Abstract
BackgroundThe only available vaccine that could be potentially beneficial against mycobacterial diseases contains live attenuated bovine tuberculosis bacillus (Mycobacterium bovis) also called Bacillus Calmette-Guérin (BCG). Even though the BCG vaccine is still widely used, results on its effectiveness in preventing mycobacterial diseases are partially contradictory, especially regarding Buruli Ulcer Disease (BUD). The aim of this case-control study is to evaluate the possible protective effect of BCG vaccination on BUD.MethodologyThe present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors.Principal FindingsAfter stratification by the three countries, two sexes and four age groups, no significant correlation was found between the presence of BCG scar and BUD status of individuals. Multivariate analysis has shown that the independent variables country (p = 0.31), sex (p = 0.24), age (p = 0.96), and presence of a BCG scar (p = 0.07) did not significantly influence the development of BUD category I or category II/III. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or time to healing of lesions.ConclusionsIn our study, we did not observe significant evidence of a protective effect of routine BCG vaccination on the risk of developing either BUD or severe forms of BUD. Since accurate data on BCG strains used in these three countries were not available, no final conclusion can be drawn on the effectiveness of BCG strain in protecting against BUD. As has been suggested for tuberculosis and leprosy, well-designed prospective studies on different existing BCG vaccine strains are needed also for BUD.
Highlights
Buruli Ulcer Disease (BUD), caused by Mycobacterium ulcerans, is an infectious disease affecting skin, subcutanous adipose tissue, and in rare cases, bones
Since accurate data on Bacillus Calmette-Guerin (BCG) strains used in these three countries were not available, no final conclusion can be drawn on the effectiveness of BCG strain in protecting against BUD
In the context of the EC-funded research project ‘‘BuruliVac’’ (FP7/2010–2013; grant agreement Nu 241500), the aim of the present study is to evaluate possible protective effectiveness of routine BCG vaccination containing live attenuated bovine tuberculosis bacillus M. bovis on BUD in the DR Congo, Ghana, and Togo
Summary
Buruli Ulcer Disease (BUD), caused by Mycobacterium ulcerans, is an infectious disease affecting skin, subcutanous adipose tissue, and in rare cases, bones. It is one of the 17 neglected tropical diseases as defined by the World Health Organization (WHO). Even though the BCG vaccine is still widely used, results on its effectiveness in preventing mycobacterial diseases are partially contradictory, especially regarding Buruli Ulcer Disease (BUD).
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