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BCG vaccination scar associated with better childhood survival in Guinea-Bissau

Roth, Adam LU ; Gustafson, Per LU ; Nhaga, Alexandro; Djana, Queba; Poulsen, Anja; Garly, May-Lill; Jensen, Henrik; Sodemann, Morten; Rodriques, Amabelia and Aaby, Peter (2005) In International Journal of Epidemiology 34(3). p.540-547
Abstract
BACKGROUND: Recent studies have suggested that Bacille Calmette-Guerin (BCG) vaccination may have a non-specific beneficial effect on infant survival and that a BCG scar may be associated with lower child mortality. No study has previously examined the influence of BCG vaccination on cause of death. METHODS: Two cohorts (A and B) were used to describe the mortality pattern for children with and without BCG scar and to determine specific causes of death. In cohort A (n = 1813), BCG scar was assessed at 6 months of age and as previously described children with a BCG scar had lower mortality over the next 12 months than children with no BCG scar. In cohort B, 1617 children aged 3 months to 5 years of age had their BCG scar status assessed in... (More)
BACKGROUND: Recent studies have suggested that Bacille Calmette-Guerin (BCG) vaccination may have a non-specific beneficial effect on infant survival and that a BCG scar may be associated with lower child mortality. No study has previously examined the influence of BCG vaccination on cause of death. METHODS: Two cohorts (A and B) were used to describe the mortality pattern for children with and without BCG scar and to determine specific causes of death. In cohort A (n = 1813), BCG scar was assessed at 6 months of age and as previously described children with a BCG scar had lower mortality over the next 12 months than children with no BCG scar. In cohort B, 1617 children aged 3 months to 5 years of age had their BCG scar status assessed in a household-based survey and mortality was assessed during a 12-month period. Causes of death were determined by verbal autopsy (VA) and related to BCG scar status in a cause-specific hazard function. RESULTS: Controlling for background factors associated with mortality, there was lower mortality for children with a BCG scar than without in cohort B, the mortality ratio (MR) being 0.45 (95% CI 0.21-0.96). Exclusion of children exposed to TB did not have any impact on the result. In a combined analysis of cohorts A and B, the MR was 0.43 (95% CI 0.28-0.65) controlling for background factors. There were no large differences in distribution of the five major causes of death (malaria, pneumonia, acute diarrhoea, chronic diarrhoea, and meningitis/encephalitis) according to BCG scar status in the two cohorts. Having a BCG scar significantly reduced the risk of death from malaria [MR 0.32 (95% CI 0.13-0.76)]. CONCLUSIONS: A BCG scar is a marker of better survival among children in countries with high child mortality. BCG vaccination may affect the response to several major infections including malaria. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
non-specific effects of vaccines, cause of death, verbal autopsy, infant mortality, BCG
in
International Journal of Epidemiology
volume
34
issue
3
pages
540 - 547
publisher
Oxford University Press
external identifiers
  • pmid:15659474
  • scopus:20744438949
ISSN
1464-3685
DOI
10.1093/ije/dyh392
language
English
LU publication?
yes
id
224e7a22-8ca1-43a3-a8d4-1cfec02f4b47 (old id 1132564)
date added to LUP
2008-06-27 11:53:07
date last changed
2017-10-22 03:41:01
@article{224e7a22-8ca1-43a3-a8d4-1cfec02f4b47,
  abstract     = {BACKGROUND: Recent studies have suggested that Bacille Calmette-Guerin (BCG) vaccination may have a non-specific beneficial effect on infant survival and that a BCG scar may be associated with lower child mortality. No study has previously examined the influence of BCG vaccination on cause of death. METHODS: Two cohorts (A and B) were used to describe the mortality pattern for children with and without BCG scar and to determine specific causes of death. In cohort A (n = 1813), BCG scar was assessed at 6 months of age and as previously described children with a BCG scar had lower mortality over the next 12 months than children with no BCG scar. In cohort B, 1617 children aged 3 months to 5 years of age had their BCG scar status assessed in a household-based survey and mortality was assessed during a 12-month period. Causes of death were determined by verbal autopsy (VA) and related to BCG scar status in a cause-specific hazard function. RESULTS: Controlling for background factors associated with mortality, there was lower mortality for children with a BCG scar than without in cohort B, the mortality ratio (MR) being 0.45 (95% CI 0.21-0.96). Exclusion of children exposed to TB did not have any impact on the result. In a combined analysis of cohorts A and B, the MR was 0.43 (95% CI 0.28-0.65) controlling for background factors. There were no large differences in distribution of the five major causes of death (malaria, pneumonia, acute diarrhoea, chronic diarrhoea, and meningitis/encephalitis) according to BCG scar status in the two cohorts. Having a BCG scar significantly reduced the risk of death from malaria [MR 0.32 (95% CI 0.13-0.76)]. CONCLUSIONS: A BCG scar is a marker of better survival among children in countries with high child mortality. BCG vaccination may affect the response to several major infections including malaria.},
  author       = {Roth, Adam and Gustafson, Per and Nhaga, Alexandro and Djana, Queba and Poulsen, Anja and Garly, May-Lill and Jensen, Henrik and Sodemann, Morten and Rodriques, Amabelia and Aaby, Peter},
  issn         = {1464-3685},
  keyword      = {non-specific effects of vaccines,cause of death,verbal autopsy,infant mortality,BCG},
  language     = {eng},
  number       = {3},
  pages        = {540--547},
  publisher    = {Oxford University Press},
  series       = {International Journal of Epidemiology},
  title        = {BCG vaccination scar associated with better childhood survival in Guinea-Bissau},
  url          = {http://dx.doi.org/10.1093/ije/dyh392},
  volume       = {34},
  year         = {2005},
}