%,对照组患病率为10.0%,差异有统计学意义(χ2=6.17,p<0.05)。结论对大学新生进行卡介苗接种可以降低其结核病的患病率。     

大学新生卡介苗接种免疫效果的对照研究

目的 为防止结核病在大学生中流行,探讨了对大学新生进行卡介苗接种的免疫效果.方法 对结核菌素试验阴性的新入学大学生进行卡介苗接种,并与对照组在校期间的结核病患病情况进行对照研究.结果 卡介苗接种组的结核病患病率为3.8%,对照组患病率为10.0%,差异有统计学意义(χ2=6.17,p＜0.05).结论 对大学新生进行卡介苗接种可以降低其结核病的患病率.     

荆门市城区新生儿卡介苗免疫效果评价

新生儿接种卡介苗(BCG)是控制结核病的一项重要措施,特别是预防婴幼儿结核性脑膜炎和播散性结核病,也是计划免疫的组成部分.卡介苗接种技术要求高、操作难度大,接种质量直接影响免疫效果.为了解荆门市城区新生儿卡介苗接种质量,对城区2007-2010年出生的新生儿卡介苗接种质量和免疫效果进行了监测.     

吐哈油田新生儿卡介苗免疫效果监测

接种卡介苗是我国控制结核病的重要措施之一，了解吐哈油田新生儿卡介苗免疫状况，评价卡介苗接种质量和效果，为控制卡介苗免疫的影响因素、提高卡介苗免疫成功率提供依据。     

389名儿童卡介苗接种率及免疫效果分析

结核病是一种广泛流行的慢性传染病,接种卡介苗是控制结核病的一项重要措施。为了摸清我县山区结核病的发病情况,努力提高卡介苗接种的成功率,降低结核病的发病率,保护好易感人群,现将三胜乡398名0～14岁儿童的卡介苗接种及免疫效果资料整理分析如下。     

西昌市1048名卡介苗初免儿童结核菌素试验结果

卡介苗（BCG）是儿童计划免疫程序规定接种疫苗之一,BCG的有效接种对预防儿童结核病具有一定效果,是结核病防控措施之一,结核菌素试验可以用于评价卡介苗接种的免疫学效果。西昌市地处少数民族地区,预防接种工作条件较差,为了解全市卡介苗接种质量和效果的现状,促进工作的提高,于2009年1～6月对1048名1岁内接种卡介苗的儿童进行了结核菌素试验,结果报道如下。     

卡介苗初种时间及接种效果观察

卡介苗初种时间及接种效果观察陈汉明据世界卫生组织最近资料表明：结核病是当今全球潜在危害较大的一种传染病。接种卡介苗是预防结核病重要措施，我国制定的儿童免疫程序规定，婴儿一出生可进行卡介苗接种，但在实际应用中，很多婴儿漏过在产房接种卡介苗机会，并且早期...     

龙口市小学生肺结核感染率和卡介苗接种效果调查

为了了解龙口市中小学校肺结核感染率和卡介苗接种效果.为今后更好地制定有效的控制措施提供依据,龙口市结核病防治所于1995～1996年对龙口市13936名中小学在校学生的卡介苗免疫情况及结核病的感染情况进行了初步调查,现将结果报告如下:1 材料与方法1.1 调查对象 龙口市部分在校中小学生.1.2 调查时间 1995年10月至1996年12月.1.3 调查方法1.3.1 卡介苗接种率及卡疤,共抽查在校学生13936人,其中7岁年龄组6640人,10岁年龄组2814人,12岁年龄组4482人.对所有儿童逐个询问结核病发病史及家族成员结核病患病史,并详细查看卡疤.同时到乡镇医院防度科逐个核对卡介苗接种记录,有接种登记者列入接种过卡介苗,并进行详细登记.     

上海市闵行区新生儿卡介苗接种质量及免疫效果分析

新生儿实施卡介苗接种是预防结核,特别是预防结核性脑膜炎及粟粒型肺结核的重要措施[1]。在我国的计划免疫工作中,卡介苗接种技术要求较高而操作难度较大,接种效果直接影响免疫效果,对预防结核病有很重要的作用。为了了解上海市闵行区新生儿卡介苗接种质量,通过对我区2005年2月所有4所产科医院出生的新生儿随访,评价医院卡介苗接种质量和免疫学效果,以便为促进我区卡介苗接种管理与监测提供科学依据。1对象与方法1.1对象2005年2月在闵行区4所有产房的医院(上海市第五人民医院、闵行区中心医院、吴泾医院、浦江医院)出生,卡介苗接种后12周的…     

