Effectiveness of the First Dose of BCG against Tuberculosis among HIV-Infected, Predominantly Immunodeficient Children.

Joaquim C V D Van-Dunem,Laura C Rodrigues,Ricardo Arraes De Alencar Ximenes,Luiz Claudio Arraes Alencar,Maria De Fátima Pessoa Militão-Albuquerque

doi:10.1155/2015/275029

Abstract

The objective of this study was to estimate the protective effect of Bacille Calmette-Guérin (BCG) vaccine against tuberculosis among (predominantly immunodeficient) HIV-infected children in Angola. A hospital-based case-control study was conducted with 230 cases, children coinfected with tuberculosis, and 672 controls, HIV-infected children from the same hospital, aged 18 months to 13 years. The presence of a vaccination scar was taken as a proxy marker for BCG vaccination. The crude effectiveness was 8% (95% CI: −26 to 32) and the adjusted effectiveness was 30% (95% CI: −75 to 72). The present study suggests that BCG does not have a protective effect against tuberculosis among immunodeficient HIV-infected children. Since BCG is no longer given to HIV-infected children, the study may not be replicated. Accepting that these findings should be considered with caution, they are nonetheless likely to be the last estimate of BCG efficacy in a sufficiently powered study.

Highlights

Tuberculosis (TB) remains a public health problem worldwide
There has only ever been one other very small study conducted in Zambia, which estimated Bacille Calmette-Guerin (BCG) efficacy in HIV-infected children [25]
Our findings suggest that the first dose of BCG has no protective effect against TB in these children

Summary

Introduction

It is estimated that in 2012 there were 8.6 million incident cases, 13% of which included people living with HIV, with 1.3 million deaths (940,000 among HIV-negative individuals and 320,000 among HIV-positive) [1]. In Angola, the incidence of TB was 320 per 100000 inhabitants [2]; it was estimated that among adults aged 15 to 49 the prevalence rate of HIV was 2.4% [3]. There has been much debate regarding the advantages and disadvantages of BCG since its use was first introduced. Key elements of the debate surrounding the effectiveness of BCG have included safety, loss of tuberculin sensitivity as a diagnostic tool, and, especially, the broad range of BCG effectiveness against TB, in 17 trials and 10 case-control studies, from no protection to 83% (95% CI: 58% to 93%) [5]

Objectives

Discussion

Conclusion