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Epidemiology. 2009 Jul;20(4):562-8. doi: 10.1097/EDE.0b013e31819e3c1a.

Targeted BCG vaccination against severe tuberculosis in low-prevalence settings: epidemiologic and economic assessment.

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1
Department of Infectious Diseases Epidemiology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. hester.korthals.altes@rivm.nl

Abstract

BACKGROUND:

BCG vaccine protects against the severe forms of tuberculosis (TB) in children. Several low-prevalence countries are reviewing their policy, usually shifting from universal vaccination to vaccination of infants in high-risk groups only. We combined an epidemiologic analysis with a cost-effectiveness analysis to evaluate the cost-effectiveness of targeted strategies.

METHODS:

We fitted a static model to the data to estimate vaccine efficacy and risk of disease. We applied our method to the Dutch situation, analyzing severe TB cases in high-risk group children age 0-5, between 1996 and 2003. We considered the current strategy targeting immigrant children from high-incidence countries, and a proposed strategy additionally targeting children from 3 lower-incidence, but higher-immigration, countries.

RESULTS:

In the absence of vaccination, the annual risk of developing severe TB for a child in the current target group is 3/100,000, while BCG vaccination reduces this risk by 73%. Therefore about 9000 children would need to be vaccinated to prevent 1 case. Vaccinating children from high-incidence countries would then cost about Euro 4,500 per discounted disability-adjusted life year averted. In the extended target group, the risk of disease is somewhat lower with a similar vaccine effectiveness, so costs are raised.

CONCLUSIONS:

The current Dutch BCG strategy, as well as the proposed inclusion of immigrant children from Turkey, Surinam and former Yugoslavia, is on average cost-effective. However, the low number of both vaccinated and unvaccinated severe TB cases leads to broad confidence intervals on vaccine efficacy, highlighting the difficulty associated with decision-making in low-prevalence settings.

PMID:
19295437
DOI:
10.1097/EDE.0b013e31819e3c1a
[Indexed for MEDLINE]
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