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J Infect Dis. 2018 Jul 24;218(5):679-687. doi: 10.1093/infdis/jiy207.

Does BCG Vaccination Protect Against Nontuberculous Mycobacterial Infection? A Systematic Review and Meta-Analysis.

Zimmermann P1,2,3,4, Finn A5,6,7, Curtis N1,2,3.

Author information

1
Department of Paediatrics, The University of Melbourne, Parkville, Australia.
2
Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Australia.
3
Infectious Diseases and Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Australia.
4
Infectious Diseases Unit, University of Basel Children's Hospital, Switzerland.
5
School of Population Health Sciences and School of Cellular and Molecular Medicine, University of Bristol, United Kingdom.
6
Bristol Children's Vaccine Centre, United Kingdom.
7
University Hospitals Bristol National Health Service Foundation Trust, United Kingdom.

Abstract

Background:

The incidence of nontuberculous mycobacterial (NTM) infections is increasing worldwide, particularly NTM lymphadenitis and skin infections (Buruli ulcer). This review summarizes the evidence for the protective effectiveness of BCG vaccination against NTM disease.

Methods:

A systematic search using PRISMA guidelines was done for controlled studies investigating the protective effectiveness of BCG vaccination against NTM disease in immunocompetent individuals. This revealed 10 studies, including almost 12 million participants.

Results:

Three cohort studies in industrialized countries suggest that the incidence of NTM lymphadenitis is greatly reduced among BCG-vaccinated children compared with BCG-unvaccinated children, with a risk ratio (RR) of 0.04 (95% confidence interval [CI], .01-.21). In two randomized trials in low-income countries, BCG protected against Buruli ulcer for the first 12 months following vaccination (RR, 0.50 [95% CI, .37-.69]). Four case-control studies had conflicting results. One cohort study found that individuals with Buruli ulcer are less likely to develop osteomyelitis if they have a BCG scar (RR, 0.36 [95% CI, .22-.58]). No studies have compared different BCG vaccine strains or the effect of revaccination in this setting.

Conclusions:

The protective effect of BCG vaccination against NTM should be taken into consideration when deciding on recommendations for discontinuation of universal BCG vaccination programs and in assessing new vaccines designed to replace BCG.

PMID:
29635431
DOI:
10.1093/infdis/jiy207

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