BCG Vaccination and Tuberculosis in Students of Nursing

Rosenthal, Sol Roy; Afremow, M L; Nikurs, Lydia; Loewinsohn, Erhard; Leppmann, Marianne; Katele, Elvyza; Liveright, Dorothy; Thorne, Margaret G.

doi:10.1097/00000446-196306000-00047

Cited by 4 publications

(4 citation statements)

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“…These articles reported data on 21 randomised or quasirandomised trials (supplementary figure 1), of which 18 reported on pulmonary tuberculosis, and six on meningeal and/or miliary tuberculosis outcomes. Ten trials were conducted in the USA between 1933 and 1950 [16][17][18][19][20][21][22][23][24][25]; four in India between 1950 and 1988 [26][27][28][29]; one each in Canada (started in 1933) [30], the UK (1950)[31], South Africa (1965) [32] and Haiti (1965) [33] (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Protection by BCG Vaccine Against Tuberculosis: A Systematic Review of Randomized Controlled Trials

Mangtani

Abubakar

Ariti

et al. 2013

Clinical Infectious Diseases

794

660

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Section: Resultsmentioning

confidence: 99%

Protection by BCG Vaccine Against Tuberculosis: A Systematic Review of Randomized Controlled Trials

Mangtani

Abubakar

Ariti

et al. 2013

Clinical Infectious Diseases

794

660

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“…Madanapalle panel presents results for bacteriologically-confirmed cases only. First panel data obtained from table IV of Ferguson 1949, 20 second panel data obtained from figure 1 of Rosenthal 1961, 23 third panel data obtained from table 3 of MRC 1972, 54 , fourth panel data obtained from table 3 of Rosenthal 1963, 37 fifth panel data obtained from tables 1 and 2 of Bettag 1964, 40 sixth panel data obtained from table 5 of Frimodt-Moller 1973, 9 seventh panel presents previously unpublished data. TB, tuberculosis.…”

Section: Methodsmentioning

confidence: 98%

Timing ofMycobacterium tuberculosisexposure explains variation in BCG effectiveness: a systematic review and meta-analysis

Trauer

Kawai

Coussens

et al. 2021

Thorax

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RationaleThe heterogeneity in efficacy observed in studies of BCG vaccination is not fully explained by currently accepted hypotheses, such as latitudinal gradient in non-tuberculous mycobacteria exposure.MethodsWe updated previous systematic reviews of the effectiveness of BCG vaccination to 31 December 2020. We employed an identical search strategy and inclusion/exclusion criteria to these earlier reviews, but reclassified several studies, developed an alternative classification system and considered study demography, diagnostic approach and tuberculosis (TB)-related epidemiological context.Main resultsOf 21 included trials, those recruiting neonates and children aged under 5 were consistent in demonstrating considerable protection against TB for several years. Trials in high-burden settings with shorter follow-up also showed considerable protection, as did most trials in settings of declining burden with longer follow-up. However, the few trials performed in high-burden settings with longer follow-up showed no protection, sometimes with higher case rates in the vaccinated than the controls in the later follow-up period.ConclusionsThe most plausible explanatory hypothesis for these results is that BCG protects against TB that results from exposure shortly after vaccination. However, we found no evidence of protection when exposure occurs later from vaccination, which would be of greater importance in trials in high-burden settings with longer follow-up. In settings of declining burden, most exposure occurs shortly following vaccination and the sustained protection observed for many years thereafter represents continued protection against this early exposure. By contrast, in settings of continued intense transmission, initial protection subsequently declines with repeated exposure to Mycobacterium tuberculosis or other pathogens.

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“…Two reports from Chicago describe BCG vaccination trials in students of nursing and medicine followed for the duration of their studies. Both were small and excluded from previous reviews for methodological limitations, with only eleven cases occurring across both trials (4, 35, 36). The trial in South African mine workers was also excluded from past reviews for including some participants who were TST-positive at baseline (6), but found fewer cases in the vaccinated over 3.6 years of follow-up (37).…”

Section: Resultsmentioning

confidence: 99%

Timing ofM. tuberculosisexposure explains variation in BCG effectiveness: A systematic review and meta-analysis

Trauer

Kawai

Coussens

et al. 2020

Preprint

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BackgroundThe variable efficacy observed in studies of BCG vaccination is incompletely explained by currently accepted hypotheses, such as latitudinal gradient in non-tuberculous mycobacteria exposure. We investigated heterogeneity in BCG vaccination in the context of participant demography, diagnostic approach and TB-related epidemiological context.MethodsWe updated previous systematic reviews of the effectiveness of BCG vaccination to 31st December 2018. We employed an identical search strategy and inclusion/exclusion criteria to past reviews, but reclassified several studies and developed an alternative classification system.ResultsOf 21 included trials, those recruiting neonates and children aged under five were consistent in demonstrating considerable protection for several years. Trials in high-burden settings with shorter follow-up also showed considerable protection, as did most trials in settings of declining burden with longer follow-up. However, the few trials performed in high-burden settings with longer follow-up showed no protection, sometimes with higher case rates in the vaccinated than the controls in the later follow-up period.ConclusionsThe most plausible explanatory hypothesis is that BCG protects against TB that results from exposure shortly after vaccination. However, risk is equivalent or increased when exposure occurs later from vaccination, a phenomenon which is predominantly observed in adults in high-burden settings with longer follow-up. In settings of declining burden, most exposure occurs shortly following vaccination and the sustained protection thereafter represents continued protection against this early exposure. By contrast, in settings of continued intense transmission, initial protection subsequently declines due to repeated exposure to M. tuberculosis or other pathogens.

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BCG Vaccination and Tuberculosis in Students of Nursing

Cited by 4 publications

References 0 publications

Protection by BCG Vaccine Against Tuberculosis: A Systematic Review of Randomized Controlled Trials

Protection by BCG Vaccine Against Tuberculosis: A Systematic Review of Randomized Controlled Trials

Timing ofMycobacterium tuberculosisexposure explains variation in BCG effectiveness: a systematic review and meta-analysis

Timing ofM. tuberculosisexposure explains variation in BCG effectiveness: A systematic review and meta-analysis

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