Line Storgaard1, Amabelia Rodrigues2, Cesario Martins2, Bibi Uhre Nielsen1, Henrik Ravn3, Christine Stabell Benn3, Peter Aaby3, Ane Bærent Fisker1. 1. Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen. 2. Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau. 3. Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital.
Abstract
BACKGROUND: Previous studies have found that BCG vaccination has nonspecific beneficial effects on child survival, especially among children who developed a BCG scar. These studies have mostly been done in settings with a high scar frequency. In rural Guinea-Bissau, many children do not develop a scar; we tested the hypothesis that among BCG-vaccinated children, a vaccination scar was associated with lower mortality and fewer hospital admissions. METHODS: During 2009-2011, children <5 years of age in villages followed by Bandim Health Project's demographic surveillance system had their scar status assessed at semiannual visits. We compared mortality and hospital admission rates of scar-positive and scar-negative BCG-vaccinated children during 6 months of follow-up in Cox proportional hazards models. RESULTS: Among 15 911 BCG-vaccinated children, only 52% had a scar. There were 106 non-injury-related deaths among scar-positive children and 137 among scar-negative children. The mortality rate ratio (MRR) was 0.74 (95% confidence interval [CI], .56-.96) overall; 0.48 (95% CI, .26-.90) in infancy, 0.69 (95% CI, .45-1.05) in the second year of life, and 0.89 (95% CI, .61-1.31) in the third-fifth year of life. The association between scar positivity and lower mortality differed significantly by cause of death and was strongest for respiratory infections (MRR, 0.20 [95% CI, .07-.55]). There were 99 hospital admissions among scar-positive children and 125 admissions among scar-negative children, resulting in an incidence rate ratio of 0.74 (95% CI, .60-.92). CONCLUSIONS: Among BCG-vaccinated children in a setting with low scar prevalence, having a scar is associated with lower mortality and morbidity. BCG scar prevalence may be an important marker of vaccination program quality.
BACKGROUND: Previous studies have found that BCG vaccination has nonspecific beneficial effects on child survival, especially among children who developed a BCG scar. These studies have mostly been done in settings with a high scar frequency. In rural Guinea-Bissau, many children do not develop a scar; we tested the hypothesis that among BCG-vaccinated children, a vaccination scar was associated with lower mortality and fewer hospital admissions. METHODS: During 2009-2011, children <5 years of age in villages followed by Bandim Health Project's demographic surveillance system had their scar status assessed at semiannual visits. We compared mortality and hospital admission rates of scar-positive and scar-negative BCG-vaccinated children during 6 months of follow-up in Cox proportional hazards models. RESULTS: Among 15 911 BCG-vaccinated children, only 52% had a scar. There were 106 non-injury-related deaths among scar-positive children and 137 among scar-negative children. The mortality rate ratio (MRR) was 0.74 (95% confidence interval [CI], .56-.96) overall; 0.48 (95% CI, .26-.90) in infancy, 0.69 (95% CI, .45-1.05) in the second year of life, and 0.89 (95% CI, .61-1.31) in the third-fifth year of life. The association between scar positivity and lower mortality differed significantly by cause of death and was strongest for respiratory infections (MRR, 0.20 [95% CI, .07-.55]). There were 99 hospital admissions among scar-positive children and 125 admissions among scar-negative children, resulting in an incidence rate ratio of 0.74 (95% CI, .60-.92). CONCLUSIONS: Among BCG-vaccinated children in a setting with low scar prevalence, having a scar is associated with lower mortality and morbidity. BCG scar prevalence may be an important marker of vaccination program quality.
Authors: Francesca Schiaffino; Gwenyth O Lee; Maribel Paredes-Olortegui; Lilia Cabrera; Pablo Penataro-Yori; Robert H Gilman; Margaret N Kosek Journal: Am J Perinatol Date: 2018-12-24 Impact factor: 1.862
Authors: Núria Serre-Delcor; Carlos Ascaso; Antoni Soriano-Arandes; Francisco Collazos-Sanchez; Begoña Treviño-Maruri; Elena Sulleiro; Diana Pou-Ciruelo; Cristina Bocanegra-Garcia; Israel Molina-Romero Journal: Am J Trop Med Hyg Date: 2018-01-01 Impact factor: 2.345
Authors: Jesper Kjærgaard; Nina M Birk; Thomas N Nissen; Lisbeth M Thøstesen; Gitte T Pihl; Christine S Benn; Dorthe L Jeppesen; Ole Pryds; Poul-Erik Kofoed; Peter Aaby; Gorm Greisen; Lone G Stensballe Journal: Pediatr Res Date: 2016-07-18 Impact factor: 3.756
Authors: Alexander Dahl Stjernholm; Sanne Marie Thysen; Igualdino Da Silva Borges; Ane Bærent Fisker Journal: BMC Public Health Date: 2021-06-17 Impact factor: 3.295
Authors: Andreas Rieckmann; Marie Villumsen; Mette Lundsby Jensen; Henrik Ravn; Zacarias J da Silva; Signe Sørup; Jennifer Lyn Baker; Amabélia Rodrigues; Christine Stabell Benn; Adam E Roth; Peter Aaby Journal: Open Forum Infect Dis Date: 2017-06-20 Impact factor: 3.835