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BMJ. 2014 Aug 5;349:g4643. doi: 10.1136/bmj.g4643.

Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis.

Author information

  • 1Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, UK.
  • 2Luton and Dunstable University Hospital, NHS Foundation Trust, Luton, UK.
  • 3London School of Hygiene and Tropical Medicine, London, UK.
  • 4Tuberculosis Research Centre, Respiratory Infections Section, National Heart and Lung Institute, Imperial College London, London, UK.
  • 5Medical Research Council, Fajara, Gambia.
  • 6Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, UK Centre for Infectious Disease Epidemiology and MRC Clinical Trials Unit, University College London, London, UK i.abubakar@ucl.ac.uk.

Abstract

OBJECTIVES:

To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children.

DESIGN:

Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts.

SETTING:

Community congregate settings and households.

INCLUSION CRITERIA:

Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays.

DATA EXTRACTION:

Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis.

RESULTS:

The primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77).

CONCLUSIONS:

BCG protects against M tuberculosis infection as well as progression from infection to disease.Trial registration PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/).

© Roy et al 2014.

PMID:
25097193
[PubMed - indexed for MEDLINE]
PMCID:
PMC4122754
Free PMC Article
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