scholarly journals Epidemiology of childhood tuberculosis after ceasing universal Bacillus Calmette–Guérin vaccination

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sayori Kobayashi ◽  
Takashi Yoshiyama ◽  
Kazuhiro Uchimura ◽  
Yuko Hamaguchi ◽  
Seiya Kato
Keyword(s):  
Policy Change ◽  
Vaccine Coverage ◽  
Lessons Learned ◽  
Public Health Authority ◽  
Bacillus Calmette Guerin ◽  
Notification Rate ◽  
Bcg Vaccination ◽  
The Past ◽  
Childhood Tb ◽  
Selective Vaccination

AbstractUniversal Bacillus Calmette–Guérin (BCG) vaccination is recommended in countries with high tuberculosis (TB) burden. Nevertheless, several countries have ceased universal BCG vaccination over the past 40 years, with scarce comparative epidemiological analyses regarding childhood TB after the policy change. We analysed data on childhood TB in countries that ceased universal BCG vaccination. Data sources included national/international databases, published papers, annual TB reports, and public health authority websites. Childhood TB notification rate increased in one of seven countries with available data. Pulmonary TB and TB lymphadenitis were the main causes of increasing childhood cases, while changes in severe forms of TB cases were minor. Maintaining high vaccine coverage for the target group was a common challenge after shifting selective vaccination. In some countries showing no increase in childhood TB after a BCG policy change, the majority of childhood TB cases were patients from abroad or those with overseas parents; these countries had changed immigration policies during the same period. Heterogeneity in childhood TB epidemiology was observed after ceasing universal BCG vaccination; several factors might obscure the influence of vaccination policy change. Lessons learned from these countries may aid in the development of better BCG vaccination strategies.

scholarly journals BCG Vaccination and Mortality of COVID-19 across 173 Countries: An Ecological Study

2020 ◽  
Vol 17 (15) ◽  
pp. 5589 ◽  
Author(s):  
Mitsuyoshi Urashima ◽  
Katharina Otani ◽  
Yasutaka Hasegawa ◽  
Taisuke Akutsu
Keyword(s):  
Urban Population ◽  
Ecological Study ◽  
Randomized Clinical Trials ◽  
Vaccine Coverage ◽  
Bcg Vaccine ◽  
Bacillus Calmette Guerin ◽  
Ecological Studies ◽  
Bcg Vaccination ◽  
Insufficient Physical Activity ◽  
Pcr Test

Ecological studies have suggested fewer COVID-19 morbidities and mortalities in Bacillus Calmette–Guérin (BCG)-vaccinated countries than BCG-non-vaccinated countries. However, these studies obtained data during the early phase of the pandemic and did not adjust for potential confounders, including PCR-test numbers per population (PCR-tests). Currently—more than four months after declaration of the pandemic—the BCG-hypothesis needs reexamining. An ecological study was conducted by obtaining data of 61 factors in 173 countries, including BCG vaccine coverage (%), using morbidity and mortality as outcomes, obtained from open resources. ‘Urban population (%)’ and ‘insufficient physical activity (%)’ in each country was positively associated with morbidity, but not mortality, after adjustment for PCR-tests. On the other hand, recent BCG vaccine coverage (%) was negatively associated with mortality, but not morbidity, even with adjustment for percentage of the population ≥ 60 years of age, morbidity, PCR-tests and other factors. The results of this study generated a hypothesis that a national BCG vaccination program seems to be associated with reduced mortality of COVID-19, although this needs to be further examined and proved by randomized clinical trials.

VP48 The Costs And Cost-Effectiveness Of Bacillus Calmette-Guérin (BCG) Vaccination In Estonia

2017 ◽  
Vol 33 (S1) ◽  
pp. 169-170
Author(s):  
Triin Võrno ◽  
Rainer Reile ◽  
Margit Närska ◽  
Lea Pehme
Keyword(s):  
Cost Effectiveness ◽  
Budget Impact ◽  
Vaccination Strategy ◽  
Universal Vaccination ◽  
Bacillus Calmette Guerin ◽  
Bcg Vaccination ◽  
Vaccination Strategies ◽  
Tb Treatment ◽  
The Cost ◽  
Selective Vaccination

