Clara Amalie Gade Timmermann1, Sofie Biering-Sørensen2,3, Peter Aaby2,3, Ane Baerent Fisker2,3, Ivan Monteiro3, Amabelia Rodrigues2,3, Christine Stabell Benn2,4, Henrik Ravn2,4. 1. Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark. 2. Research Centre for Vitamins and Vaccines, Bandim Health Project, Bissau, Guinea-Bissau. 3. Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau. 4. OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark.
Abstract
OBJECTIVE: To test the hypothesis that having a scar and a positive tuberculin skin test (TST) response after vaccination with Bacille Calmette-Guérin (BCG) is associated with reduced infant mortality. METHODS: We studied cohorts of 2709 normal-birthweight (NBW) and 1102 low-birthweight (LBW) infants in Guinea-Bissau. Children were enrolled in randomised trials between year 2002 and 2008 and received BCG vaccination at birth. BCG scars and TST responses were assessed at 2 and 6 months of age. The infants were followed for mortality to 12 months of age, and survival was analysed using Cox regression. RESULTS: At age 2 months, 88% of NBW children and 91% of LBW children had a BCG scar, and 36% and 17% had a TST response, respectively. The LBW infants had nearly twofold higher mortality (4.5%) than the NBW infants (2.8%) between 2 and 12 months of age. In the LBW cohort, the adjusted mortality rate ratio (MRR) comparing children with a BCG scar with those without was 0.42 (95% CI = 0.19; 0.93). There was a similar tendency for TST positivity: MRR = 0.47 (95% CI = 0.14; 1.54). For LBW children who had both a positive TST reaction and a scar, the MRR was 0.22 (95% CI = 0.05; 0.87). For NBW children, a scar and a positive TST were associated with 20% reductions in mortality, which did not reach statistical significance. CONCLUSION: We confirmed previous observations that having a scar and a TST response after BCG vaccination is associated with lower mortality risk. The possibility of revaccinating scar-negative children should be considered.
RCT Entities:
OBJECTIVE: To test the hypothesis that having a scar and a positive tuberculin skin test (TST) response after vaccination with Bacille Calmette-Guérin (BCG) is associated with reduced infant mortality. METHODS: We studied cohorts of 2709 normal-birthweight (NBW) and 1102 low-birthweight (LBW) infants in Guinea-Bissau. Children were enrolled in randomised trials between year 2002 and 2008 and received BCG vaccination at birth. BCG scars and TST responses were assessed at 2 and 6 months of age. The infants were followed for mortality to 12 months of age, and survival was analysed using Cox regression. RESULTS: At age 2 months, 88% of NBW children and 91% of LBW children had a BCG scar, and 36% and 17% had a TST response, respectively. The LBW infants had nearly twofold higher mortality (4.5%) than the NBW infants (2.8%) between 2 and 12 months of age. In the LBW cohort, the adjusted mortality rate ratio (MRR) comparing children with a BCG scar with those without was 0.42 (95% CI = 0.19; 0.93). There was a similar tendency for TST positivity: MRR = 0.47 (95% CI = 0.14; 1.54). For LBW children who had both a positive TST reaction and a scar, the MRR was 0.22 (95% CI = 0.05; 0.87). For NBW children, a scar and a positive TST were associated with 20% reductions in mortality, which did not reach statistical significance. CONCLUSION: We confirmed previous observations that having a scar and a TST response after BCG vaccination is associated with lower mortality risk. The possibility of revaccinating scar-negative children should be considered.
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: Katarina M Funch; Sanne M Thysen; Amabelia Rodrigues; Cesario L Martins; Peter Aaby; Christine S Benn; Ane B Fisker Journal: Hum Vaccin Immunother Date: 2018-01-23 Impact factor: 3.452
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
Authors: Frederik Schaltz-Buchholzer; Mike Berendsen; Adam Roth; Kristoffer Jarlov Jensen; Morten Bjerregaard-Andersen; Marcus Kjær Sørensen; Ivan Monteiro; Peter Aaby; Christine Stabell Benn Journal: BMJ Glob Health Date: 2020-09