BCG scar and positive tuberculin reaction associated with reduced child mortality in West Africa. A non-specific beneficial effect of BCG?
(2003) In Vaccine 21(21-22). p.2782-2790- Abstract
- Previous studies have suggested that the bacille Calmette-Guerin (BCG) vaccine may have a non-specific beneficial effect on childhood survival in areas with high mortality. We examined whether BCG-vaccinated children with a BCG scar or a positive tuberculin reaction had better survival than children without such reactions. As part of an ongoing two-dose measles vaccine trial for which children were recruited at 6 months of age, we examined 1813 children for BCG scar at 6 months of age and 813 BCG-vaccinated children were skin-tested for delayed hypersensitivity to tuberculin, tetanus and diphtheria. We found that BCG-vaccinated children with a BCG scar had significantly lower mortality compared with BCG scar-negative children, the... (More)
- Previous studies have suggested that the bacille Calmette-Guerin (BCG) vaccine may have a non-specific beneficial effect on childhood survival in areas with high mortality. We examined whether BCG-vaccinated children with a BCG scar or a positive tuberculin reaction had better survival than children without such reactions. As part of an ongoing two-dose measles vaccine trial for which children were recruited at 6 months of age, we examined 1813 children for BCG scar at 6 months of age and 813 BCG-vaccinated children were skin-tested for delayed hypersensitivity to tuberculin, tetanus and diphtheria. We found that BCG-vaccinated children with a BCG scar had significantly lower mortality compared with BCG scar-negative children, the mortality ratio in the first 12 months of follow-up being 0.41 (0.25-0.67). BCG-vaccinated children with a positive tuberculin test had a mortality ratio of 0.45 (0.24-0.85) compared with tuberculin negative children. These results were unchanged by control for potential confounders or using different cut-off points for a tuberculin-positive response. Exclusion of dead children who had HIV antibodies did not modify the estimate (mortality rate (MR)=0.46 (0.23-0.94)). After censoring for tuberculosis (TB) exposure at home, the mortality ratios for having a scar and being tuberculin-positive were 0.46 (0.27-0.79) or 0.42 (0.21-0.84), respectively. Children positive to tetanus or diphtheria in the skin test had the same mortality as children not responding to these vaccine-related antigens. Thus, BCG scar and a positive tuberculin reaction were associated with better survival in early childhood in an area with high mortality. Since nothing similar was found for responders to diphtheria-tetanus-pertussis (DTP) vaccine, and the effect could not be explained by protection against tuberculosis, the effect of BCG vaccination could be due to non-specific immune-stimulation protecting against other infections. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1127231
- author
- Garly, May-Lill ; Martins, Cesario Lourenco ; Bale, Carlitos ; Balde, Mamadu Aliu ; Hedegaard, Kathryn Louise ; Gustafson, Per LU ; Lisse, Ida M ; Whittle, Hilton C and Aaby, Peter
- publishing date
- 2003
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Vaccine
- volume
- 21
- issue
- 21-22
- pages
- 2782 - 2790
- publisher
- Elsevier
- external identifiers
-
- pmid:12798618
- scopus:0038043371
- ISSN
- 1873-2518
- DOI
- 10.1016/S0264-410X(03)00181-6
- language
- English
- LU publication?
- no
- id
- 0792d1c5-f436-4d58-a081-b859e23abc84 (old id 1127231)
- date added to LUP
- 2016-04-01 12:11:19
- date last changed
- 2022-04-21 03:42:20
@article{0792d1c5-f436-4d58-a081-b859e23abc84,
abstract = {{Previous studies have suggested that the bacille Calmette-Guerin (BCG) vaccine may have a non-specific beneficial effect on childhood survival in areas with high mortality. We examined whether BCG-vaccinated children with a BCG scar or a positive tuberculin reaction had better survival than children without such reactions. As part of an ongoing two-dose measles vaccine trial for which children were recruited at 6 months of age, we examined 1813 children for BCG scar at 6 months of age and 813 BCG-vaccinated children were skin-tested for delayed hypersensitivity to tuberculin, tetanus and diphtheria. We found that BCG-vaccinated children with a BCG scar had significantly lower mortality compared with BCG scar-negative children, the mortality ratio in the first 12 months of follow-up being 0.41 (0.25-0.67). BCG-vaccinated children with a positive tuberculin test had a mortality ratio of 0.45 (0.24-0.85) compared with tuberculin negative children. These results were unchanged by control for potential confounders or using different cut-off points for a tuberculin-positive response. Exclusion of dead children who had HIV antibodies did not modify the estimate (mortality rate (MR)=0.46 (0.23-0.94)). After censoring for tuberculosis (TB) exposure at home, the mortality ratios for having a scar and being tuberculin-positive were 0.46 (0.27-0.79) or 0.42 (0.21-0.84), respectively. Children positive to tetanus or diphtheria in the skin test had the same mortality as children not responding to these vaccine-related antigens. Thus, BCG scar and a positive tuberculin reaction were associated with better survival in early childhood in an area with high mortality. Since nothing similar was found for responders to diphtheria-tetanus-pertussis (DTP) vaccine, and the effect could not be explained by protection against tuberculosis, the effect of BCG vaccination could be due to non-specific immune-stimulation protecting against other infections.}},
author = {{Garly, May-Lill and Martins, Cesario Lourenco and Bale, Carlitos and Balde, Mamadu Aliu and Hedegaard, Kathryn Louise and Gustafson, Per and Lisse, Ida M and Whittle, Hilton C and Aaby, Peter}},
issn = {{1873-2518}},
language = {{eng}},
number = {{21-22}},
pages = {{2782--2790}},
publisher = {{Elsevier}},
series = {{Vaccine}},
title = {{BCG scar and positive tuberculin reaction associated with reduced child mortality in West Africa. A non-specific beneficial effect of BCG?}},
url = {{http://dx.doi.org/10.1016/S0264-410X(03)00181-6}},
doi = {{10.1016/S0264-410X(03)00181-6}},
volume = {{21}},
year = {{2003}},
}