INTRODUCTION:Many countries that have used Bacillus Calmette-Guérin (BCG) vaccine against tuberculosis (TB) have switched from universal vaccination of infants and children to selective vaccination, or discontinued with vaccination at all. The aim of the study is to assess the costs and cost-effectiveness of BCG vaccination in Estonia.METHODS:A Markov cohort model and budget impact analysis were used to compare the current, universal BCG vaccination to selective and non-vaccination strategies. The epidemiological and economic impact of BCG vaccination were estimated for the period 2018–2032 following the hypothetical change in the vaccination policy in 2018. The results were presented as the cost per case of TB adverted, changes in the occurrence of TB and yearly (undiscounted) costs associated with vaccination and TB treatment.RESULTS:In a cohort of 13,500 infants over a time-period of 15 years Estonian universal BCG vaccination prevents around two TB cases compared to selective or non-vaccination strategies. The cost per one TB case averted for the universal strategy compared to non-vaccination strategy was EUR12,234 (EUR4,059–28,748 in sensitivity analysis) and compared to selective vaccination EUR3,847 (EUR504–10,568). The number of TB cases in 0–14-year old children in 2032 was estimated to be 1.3 for universal vaccination, 2.7 for selective and 2.9 for non-vaccination strategy. The total costs of vaccination and TB treatment in 2032 were estimated to be EUR23,764, EUR16,459 and EUR7,553 respectively.CONCLUSIONS:The cost per case of TB averted is dependent on vaccine efficacy, and is high compared with the cost of treating one case of TB. At the same time, the total costs of BCG vaccination and TB treatment are marginal compared to other vaccination programs used in Estonia. Despite the limited budget impact, several organizational challenges need to be addressed if the universal program is replaced with selective BCG vaccination.

scholarly journals Exercising caution in correlating COVID-19 incidence and mortality rates with BCG vaccination policies due to variable rates of SARS CoV-2 testing

2020 ◽  
Author(s):  
Janine Hensel ◽  
Kathleen M. McAndrews ◽  
Daniel J. McGrail ◽  
Dara P. Dowlatshahi ◽  
Valerie S. LeBleu ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Bcg Vaccine ◽  
The Novel ◽  
Bacillus Calmette Guerin ◽  
Vaccination Policy ◽  
Bcg Vaccination ◽  
The Past ◽  
Incidence And Mortality ◽  
Novel Coronavirus ◽  
A Current

ABSTRACTThe Bacillus Calmette-Guerin (BCG) vaccine provides protection against tuberculosis (TB), and is proposed to provide protection to non-TB infectious diseases. The COVID-19 outbreak results from infection with the novel coronavirus SARS-CoV-2 (CoV-2) and was declared a pandemic on March 11th, 2020. We queried whether the BCG vaccine offers protection against CoV-2 infection. We observed that countries with a current universal BCG vaccination policy have a significantly lower COVID-19 incidence than countries which never had a universal BCG policy or had one in the past. However, population density, median age, TB incidence, urban population, and, most significantly, CoV-2 testing rate, were also connected with BCG policy and could potentially confound the analysis. By limiting the analysis to countries with high CoV-2 testing rates, defined as greater than 2,500 tests per million inhabitants, these parameters were no longer statistically associated with BCG policy. When analyzing only countries with high testing rates, there was no longer a significant association between the number of COVID-19 cases per million inhabitants and the BCG vaccination policy. Although preliminary, our analyses indicate that the BCG vaccination may not offer protection against CoV-2 infection. While reporting biases may confound our observations, our findings support exercising caution in determining potential correlation between BCG vaccination and COVID-19 incidence, in part due significantly lower rates of CoV-2 testing per million inhabitants in countries with current universal BCG vaccination policy.

scholarly journals A Note on the Potential BCG Vaccination – COVID-19 Molecular Link

Coronaviruses ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 4-6 ◽  
Author(s):  
Alex Y. Strongin ◽  
Alex Sloutsky ◽  
Piotr Cieplak
Keyword(s):  
B Cells ◽  
Mycobacterium Bovis ◽  
Sequence Homology ◽  
Experimental Studies ◽  
Memory B Cells ◽  
Bacillus Calmette Guerin ◽  
Bcg Vaccination ◽  
The Past ◽  
Specific Memory

