Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Background Until recently, evidence that protection from the bacillus Calmette–Guérin (BCG) vaccination lasted beyond 10 years was limited. In the past few years, studies in Brazil and the USA (in Native Americans) have suggested that protection from BCG vaccination against tuberculosis (TB) in childhood can last for several decades. The UK’s universal school-age BCG vaccination programme was stopped in 2005 and the programme of selective vaccination of high-risk (usually ethnic minority) infants was enhanced. Objectives To assess the duration of protection of infant and school-age BCG vaccination against TB in the UK. Methods Two case–control studies of the duration of protection of BCG vaccination were conducted, the first on minority ethnic groups who were eligible for infant BCG vaccination 0–19 years earlier and the second on white subjects eligible for school-age BCG vaccination 10–29 years earlier. TB cases were selected from notifications to the UK national Enhanced Tuberculosis Surveillance system from 2003 to 2012. Population-based control subjects, frequency matched for age, were recruited. BCG vaccination status was established from BCG records, scar reading and BCG history. Information on potential confounders was collected using computer-assisted interviews. Vaccine effectiveness was estimated as a function of time since vaccination, using a case–cohort analysis based on Cox regression. Results In the infant BCG study, vaccination status was determined using vaccination records as recall was poor and concordance between records and scar reading was limited. A protective effect was seen up to 10 years following infant vaccination [< 5 years since vaccination: vaccine effectiveness (VE) 66%, 95% confidence interval (CI) 17% to 86%; 5–10 years since vaccination: VE 75%, 95% CI 43% to 89%], but there was weak evidence of an effect 10–15 years after vaccination (VE 36%, 95% CI negative to 77%; p = 0.396). The analyses of the protective effect of infant BCG vaccination were adjusted for confounders, including birth cohort and ethnicity. For school-aged BCG vaccination, VE was 51% (95% CI 21% to 69%) 10–15 years after vaccination and 57% (95% CI 33% to 72%) 15–20 years after vaccination, beyond which time protection appeared to wane. Ascertainment of vaccination status was based on self-reported history and scar reading. Limitations The difficulty in examining vaccination sites in older women in the high-risk minority ethnic study population and the sparsity of vaccine record data in the later time periods precluded robust assessment of protection from infant BCG vaccination > 10 years after vaccination. Conclusions Infant BCG vaccination in a population at high risk for TB was shown to provide protection for at least 10 years, whereas in the white population school-age vaccination was shown to provide protection for at least 20 years. This evidence may inform TB vaccination programmes (e.g. the timing of administration of improved TB vaccines, if they become available) and cost-effectiveness studies. Methods to deal with missing record data in the infant study could be explored, including the use of scar reading. Funding The National Institute for Health Research Health Technology Assessment programme. During the conduct of the study, Jonathan Sterne, Ibrahim Abubakar and Laura C Rodrigues received other funding from NIHR; Ibrahim Abubakar and Laura C Rodrigues have also received funding from the Medical Research Council. Punam Mangtani received funding from the Biotechnology and Biological Sciences Research Council.

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Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.49.1900220 ◽

2019 ◽

Vol 24 (49) ◽

Cited By ~ 1

Author(s):

Sam Abbott ◽

Hannah Christensen ◽

Nicky J. Welton ◽

Ellen Brooks-Pollock

Keyword(s):

High Risk ◽

Labour Force ◽

Demographic Data ◽

Credible Interval ◽

Incidence Rates ◽

School Age Children ◽

School Age ◽

Bcg Vaccination ◽

The Uk ◽

The Impact

Background In 2005 in England, universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates. Aim Estimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England. Methods We 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. 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). 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. Conclusions Withdrawing 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.

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Estimating the effect of the 2005 change in BCG policy in England: A retrospective cohort study

10.1101/567511 ◽

2019 ◽

Author(s):

Sam Abbott ◽

Hannah Christensen ◽

Nicky Welton ◽

Ellen Brooks-Pollock

Keyword(s):