Economic evaluation of universal BCG vaccination of Japanese infants

BACKGROUND: The international controversy surrounding the use and effectiveness of the Bacillus Calmette-Guérin (BCG) vaccine and the low incidence of tuberculosis (TB) among Japanese children prompted this study. METHODS: We compared 'universal BCG vaccination' with 'no vaccination at all' using a cost-effectiveness analysis. The study population was a hypothetical cohort comprising a total of 1.2 million infants born in 1996 at locations all over Japan. A model was developed to calculate the number of TB cases prevented by the vaccination programme. Assuming 40-80% overall vaccine efficacy (64-86% for TB-meningitis) and 10 years of protection, we calculated the cost and number of immunizations required to prevent one child from developing TB, the total number of TB cases averted by vaccination and total costs required for the programme. RESULTS: Based on an assumption of flexible vaccine efficacy (40-80%), we estimated that 111-542 TB cases including 10-27 of TB-meningitis would be prevented during the 10 years after BCG vaccination among the cohort of infants born in 1996. About US$35 950-175 862 or 2125-10 399 immunizations would be required to prevent one child from developing TB. Sensitivity analyses covering a wide duration of protection, incidence of TB, vaccine coverage and discount rate, revealed that other than vaccine efficacy, the cost of preventing a single case of TB is highly sensitive to the duration of BCG protection and TB incidence. CONCLUSION: The cost per case of TB prevented is heavily dependent on vaccine efficacy and the duration of protection, and is high compared with the cost of treating one child who has developed TB.     

The impact of a change in infant BCG vaccination policy on adolescent TB incidence rates: A South African population-level cohort study

ObjectiveSouth Africa’s infant Bacille Calmette Guerin (BCG) vaccine policy changed from percutaneous (PC) BCG Japan to intradermal (ID) BCG Denmark in 2000. This study investigated whether this change in infant BCG vaccination had any durable impact on TB incidence rates (IR) into adolescence.MethodsThe Cape Town electronic TB register provided data (from 2008 to 2018) on HIV-negative TB patients born in 1991–1999 (BCG Japan cohort) and 2001–2008 (BCG Denmark cohort). Statistics South Africa provided population estimates. Annual TB IR per 100,000 population were calculated stratified by age, gender and birth year. Interrupted time series analysis with a segmented Poisson regression and birth cohort analyses were used to compare incidence between the BCG cohorts and trends over time.FindingsTB IR increased throughout adolescence, with 17-year-olds having 7.34 [95% confidence interval (CI), 6.48–8.32] times higher TB IR than 10-year-olds. Females had 1.22 [95% CI 1.17–1.27] higher IR than males. Overall, adolescents who received ID BCG Denmark had a lower TB IR compared to PC BCG Japan (rate ratio 0.86, [95% CI 0.80–0.94]). No interaction between BCG and age, nor BCG and gender were identified. Birth cohort analyses showed the increase in TB IR started around one year earlier in females than in males.ConclusionThe change in infant BCG policy was associated with a modest decrease in TB incidence in 10- to 17-year-old HIV-negative adolescents. However, TB incidence rapidly increased with age in both adolescent cohorts and remained high despite BCG vaccination at birth.     

Induction of mycobacterial protective immunity by sublingual BCG vaccination

Tuberculosis (TB) remains a tremendous global health problem, with 1/4 of the world’s population infected and causing > 1 million deaths annually. Intradermal Bacillus Calmette-Guérin (BCG) vaccine given during infancy protects against severe forms of acute disease but does not prevent chronic infection or development of pulmonary TB. TB vaccine mucosal targeting potentially could induce mucosal resident immune cells with increased protective capacity against pulmonary infection and disease. Sublingual (SL) administration of vaccines may be an optimal mucosal delivery platform based on the high absorptive capacity of this mucosal surface, the extensive lymphoid tissue, and published preclinical studies demonstrating efficacy of SL vaccination against other pathogens. To this end, we performed preliminary testing of sublingual TB vaccines. Vaccination of mice with SL BCG elicited potent mycobacteria-specific T cell responses which persisted 16 weeks post-immunization. The magnitudes of the T cell responses were similarly induced after sublingual, intranasal, and subcutaneous BCG vaccination. Interestingly, serum mycobacteria-specific antibody responses and systemic recovery of BCG post-vaccination were lower after SL BCG compared with systemic BCG immunization. However, more importantly, SL BCG vaccinated mice were significantly protected against an aerosolized virulent M. tuberculosis challenge (P < 0.0001 compared to unvaccinated mice). Furthermore, this protection was long-lived, persisting for 16 weeks with >1 log CFU reduction compared with naïve challenged mice in both lungs and spleens (P < 0.0001 and P < 0.0028, respectively). These exciting results provide strong support for further studies exploring the mechanisms of protective immunity induced by sublingual BCG vaccination.     