Objective: Our goal was to elucidate a potential molecular link between the past and current tuberculosis vaccine Bacillus Calmette-Guérin (BCG; a live attenuated strain of Mycobacterium bovis) immunization policies and COVID-19. Methods: Our sequence homology analyses have demonstrated that there is an intriguing level of sequence homology between a few of the BCG and Sars-CoV-2 proteins. Results: The data suggest that the BCG-specific memory B-cells that are preserved in BCG-vaccinated patients cross-recognize SARS-CoV-2 and that this cross-recognition may affect the virus proliferation and COVID-19 severity. Conclusion: Our results can stimulate the sharply focused follow-up experimental studies.

scholarly journals COVID-19 Infection and Previous BCG Vaccination Coverage in the Ecuadorian Population

Vaccines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 91
Author(s):  
Daniel Garzon-Chavez ◽  
Jackson Rivas-Condo ◽  
Adriana Echeverria ◽  
Jhoanna Mozo ◽  
Emmanuelle Quentin ◽  
...  
Keyword(s):  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
National Level ◽  
Kendall Test ◽  
Amino Acid Sequences ◽  
Bcg Vaccination ◽  
High Prevalence ◽  
Health Organization ◽  
Low Coverage ◽  
Homologous Amino Acid

The Bacillus Calmette–Guérin (BCG) is a well-known vaccine with almost a century of use, with the apparent capability to improve cytokine production and epigenetics changes that could develop a better response to pathogens. It has been postulated that BCG protection against SARS-CoV-2 has a potential role in the pandemic, through the presence of homologous amino acid sequences. To identify a possible link between BCG vaccination coverage and COVID-19 cases, we used official epidemic data and Ecuadorian Ministry of Health and Pan American Health Organization vaccination information. BCG information before 1979 was available only at a national level. Therefore, projections based on the last 20 years were performed, to compare by specific geographic units. We used a Mann–Kendall test to identify BCG coverage variations, and mapping was conducted with a free geographic information system (QGIS). Nine provinces where BCG vaccine coverage was lower than 74.25% show a significant statistical association (χ2 Pearson’s = 4.800, df = 1, p = 0.028), with a higher prevalence of cases for people aged 50 to 64 years than in younger people aged 20 to 49 years. Despite the availability of BCG vaccination data and the mathematical models needed to compare these data with COVID-19 cases, our results show that, in geographic areas where BCG coverage was low, 50% presented a high prevalence of COVID-19 cases that were young; thus, low-coverage years were more affected.

scholarly journals Times of change in complex environments - Evaluating hospital co-payments in Palestine refugee camps

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S V Valente de Almeida ◽  
H Ghattas ◽  
G Paolucci ◽  
A Seita
Keyword(s):  
Length Of Stay ◽  
Policy Change ◽  
Negative Binomial ◽  
Negative Impact ◽  
Average Length ◽  
Lessons Learned ◽  
Policy Impact ◽  
Average Length Of Stay ◽  
Ex Post ◽  
The Impact

Abstract We measure the impact introducing a of 10% co-payment component on hospitalisation costs for Palestine refugees from Lebanon in public and private hospitals. This ex-post analysis provides a detailed insight on the direction and magnitude of the policy impact in terms of demand and supply for healthcare. The data was collected by the United Nations Relief and Works Agency for Palestine Refugees in the Near East and include episode level information from all public, private and Red Crescent Hospitals in Lebanon, between April 2016 and October 2017. This is a complete population episode level dataset with information from before and after the policy change. We use multinomial logit, negative binomial and linear models to estimate the policy impact on demand by type of hospital, average length of stay and treatment costs for the patient and the provider. After the new policy was implemented patients were 18% more likely to choose a (free-of-charge) PRCS hospital for secondary care, instead of a Private or Public hospital, where the co-payment was introduced. This impact was stronger for episodes with longer stays, which are also the more severe and more expensive cases. Average length of stay decreased in general for all hospitals and we could not find a statistically significant impact on costs for the provider nor the patient. We find evidence that the introduction of co-payments is hospital costs led to a shift in demand, but it is not clear to what extent the hospitals receiving this demand shift were prepared for having more patients than before, also because these are typically of less quality then the others. Regarding costs, there is no evidence that the provider managed to contain costs with the new policy, as the demand adapted to the changes. Our findings provide important information on hospitalisation expenses and the consequences of a policy change from a lessons learned perspective that should be taken into account for future policy decision making. Key messages We show that in a context of poverty, the introduction of payment for specific hospital types can be efficient for shifting demand, but has doubtable impact on costs containment for the provider. The co-payment policy can have a negative impact on patients' health since after its implementation demand increased at free-of-charge hospitals, which typically have less resources to treat patients.

