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BCG skin reactions ...
BCG skin reactions by 2 months of age are associated with better survival in infancy : A prospective observational study from Guinea-Bissau
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- Schaltz-Buchholzer, Frederik (författare)
- University of Southern Denmark,Bandim Health Project,Danish Serum Institute, Copenhagen,Odense University Hospital
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- Berendsen, Mike (författare)
- Odense University Hospital,Radboud University Nijmegen,University of Southern Denmark,Bandim Health Project,Danish Serum Institute, Copenhagen
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- Roth, Adam (författare)
- Lund University,Lunds universitet,Klinisk mikrobiologi, Malmö,Forskargrupper vid Lunds universitet,Clinical Microbiology, Malmö,Lund University Research Groups,Public Health Agency of Sweden
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- Jensen, Kristoffer Jarlov (författare)
- Technical University of Denmark,University of Southern Denmark,Odense University Hospital
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- Bjerregaard-Andersen, Morten (författare)
- Bandim Health Project,Danish Serum Institute, Copenhagen
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- Kjær Sørensen, Marcus (författare)
- Danish Serum Institute, Copenhagen,Bandim Health Project
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- Monteiro, Ivan (författare)
- Bandim Health Project
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- Aaby, Peter (författare)
- Bandim Health Project
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- Stabell Benn, Christine (författare)
- University of Southern Denmark,Odense University Hospital,Bandim Health Project,Danish Serum Institute, Copenhagen
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(creator_code:org_t)
- 2020-09-25
- 2020
- Engelska.
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Ingår i: BMJ Global Health. - : BMJ. - 2059-7908. ; 5:9
- Relaterad länk:
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http://dx.doi.org/10... (free)
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https://gh.bmj.com/c...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Introduction Receiving Bacille Calmette-Guérin (BCG)-Denmark vaccine at birth has been associated with ∼40% reductions in all-cause neonatal mortality. We evaluated determinants of BCG skin reaction characteristics by age 2 months and tested the association with subsequent mortality. Methods Prospective observational study amalgamating five trials providing BCG-at-birth that were conducted between 2002 and 2018 in Guinea-Bissau. The reaction status and size were evaluated at home-visits by 2 months of age among 6012 neonates; mortality from 2 to 12 months was assessed at subsequent visits. Reaction determinants were evaluated by binomial regression providing risk ratios (RRs). In Cox-models providing adjusted mortality rate ratios (aMRRs), we assessed the association between (1) having a 2-month reaction (yes/no) and (2) reaction size tertiles and subsequent all-cause mortality risk. A subgroup had their BCG reaction evaluated and were bled at age 4 weeks; their samples underwent in vitro analysis for specific and non-specific cytokine responses. Results The BCG strain was the main determinant for developing a 2-month reaction and the reaction size: the BCG-Russia/BCG-Denmark RR for large-reaction was 0.38 (0.30-0.47) and the BCG-Russia/BCG-Japan RR was 0.61 (0.51-0.72). 5804 infants (96.5%) were reactors by age 2 months; 208 (3.5%) were non-reactors. The 2-12 months mortality risk was 4.8% (10/208) for non-reactors, 2.9% (64/2213) for small reactors, 1.8% (30/1710) for medium reactors and 0.8% (15/1881) for large reactors. The reactor/non-reactor aMRR was 0.49 (0.26-0.95) and there was a linear trend of decreasing mortality with increasing reaction size (p for trend <0.001). BCG reactors had higher 4-week specific and non-specific cytokine responses, responses that were highest among those with large reactions. Conclusion Among BCG-vaccinated infants, having a BCG skin reaction by age 2 months was associated with markedly better survival, as was the reaction size. Our findings thus support that BCG has substantial effects on all-cause mortality. Emphasising at-birth vaccination with immunogenic BCG strains and revaccinating non-reactors and small reactors could have major public health benefits.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
Nyckelord
- child health
- epidemiology
- immunisation
- other study design
- public health
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
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