Developing vaccines to prevent sustained infection with Mycobacterium tuberculosis: Conference proceedings: National Institute of Allergy and Infectious Diseases,Rockville, Maryland USA,November 7, 2014

On November 7, 2014, Aeras and the National Institute of Allergy and Infectious Diseases convened a conference entitled “Vaccine Prevention of Sustained Mycobacterium tuberculosis Infection.” The purpose of this meeting was to explore the biologic plausibility, potential public health and economic impact, and regulatory feasibility in attempting to develop a vaccine to prevent sustained infection with Mycobacterium tuberculosis (Mtb). Currently there are two main goals for tuberculosis (TB) vaccine development, to develop a vaccine that could serve as a booster to Bacille Calmette-Guérin (BCG) vaccination and prevent active TB in adolescents and adults, and to develop an improved vaccine to replace BCG in infants. Although prevention of sustained Mtb infection is being used as a proof of biological activity for vaccines in mid-Phase 2 development, there currently are no plans for pursuing a prevention of Mtb infection licensure indication for TB vaccines. Ultimately, pursuing a prevention of sustained Mtb infection indication for TB vaccines, in parallel with ongoing efforts to develop vaccines to prevent active TB disease, was deemed a potentially important effort, but would require further resources, particularly to improve diagnostic assays, to increase the regulatory feasibility of this endeavor.     

Tuberculin reactivity in adults after 50 years of universal bacille Calmette-Guerin vaccination in Taiwan

We aimed to assess whether tuberculin reactivity in adults is affected by bacille Calmette-Guerin (BCG) vaccination after 50 years of universal BCG vaccination with 80-95% coverage. A community-based study on tuberculin reactivity in 619 participants was conducted in February 2000 in Keelung city, Taiwan. Information on BCG vaccination policies and annual risk of infection (ARI) in the underlying population was extracted from consecutive national prevalence surveys relating to the period 1952-1997. Compared with the expected ARI estimate, the standardized morbidity ratio of positive tuberculin response for vaccination in infancy was 2.2 (95% CI 0.3-15.5) for those aged <10 years. The corresponding figures for older age groups ranged from 3.6 (95% CI 2.2-5.9) for those aged 10-12 years to 0.7 (95% CI 0.5-0.9) for those aged 57-67 years. This suggests that the effect of BCG vaccination on positive tuberculin response in adults aged >30 years is probably negligible irrespective of age at vaccination or revaccination and that the tuberculin skin test can be used to diagnose TB in control programmes in countries with moderate or high incidence of TB.     

The effect of tuberculin skin test and BCG vaccination on the expansion of PPD-specific IFN-gamma producing cells ex vivo

Understanding the immunogenicity of BCG in a population where it has failed will facilitate the design of new TB vaccines. We assessed the immunogenicity of M. bovis BCG over 12 months by ELISPOT assay. Forty-one adolescents and young Gambian male adults received a tuberculin skin test (TST) which was followed one week later by BCG vaccination, but the 23 control subjects received neither of these. TST alone significantly induced PPD-specific IFN-γ producing cells. Twenty-three percent of subjects did not respond to BCG, which was associated with higher pre-existing ex vivo response to PPD. Paradoxically, amongst BCG responders there was a correlation between pre-existing response and subsequent response to BCG. We conclude that BCG is immunogenic, but this effector response is short-lived and can be limited in higher pre-existing anti-mycobacterial immunity, suggesting a possible threshold beyond which BCG immunogenicity is inhibited.     

Modelling the effect of discontinuing universal Bacillus Calmette-Guérin vaccination in an intermediate tuberculosis burden setting

