Childhood tuberculosis in Sweden: An epidemiological study made six years after the cessation of general BCG vaccination of the newborn

Abstract

General BCG vaccination of the newborn was started in Sweden in the 1940s and was stopped on April 1, 1975. The effect of this change in policy has been analysed in a study of children born in Sweden in 1969 or later and whose names were entered in the Central Tuberculosis Register from 1969 to 1980. A comparison was made between two groups of children: 1. children born in Sweden between April 1, 1969 and December 31, 1974 and who contracted tuberculosis during that period; all the children in this group were BCG-vaccinated ; 2. children born between April 1, 1975 and December 31, 1980 and who contracted tuberculosis during that period. Only one child in this group had been vaccinated. In the first group of vaccinated children 4 cases of pulmonary tuberculosis, one case of meningitis and one case of lymphadenitis were recorded. Among the unvaccinated children in the second group, 20 cases of pulmonary tuberculosis, one fatal case of miliary tuberculosis and two cases of meningitis were recorded. In addition 13 cases of mycobacterial lymph node disease and one case of skin granuloma were found, but these were considered likely to be caused by non-tuberculous mycobacterial infection. The incidence of pulmonary, miliary and meningeal tuberculosis was 8 times higher among children born to foreign parents (6.4 per 100 000 person-years) than among unvaccinated Swedish children (0.8 per 100 000). Despite the increase in incidence of tuberculosis which occurred after the cessation of vaccination of the newborn, the continued low incidence of tuberculosis in Swedish children up to and including 1980 does not justify the reintroduction of general BCG vaccination of the newborn in Sweden.