High Risk ◽

Negative Binomial ◽

Labour Force ◽

Incidence Rates ◽

School Age Children ◽

List Type ◽

School Age ◽

Bcg Vaccination ◽

The Uk ◽

The Impact

ABSTRACTBackgroundIn 2005, England changed from universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children to targeted BCG vaccination of high-risk children at birth.MethodsWe combined notification data from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts of individuals in England relevant to both the universal, and targeted vaccination programmes between Jan 1, 2000 and Dec 31, 2010. For each cohort, we estimated incidence rates over a 5 year follow-up period and used Poisson and Negative Binomial regression models in order to estimate the impact of the change in policy on TB.ResultsIn the non-UK born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age IRR: 0.74 (95%CI 0.61, 0.88), neonatal IRR: 0.62 (95%CI 0.44, 0.88)). We found some evidence that the change in BCG policy was associated with a increase in incidence rates in the UK born school-age population (IRR: 1.08 (95%CI 0.97, 1.19)) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96 (95%CI 0.82, 1.14)). Overall, we found that the change in BCG policy was associated with directly preventing 385 (95% CI −105, 881) TB cases.ConclusionsWithdrawing universal vaccination at school-age and targeting BCG vaccination towards high-risk neonates was associated with reduced incidence of TB in England. This was largely driven by reductions in the non-UK born. There was a slight increase in UK born school-age cases.Key MessagesThere is little existing literature on the impact of withdrawing universal school-age BCG vaccination and introducing high-risk neonatal BCG vaccination on TB incidence rates in the populations directly affected by the vaccination programmes.There was strong evidence that the change in policy was associated with a decrease in TB incidence rates in non-UK born neonates and school-age children. In the UK born individuals, there was some evidence that the change in policy was associated with an increase in TB incidence rates in those relevant to the universal school-age scheme, with little evidence of a decrease in incidence rates in those relevant to the high-risk neonatal vaccination scheme.Overall the change in vaccination policy was associated with preventing TB cases, mainly in the non-UK born.These results provide an important evaluation of the direct effects of both withdrawing and implementing a BCG vaccination programme in a low incidence, high income, country and are relevant to several other countries that have made similar changes to their vaccination programmes.

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BCG Vaccination in HIV-Infected Children

Tuberculosis Research and Treatment ◽

10.1155/2011/712736 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

James J. C. Nuttall ◽

Brian S. Eley

Keyword(s):

High Risk ◽

Young Children ◽

Protective Efficacy ◽

Bacillus Calmette Guerin ◽

Paper Briefly ◽

Safety And Efficacy ◽

Bcg Vaccination ◽

Vaccination Strategies ◽

Policy Shifts ◽

Infants And Young Children

Despite the use of Bacillus Calmette-Guérin (BCG) vaccination for many years, infants and young children exposed to adults with infectious forms of tuberculosis (TB) are at high risk of developing complicated TB disease. This risk is much higher among HIV-infected children, and data on BCG protective efficacy in HIV-infected children is lacking. Recent research on BCG safety in HIV-infected infants has resulted in policy shifts, but implementation is challenging. New approaches to preventing TB among infants and children, particularly HIV-infected infants, are needed. This paper briefly reviews BCG safety and efficacy considerations in HIV-infected infants and discusses other approaches to preventing TB, including new TB vaccines and vaccination strategies.

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BCG Vaccination Status, Age, and Gender as Risk Factors for Leprosy in Endemic Areas in the Brazilian Amazon

Infectious Disease Reports ◽

10.3390/idr12030019 ◽

2020 ◽

Vol 12 (3) ◽

pp. 97-104

Author(s):

Luana Nepomuceno Gondim Costa Lima ◽

Jasna Letícia Pinto Paz ◽

Maria do Perpétuo Socorro Corrêa Amador Silvestre ◽

Letícia Siqueira Moura ◽

Ismari Perini Furlaneto ◽

...

Keyword(s):

Vaccination Status ◽

World Health ◽

Age Group ◽

Bacillus Calmette Guerin ◽

Age And Gender ◽

Bcg Vaccination ◽

Northern Brazil ◽

Per Se ◽

And Gender ◽

Health Organization

In 2018, 208,619 new cases of leprosy were reported to the World Health Organization (WHO). Of these, 30,957 occurred in the Americas region and 28,660 (92.6% of the total in the Americas) were reported in Brazil. This study aimed to show the reality of the profile of a population in an endemic leprosy area in northern Brazil in relation to age, gender, and bacillus Calmette–Guérin (BCG) vaccination status through the collection of data in the field with the evaluation of the study individuals, who were recruited by spontaneous demand. A total of 405 individuals participated in the study, with 100 multibacillary, 57 paucibacillary, and 248 healthy contacts. A relationship was observed between the occurrence of the disease, as well as the multibacillary form with the largest age group. The male gender was associated with leprosy per se, with the multibacillary form and was the largest representative of the group that was not vaccinated once. BCG vaccination was effective both in protecting against leprosy per se and in the multibacillary form. These results are limited by sample size, may not be conclusive, and will need further confirmation in a larger cohort.