BackgroundBacillus Calmette-Guérin (BCG) vaccination is a widely-used public health intervention for tuberculosis (TB) control. In Taiwan, like other intermediate TB burden settings, steadily declining TB incidence raises important questions on whether universal BCG vaccination should be discontinued. Recent surveys on adverse events following immunisation, such as BCG-induced osteomyelitis/osteitis, also suggest a need to re-evaluate the vaccination programme.MethodsWe developed an age-structured transmission dynamic model, calibrated to population demography and age-specific TB notification rates in Taiwan. We adopted ‘weak-protection’ and ‘strong-protection’ scenarios, representing a range of characteristics including the duration of BCG protection and vaccine efficacies against TB infection and progression. We estimated averted disability-adjusted life years (DALYs) and incremental costs over 10 years after discontinuing universal BCG vaccination in 2018, 2035, and 2050. We also examined the potential impact of ‘surveillance-guided’ discontinuation, triggered once notification rates fall to a given threshold.ResultsIn the weak-protection scenario, discontinuing BCG would result in 2.8 (95% uncertainty range: 2.3, 3.1) additional notified TB cases and −4.1 (−7.7, 0.8) net averted DALYs over 2018–2027. In the strong-protection scenario, 82.9 (72.6, 91.6) additional cases and −402.7 (−506.6, −301.2) averted DALYs would be reported, suggesting a robustly negative health impact. However, in this vaccine scenario, there could be an overall health benefit if BCG is discontinued once TB notification falls below 5 per 100,000 population. The most influential vaccine characteristic for the net health impact is the vaccine efficacy against progression to pulmonary TB. In financial terms, the eliminated cost of the vaccination programme substantially outweighed the incremental cost for TB treatment regardless of BCG protection.ConclusionsBCG discontinuation may be warranted in intermediate burden settings, depending on the quality of vaccine protection, and the potential for refocusing on other TB control activities for earlier detection and treatment.     

Patterns of helminth infection and relationship to BCG vaccination in Karonga District, northern Malawi

Surveys of enteric and urinary helminth infections were carried out in 1999 among 501 schoolchildren and among 320 adolescents and young adults participating in a study of immune responses to BCG vaccine in Karonga District, northern Malawi. Hookworm, Schistosoma mansoni and S. haematobium infections were detected in 64%, 27% and 20% of schoolchildren and in 55%, 40% and 25% of the immunology study subjects, respectively. Other helminths were appreciably less common. The prevalence of 'at least one' helminth infection was 76% among schoolchildren, ranging from 60% to 92% in the 4 schools, and was 79% in the immunology study participants. There was no evidence for an association between the presence of a BCG scar and presence or intensity of infection with worms in the schoolchildren, nor evidence that BCG vaccination of adolescents and young adults had any effect on the prevalence of helminth infections 1 year later.     

Clinical inquiries. How should we manage a patient with a positive PPD and prior BCG vaccination?

Prior bacille Calmette-Guerin (BCG) vaccination increases the likelihood of a positive tuberculosis (TB) 5TU purified protein derivative (PPD) skin test. The PPD response following BCG vaccine varies with age at vaccination, number of years since the BCG vaccination, number of times vaccinated, and number of PPDs performed. An induration of greater than 14 mm is unlikely to be due to prior BCG vaccination (strength of recommendation [SOR]: A, based on meta-analysis of validation cohort studies). The variable reaction after BCG vaccination, along with the desire to detect all cases of TB, has led to recommendations that all patients with a positive PPD test be treated as true positives. These patients should undergo chest radiography and appropriate treatment, regardless of history of BCG vaccine (SOR: B, extrapolation from level 1 study). A recently developed alternative is the interferon-gamma assay (QuantiFERON-TB Gold test), which may be used in place of, or in addition to, the PPD skin test for patients who are known to have received a BCG vaccine (SOR: B, extrapolation from a validation cohort study).     

Exploring the effects of BCG vaccination in patients diagnosed with tuberculosis: Observational study using the Enhanced Tuberculosis Surveillance system

BackgroundBacillus Calmette–Guérin (BCG) is one of the most widely-used vaccines worldwide. BCG primarily reduces the progression from infection to disease, however there is evidence that BCG may provide additional benefits. We aimed to investigate whether there is evidence in routinely-collected surveillance data that BCG vaccination impacts outcomes for tuberculosis (TB) cases in England.MethodsWe obtained all TB notifications for 2009–2015 in England from the Enhanced Tuberculosis surveillance system. We considered five outcomes: All-cause mortality, death due to TB (in those who died), recurrent TB, pulmonary disease, and sputum smear status. We used logistic regression, with complete case analysis, to investigate each outcome with BCG vaccination, years since vaccination and age at vaccination, adjusting for potential confounders. All analyses were repeated using multiply imputed data.ResultsWe found evidence of an association between BCG vaccination and reduced all-cause mortality (aOR:0.76 (95%CI 0.64–0.89), P:0.001) and weak evidence of an association with reduced recurrent TB (aOR:0.90 (95%CI 0.81–1.00), P:0.056). Analyses using multiple imputation suggested that the benefits of vaccination for all-cause mortality were reduced after 10 years.ConclusionsWe found that BCG vaccination was associated with reduced all-cause mortality in people with TB although this benefit was less pronounced more than 10 years after vaccination. There was weak evidence of an association with reduced recurrent TB.