BCG vaccination and tuberculosis prevention: A forty years cohort study, Monastir, Tunisia.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
22
02
2019
accepted:
04
07
2019
entrez:
6
8
2019
pubmed:
6
8
2019
medline:
3
3
2020
Statut:
epublish
Résumé
We aimed to describe incidence, trends of tuberculosis (TB) over 18 years and to evaluate the impact of the BCG vaccine after four decades of immunization program according to three protocols. We performed a cohort study including declared cases in Monastir from January 1, 2000 to December 31, 2017. We reported 997 cases of TB. The predominant site was pulmonarylocalization (n = 486). The age standardized incidence of pulmonary and lymph node TB per 100,000 inh were 5.71 and 2.57 respectively. Trends were negative for pulmonary TB (PTB) (b = - 0.82; r = -0.67; p<10-3) and positive for lymph node localization (b = 1.31; r = 0.63; p<10-3). We had not notified cases of HIV associated with TB. Crude incidence rate (CIR) of PTB per 100,000 inh was 8.17 in Non-Vaccinated Cohort (NVC) and 2.85 in Vaccinated Cohort (VC) (p < 0.0001). Relative risk reduction (RRR) of BCG vaccination was 65.1% (95%CI:57.5;71.4) for pulmonary localization and 65% (95%CI:55; 73) for other localizations. We have not established a significant RRR of BCG vaccination on lymph node TB. Protocol 3 (at birth) had the highest effectiveness with a RRR of 96.7% (95%CI: 86.6%; 99.2%) and 86% (95%CI:71%;91%) in patients with PTB and other localizations TB respectively. In Cox regression model the HR was 0.061 (95% CI 0.015-0.247) for PTB and 0.395 (95% CI 0.185-0.844) for other localizations TB in patients receiving protocol 3 compared to NVC. For lymph-node TB, HR was 1.390 (95% CI 1.043-1.851) for protocol 1 and 1.849 (95% CI 1.232-2.774) for protocol 2 compared to NVC. Depending on the three protocols, the BCG vaccine had a positive impact on PTB and other TB localizations that must be kept and improved. However, protocols 1 and 2 had a reverse effect on lymph node TB.
Identifiants
pubmed: 31381577
doi: 10.1371/journal.pone.0219991
pii: PONE-D-19-02598
pmc: PMC6682306
doi:
Substances chimiques
BCG Vaccine
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0219991Commentaires et corrections
Type : ErratumIn
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Afr Health. 1994 Mar;16(3):8-10
pubmed: 12318774
Osteoporos Int. 2005 Feb;16(2):180-3
pubmed: 15197539
Lancet. 2006 Apr 8;367(9517):1173-80
pubmed: 16616560
Arch Intern Med. 2007 Feb 26;167(4):335-42
pubmed: 17325294
Eur Respir J. 2008 Jan;31(1):99-105
pubmed: 17804450
Int J Infect Dis. 2010 Feb;14(2):e102-10
pubmed: 19541522
Tunis Med. 2009 Oct;87(10):693-8
pubmed: 20187360
Sante. 2010 Apr-Jun;20(2):87-92
pubmed: 20685638
Clin Infect Dis. 2011 Apr 1;52(7):911-6
pubmed: 21427399
BMC Public Health. 2012 Jul 06;12:504
pubmed: 22770435
Pneumonol Alergol Pol. 2013;81(2):121-9
pubmed: 23420428
Clin Infect Dis. 2014 Feb;58(4):470-80
pubmed: 24336911
Immunol Rev. 2015 Mar;264(1):103-20
pubmed: 25703555
Vaccine. 2015 Sep 22;33(39):5035-41
pubmed: 26319069
Lancet. 2016 Mar 19;387(10024):1211-26
pubmed: 26377143
Nat Immunol. 2015 Nov;16(11):1114-23
pubmed: 26482978
Iran J Public Health. 2016 Mar;45(3):305-13
pubmed: 27141492
Int J Mycobacteriol. 2015 Sep;4(3):196-201
pubmed: 27649866
Int J Mycobacteriol. 2017 Oct-Dec;6(4):356-359
pubmed: 29171449
Epidemiol Infect. 2018 Jun;146(8):946-953
pubmed: 29655391
N Engl J Med. 2018 Jul 12;379(2):138-149
pubmed: 29996082
Medicine (Baltimore). 2018 Jul;97(30):e11732
pubmed: 30045341
Tunis Med. 2018 Oct-Nov;96(10-11):696-705
pubmed: 30746663
Indian J Med Res. 1980 Jul;72 Suppl:1-74
pubmed: 7005086
Lancet. 1995 Nov 18;346(8986):1339-45
pubmed: 7475776
JAMA. 1994 Mar 2;271(9):698-702
pubmed: 8309034