Abstract
BackgroundIn 2005 in England, universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates.AimEstimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England.MethodsWe conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both the universal and targeted vaccination between 1 January 2000 and 31 December 2010. We then estimated incidence rates over a 5-year follow-up period and used regression modelling to estimate the impact of the change in policy on TB.ResultsIn the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR): 0.74; 95% credible interval (CrI): 0.61 to 0.88 and neonatal IRR: 0.62; 95%CrI: 0.44 to 0.88). We found some evidence that the change in policy was associated with an increase in incidence rates in the UK born school-age population (IRR: 1.08; 95%CrI: 0.97 to 1.19) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96; 95%CrI: 0.82 to 1.14). Overall, we found that the change in policy was associated with directly preventing 385 (95%CrI: −105 to 881) cases.ConclusionsWithdrawing universal vaccination at school age and targeting vaccination towards high-risk neonates was associated with reduced incidence of TB. This was largely driven by reductions in the non-UK born with cases increasing in the UK born.
Highlights
In 2005, England changed its Bacillus Calmette–Guérin (BCG) vaccination policy against tuberculosis (TB) from a universal programme aimed at 13 and 14 year olds to a targeted programme aimed at high-risk neonates
In the non-United Kingdom (UK) born incidence rates were lower after the change in BCG policy in both the cohort relevant to the universal school-age scheme and the cohort relevant to the targeted neonatal scheme (Figure)
In the non-UK born we found evidence of an association between the change in BCG policy and a decrease in TB incidence rates in both those at school age and neonates, after 5 years of follow-up
Summary
In 2005, England changed its Bacillus Calmette–Guérin (BCG) vaccination policy against tuberculosis (TB) from a universal programme aimed at 13 and 14 year olds to a targeted programme aimed at high-risk neonates. In Sweden, which discontinued universal vaccination of neonates in favour of targeted vaccination of those at high risk, incidence rates in Swedish-born children increased slightly after the change in policy [8]. Results: In the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR): 0.74; 95% credible interval (CrI): 0.61 to 0.88 and neonatal IRR: 0.62; 95%CrI: 0.44 to 0.88). This was largely driven by reductions in the non-UK born with cases increasing in the UK born
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