Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study
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 Gui...
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BMJ Publishing Group
2020-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/2/e035595.full |
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| author | Peter Aaby Per Kallestrup Christine Stabell Benn Sanne M Thysen Ane Fisker Victor Francisco Gomes Frauke Rudolf Christian Wejse Adam Roth |
| author_facet | Peter Aaby Per Kallestrup Christine Stabell Benn Sanne M Thysen Ane Fisker Victor Francisco Gomes Frauke Rudolf Christian Wejse Adam Roth |
| author_sort | Peter Aaby |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-e5669e73d0a547dc974ad3bb3aa41717 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e5669e73d0a547dc974ad3bb3aa417172025-02-06T23:05:14ZengBMJ Publishing GroupBMJ Open2044-60552020-02-0110210.1136/bmjopen-2019-035595Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort studyPeter Aaby0Per Kallestrup1Christine Stabell Benn2Sanne M Thysen3Ane Fisker4Victor Francisco Gomes5Frauke Rudolf6Christian Wejse7Adam Roth8Bandim Health Project, Danish Epidemiology Science Centre, Statens Serum Institut, 2300 Copenhagen S, DenmarkEast Africa NCD Alliance, Kampala, UgandaResearch Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark4 Center for Global Health (GloHAU), Aarhus University, Aarhus, Denmark1 OPEN, University of Southern Denmark, Odense, DenmarkBandim Health Project, Bissau, Guinea-Bissau1 Department of Infectious Diseases, Aarhus Universitetshospital, Aarhus, DenmarkInfectious Diseases, Aarhus University Hospital, Aarhus, DenmarkDepartment of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, SwedenObjectives 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.https://bmjopen.bmj.com/content/10/2/e035595.full |
| spellingShingle | Peter Aaby Per Kallestrup Christine Stabell Benn Sanne M Thysen Ane Fisker Victor Francisco Gomes Frauke Rudolf Christian Wejse Adam Roth Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study BMJ Open |
| title | Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study |
| title_full | Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study |
| title_fullStr | Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study |
| title_full_unstemmed | Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study |
| title_short | Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study |
| title_sort | neonatal bcg vaccination and child survival in tb exposed and tb unexposed children a prospective cohort study |
| url | https://bmjopen.bmj.com/content/10/2/e035595.full |
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