Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study
ObjectivesTo 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.DesignProspective cohort study.SettingBandim Health Project runs an urban Health and Demographic Surveillance site in Guinea...
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doaj-e5669e73d0a547dc974ad3bb3aa417172021-07-31T15:32:59ZengBMJ 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 studyPer Kallestrup0Christine Stabell Benn1Sanne M Thysen2Ane Fisker3Victor Francisco Gomes4Frauke Rudolf5Adam Roth6Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, DenmarkOPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark 1 OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark 1 OPEN, University of Southern Denmark, Odense, Denmark Bandim Health Project, Bissau, Guinea-BissauBandim Health Project, Bissau, Guinea-BissauDepartment of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, Solna, Stockholm, SwedenObjectivesTo 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.DesignProspective cohort study.SettingBandim Health Project runs an urban Health and Demographic Surveillance site in Guinea-Bissau with registration of mortality, vaccination status and TB cases.ParticipantsChildren 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.MethodsUsing 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 measureHR for neonatal BCG compared with no neonatal BCG by TB-exposure status.ResultsAmong 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.ConclusionNeonatal 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 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Per Kallestrup Christine Stabell Benn Sanne M Thysen Ane Fisker Victor Francisco Gomes Frauke Rudolf Adam Roth |
spellingShingle |
Per Kallestrup Christine Stabell Benn Sanne M Thysen Ane Fisker Victor Francisco Gomes Frauke Rudolf Adam Roth Neonatal BCG vaccination and child survival in TB-exposed and TB-unexposed children: a prospective cohort study BMJ Open |
author_facet |
Per Kallestrup Christine Stabell Benn Sanne M Thysen Ane Fisker Victor Francisco Gomes Frauke Rudolf Adam Roth |
author_sort |
Per Kallestrup |
title |
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_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_sort |
neonatal bcg vaccination and child survival in tb-exposed and tb-unexposed children: a prospective cohort study |
publisher |
BMJ Publishing Group |
series |
BMJ Open |
issn |
2044-6055 |
publishDate |
2020-02-01 |
description |
ObjectivesTo 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.DesignProspective cohort study.SettingBandim Health Project runs an urban Health and Demographic Surveillance site in Guinea-Bissau with registration of mortality, vaccination status and TB cases.ParticipantsChildren 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.MethodsUsing 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 measureHR for neonatal BCG compared with no neonatal BCG by TB-exposure status.ResultsAmong 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.ConclusionNeonatal 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. |
url |
https://bmjopen.bmj.com/content/10/2/e035595.full |
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