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Does Latent Tuberculosis Lead to a Spurious Correlation between BCG and COVID-19 Mortality?

10.21203/rs.3.rs-1138086/v1 ◽

2021 ◽

Author(s):

Tareef Fadhil Raham

Keyword(s):

Roc Analysis ◽

Latent Tuberculosis ◽

Vaccination Status ◽

Mortality Data ◽

Bacillus Calmette Guerin ◽

Confounding Effect ◽

Bcg Vaccination ◽

Spurious Correlation ◽

The Relationship ◽

Stem Leaf

Abstract Background: Many factors have been suggested to confound coronavirus disease 2019 (COVID-19) studies, and BCG studies have been criticized for not adjusting for many confounders. We conducted this study to analyze the presumed effectiveness of the Bacillus Calmette–Guérin (BCG) vaccine in decreasing the COVID-19 mortality rate, and to answer the question of whether this is confounded by latent tuberculosis (LTB) prevalence.Materials and methods: We chose sixty-nine malaria-free countries with different BCG vaccination policies. TB prevalence was considered as a proxy for LTB. The BCG, TB prevalence, and COVID-19 mortality data are publically available. Contingency coefficients (C.C.) and a ROC analysis were used to assess the relationship between TB prevalence and BCG status, and identify cutoff points in each BCG group category. A stem–leaf plot was also used to explore the data’s apparent behavior concerning COVID-19 in relation to the BCG groups.Results: TB prevalence was significantly associated with BCG status. The BCG vaccination status apparently had a relationship with BCG status.Conclusions: TB is suggested to have a confounding effect on BCG results, leading to a spurious correlation between BCG and COVID-19 mortality.

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Reassessing the Evidence for Universal School-age Bacillus Calmette Guerin (BCG) Vaccination in England and Wales

10.1101/624916 ◽

2019 ◽

Author(s):

Sam Abbott ◽

Hannah Christensen ◽

Ellen Brooks-Pollock

Keyword(s):

Parameter Uncertainty ◽

Incidence Rates ◽

School Age Children ◽

List Type ◽

School Age ◽

Bacillus Calmette Guerin ◽

England And Wales ◽

Bcg Vaccination ◽

Notification Data ◽

The Impact

AbstractBackgroundIn 2005, England and Wales switched from universal BCG vaccination against tuberculosis (TB) disease for school-age children to targeted vaccination of neonates. We assessed the quantitative evidence that informed this policy change.MethodsWe recreated a previous approach for estimating the impact of ending the BCG schools’ scheme in England and Wales, updating the model with parameter uncertainty. We investigated scenarios considered by the UK’s Joint Committee on Vaccination and Immunisation, and explored new approaches using notification data. We estimated the number of vaccines needed to prevent a single notification, and the average annual additional notifications caused by ending the BCG schools’ scheme.ResultsWe found a 1.9% annual decrease in TB incidence rates best matched notification data. We estimate that 1600 (2.5-97.5% Quantiles (Q): 1300 - 2100) vaccines would have been required to prevent a single notification in 2004. If the scheme had ended in 2001, 302 (2.5-97.5% Q: 238 - 369) additional annual notifications would have occurred compared to if the scheme had continued. If the scheme ended in 2016, 120 (2.5-97.5% Q: 88 - 155) additional annual notifications would have occurred.ConclusionsOur estimates of the impact of ending the BCG schools’ scheme were highly sensitive to the annual decrease in incidence rates. The impact of ending the BCG schools’ scheme was found to be greater than previously thought when parameter values were updated and notification data were used. Our results highlight the importance of including uncertainty when forecasting the impact of changes in vaccination policy.What is already known on this subjectTargeted Bacillus Calmette Guerin (BCG) vaccination against TB is recommended in low incidence countries over universal vaccination.The impact of replacing universal BCG vaccination in England and Wales with a targeted programme in 2005 was assessed under the assumption of static declines in TB rates.The BCG Guerin vaccine was shown to be effective in the UK born in England, regardless of the age at which it was given. School-age vaccination maybe more beneficial in this population than in other settings.What this study addsUsing notification data from England and Wales from 1973 to 2015, we estimate that the ending the BCG schools’ scheme likely resulted in more additional cases than was predicted.The inclusion of parameter uncertainty, and measurement error, allowed the uncertainty in the final estimates to be presented. Previously published estimates may have been spuriously precise.This study highlights the need for a more detailed evaluation of the 2005 change in BCG policy. In particular, the impact of including the introduction of targeted neonatal vaccination and capturing the long term, indirect, effects needs further study.