Present Bias: Lessons Learned and To Be Learned

2015 ◽  
Vol 105 (5) ◽  
pp. 273-279 ◽  
Author(s):  
Ted O'Donoghue ◽  
Matthew Rabin
Keyword(s):  
Lessons Learned ◽  
Theoretical Understanding ◽  
Present Bias ◽  
The Past ◽  
Empirical Analyses

While present bias is an old idea, it only took hold in economics following David Laibson's (1994) dissertation. Over the past 20 years, research has led to a much better theoretical understanding of present bias, when and how to apply it, and which ancillary assumptions are appropriate in different contexts. Empirical analyses have demonstrated how present bias can improve our understanding of behavior in various economic field contexts. Nonetheless, there is still much to learn. In this paper, we give our assessment of some lessons learned, and to be learned.

Lessons learned from the past on mental health care of refugee children in Serbia

2016 ◽  
Vol 25 (6) ◽  
pp. 669-672 ◽  
Author(s):  
Milica Pejovic Milovancevic ◽  
Veronika Ispanovic ◽  
Dusko Stupar
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Lessons Learned ◽  
Refugee Children ◽  
The Past

Transportation Fuel Resiliency: Case Study of Tampa Bay

2021 ◽  
pp. 036119812110416
Author(s):  
Alexander Kolpakov ◽  
Austin Marie Sipiora ◽  
Caley Johnson ◽  
Erin Nobler
Keyword(s):  
Alternative Fuels ◽  
The United States ◽  
Tampa Bay ◽  
Lessons Learned ◽  
Transportation Fuel ◽  
Fuel Supply ◽  
Preparedness Planning ◽  
The Past ◽  
Hurricane Irma

This case study presents findings from an analysis of the emergency preparation and response for Hurricane Irma, the most recent hurricane impacting the Tampa Bay region. The Tampa Bay region, in particular, is considered one of the most vulnerable areas in the United States to hurricanes and severe tropical weather. A particular vulnerability stems from how all petroleum fuel comes to the area by marine transport through Port Tampa Bay, which can be (and has been in the past) impacted by hurricanes and tropical storms. The case study discussed in this paper covers previous fuel challenges, vulnerabilities, and lessons learned by key Tampa Bay public agency fleets during the past 10 years (mainly as a result of the most recent 2017 Hurricane Irma) to explore ways to improve the area’s resilience to natural disasters. Some of the strategies for fuel-supply resiliency include maintaining emergency fuel supply, prioritizing fuel use, strategically placing the assets around the region to help with recovery, investing in backup generators (including generators powered by alternative fuels), planning for redundancies in fuel supply networks, developing more efficient communication procedures between public fleets, hurricane preparedness-planning, and upgrading street drainage systems to reduce the threat of local flooding.

115 An Audit on Dexamethasone Prescribing Practice on Surgically Managed Metastatic Spinal Cord Compression Patients in the Manchester Centre for Clinical Neurosciences: Lessons Learned in Closing the Loop

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Laurente ◽  
R Mohammed ◽  
M Elmalky
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Lessons Learned ◽  
Metastatic Spinal Cord Compression ◽  
Loading Dose ◽  
The Past ◽  
Prescribing Practice ◽  
Closing The Loop ◽  
Almost All

Abstract Metastatic Spinal Cord Compression is a surgical emergency owing to its propensity to cause significant morbidity and mortality. Dexamethasone is prescribed to reduce oedema and promote vascular membrane stabilization. The is done so until a more definitive management has been performed. This is a retrospective study evaluating the steroid-prescribing practice for MSCC patients in 2018 at a tertiary spinal unit in Greater Manchester. Thirty-three patients who underwent stabilisation were evaluated in terms of both steroid prescribing and weaning practices. Standards used against for both were the NICE guidelines and the Edinburgh/Christie’s guidelines. Of the 33 patients evaluated, only 1 patient received the correct loading dose of 16mg, whilst 27 went straight to being given 8mg BD. 5 did not receive dexamethasone at all. In terms of discontinuation/weaning, 26 were weaned accordingly and 2 were not weaned to continue as adjuvant treatment. Dexamethasone prescribing practises has since improved over the past two years. 93% of the patients have been correctly weaned as compared to 38% in the past. In terms of prescription, much needs to be done as almost all the patients evaluated did not get the correct loading dose despite receiving the appropriate maintenance.

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