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Exploring the effects of BCG vaccination in patients diagnosed with tuberculosis: Observational study using the Enhanced Tuberculosis Surveillance system

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)5067-5072
Number of pages6
JournalVaccine
Volume37
Issue number35
Early online date8 Jul 2019
DOIs
DateAccepted/In press - 18 Jun 2019
DateE-pub ahead of print - 8 Jul 2019
DatePublished (current) - 14 Aug 2019

Abstract

Background
Bacillus Calmette–Guérin (BCG) is one of the most widely-used vaccines worldwide. BCG primarily reduces the progression from infection to disease, however there is evidence that BCG may provide additional benefits. We aimed to investigate whether there is evidence in routinely-collected surveillance data that BCG vaccination impacts outcomes for tuberculosis (TB) cases in England.

Methods
We obtained all TB notifications for 2009–2015 in England from the Enhanced Tuberculosis surveillance system. We considered five outcomes: All-cause mortality, death due to TB (in those who died), recurrent TB, pulmonary disease, and sputum smear status. We used logistic regression, with complete case analysis, to investigate each outcome with BCG vaccination, years since vaccination and age at vaccination, adjusting for potential confounders. All analyses were repeated using multiply imputed data.

Results
We found evidence of an association between BCG vaccination and reduced all-cause mortality (aOR:0.76 (95%CI 0.64–0.89), P:0.001) and weak evidence of an association with reduced recurrent TB (aOR:0.90 (95%CI 0.81–1.00), P:0.056). Analyses using multiple imputation suggested that the benefits of vaccination for all-cause mortality were reduced after 10 years.

Conclusions
We found that BCG vaccination was associated with reduced all-cause mortality in people with TB although this benefit was less pronounced more than 10 years after vaccination. There was weak evidence of an association with reduced recurrent TB.

    Research areas

  • BCG, Mortality, Non-specific, Surveillance, Tuberculosis

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  • Full-text PDF (accepted author manuscript)

    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://www.sciencedirect.com/science/article/pii/S0264410X19308187?via%3Dihub. Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 408 KB, PDF document

    Embargo ends: 8/07/20

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    Licence: CC BY-NC-ND

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