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Self-reported Occupational Risk for COVID-19 in Hospital Doctors from Black Asian & Minority Ethnic Communities in UK

The Physician ◽

10.38192/1.6.1.9 ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Sunil Daga ◽

Indranil Chakravorty ◽

JS Bamrah ◽

Geeta Menon ◽

Subodh Dave ◽

...

Keyword(s):

High Risk ◽

Healthcare Workers ◽

Demographic Variables ◽

Occupational Risk ◽

Institutional Factors ◽

Ethnic Communities ◽

Increased Risk ◽

Hospital Doctors ◽

The Uk ◽

Minority Ethnic

Emerging data from COVID-19 pandemic shows a trend for increased risk for healthcare workers in the UK, compared to other countries. In addition, there is a disproportionately high risk observed in healthcare workers from Black, Asian & Minority Ethnic backgrounds. This high risk is independent of biological or demographic variables. This paper presents sub-analysis of a larger survey of healthcare workers, particularly describing possible occupational risk of COVID-19 in a subset of doctors in UK hospitals from a BAME background. The results show higher rates of inability to access personal protection or comply with social distancing. The inability to self-isolate was associated with a 1.7x higher risk of COVID-19. The results of this survey suggest further research is needed to explore and understand institutional factors that may explain excess risks to BAME hospital doctors.

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Ethnic Differences in Self-Poisoning Across South London

Crisis ◽

10.1027/0227-5910/a000258 ◽

2014 ◽

Vol 35 (4) ◽

pp. 268-272

Author(s):

Sean Cross ◽

Dinesh Bhugra ◽

Paul I. Dargan ◽

David M. Wood ◽

Shaun L. Greene ◽

...

Keyword(s):

Black Women ◽

Data Collection ◽

White Women ◽

Population Based ◽

Care Services ◽

Self Harm ◽

Managing Risk ◽

The Uk ◽

Incident Cases ◽

Minority Ethnic

Background: Self-poisoning (overdose) is the commonest form of self-harm cases presenting to acute secondary care services in the UK, where there has been limited investigation of self-harm in black and minority ethnic communities. London has the UK’s most ethnically diverse areas but presents challenges in resident-based data collection due to the large number of hospitals. Aims: To investigate the rates and characteristics of self-poisoning presentations in two central London boroughs. Method: All incident cases of self-poisoning presentations of residents of Lambeth and Southwark were identified over a 12-month period through comprehensive acute and mental health trust data collection systems at multiple hospitals. Analysis was done using STATA 12.1. Results: A rate of 121.4/100,000 was recorded across a population of more than half a million residents. Women exceeded men in all measured ethnic groups. Black women presented 1.5 times more than white women. Gender ratios within ethnicities were marked. Among those aged younger than 24 years, black women were almost 7 times more likely to present than black men were. Conclusion: Self-poisoning is the commonest form of self-harm presentation to UK hospitals but population-based rates are rare. These results have implications for formulating and managing risk in clinical services for both minority ethnic women and men.

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Archives of the Dance (21): Siobhan Davies Dance Online

Dance Research ◽

10.3366/e0264287508000212 ◽

2008 ◽

Vol 26 (2) ◽

pp. 244-257 ◽

Cited By ~ 3

Author(s):

SARAH WHATLEY

Keyword(s):

Research Council ◽

Research Community ◽

Limited Resources ◽

Digital Archive ◽

Arts And Humanities ◽

The Uk

In 2006, an Arts and Humanities Research Council (AHRC) grant was awarded to researchers at Coventry University to create a digital archive of the work of Siobhan Davies Dance. The award is significant in acknowledging the limited resources readily available to dance scholars as well as to dance audiences in general. The archive, Siobhan Davies Dance Online, 1 will be the first digital dance archive in the UK. Mid-way through the project, Sarah Whatley, who is leading the project, reflects on some of the challenges in bringing together the collection, the range of materials that is going to be available within the archive and what benefits the archive should bring to the research community, the company itself and to dance in general.

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