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Can J Public Health. 2004 Jul-Aug;95(4):249-55.

Pediatric tuberculosis in Alberta First Nations (1991-2000): outbreaks and the protective effect of bacille Calmette-Guérin (BCG) vaccine.

Author information

1
Department of Medicine, University of Alberta, Edmonton, AB. richard.long@ualberta.ca

Abstract

BACKGROUND:

The tuberculosis control strategy of vaccinating First Nations newborns with BCG (bacille Calmette-Guerin) is currently undergoing re-evaluation in Canada. Review of recent pediatric tuberculosis morbidity could inform this re-evaluation.

METHODS:

Potential source cases and pediatric cases of tuberculosis from Alberta First Nations were identified over the 10 years 1991-2000. The distribution of pediatric disease was described. The effect of BCG on tuberculosis morbidity in two large outbreaks was determined.

RESULTS:

A total of 57 potential source cases and 41 pediatric cases of tuberculosis were reported from 17 (41.5%) and 8 (19.5%) of the 41 on-reserve First Nation Community Health Centres, respectively. Three outbreaks traceable to three source cases accounted for 34 (18, 3, and 13, respectively) of the 41 (82.9%) pediatric cases. Each outbreak was spatially and temporally separate from the other. Each outbreak strain of Mycobacterium tuberculosis had a unique DNA fingerprint. In the largest outbreaks, disease-to-infection ratios (secondary case rates) were higher in newly infected unvaccinated versus vaccinated close pediatric contacts (12/13 [92.3%] versus 7/15 [46.7%], p=0.02), but the infection rate was almost certainly falsely high in the BCG vaccinated. One unvaccinated child had a brain tuberculoma in addition to primary pulmonary tuberculosis.

CONCLUSION:

For most Alberta First Nations communities, the spatial and temporal distribution of disease, and the meager impact on morbidity, challenge the rationale for continued use of BCG.

PMID:
15362464
[Indexed for MEDLINE]

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