Couverture vaccinale par le BCG ciblé en maternité avant et après la suspension de l’obligation vaccinale

Abstract

To evaluate vaccine coverage in at-risk newborns during the maternity hospital stay and at the age of 3 months, before and after the change in the French national Calmette-Guérin Bacillus (BCG) vaccine policy. A vaccine program targeting newborns at risk for tuberculosis was implemented in a university maternity hospital in Marseille, France, in 2007. At-risk newborns were mainly defined as those with 1 parent born in an endemic country for tuberculosis, those planning to travel in such a country for at least 1 month in their 1st year of life, or those with previous tuberculosis cases within the family. From February to November 2007, the French BCG policy changed (BCG was no longer mandatory, but only recommended for at-risk children). Parental acceptance of a targeted vaccine delivered during the hospital stay and BCG vaccination during the infant's first 3 months were evaluated before and after the change. A total of 289 newborns at risk of tuberculosis were included. BCG vaccine coverage in the maternity hospital was 72%, significantly higher when BCG was not mandatory (81% versus 66%; p<0.05). At 3 months of age, 90% of the children were BCG vaccinated. Among the infants whose parents refused an early vaccine, the BCG coverage rate at 3 months of age decreased from 78 to 41% (p<0.005) when only a targeted vaccine was recommended. Targeted vaccination of newborns at risk for tuberculosis in a maternity hospital is acceptable. When BCG was not mandatory, parental acceptance of an early-targeted vaccine increased, whereas the policy change decreased later vaccination rates within the first 3 months in children whose parents had previously refused. Early BCG vaccination of at-risk newborns in the maternity hospital may prevent a low BCG coverage rate at 3 months and subsequent tuberculosis cases in this population.