BCG vaccination in England since 2005: a survey of policy and practice

Pilger, Daniel; Nguipdop-Djomo, Patrick; Abubakar, Ibrahim; Elliman, David; Rodrigues, Laura C.; Watson, John M.; Eastman, Vera; Mangtani, Punam

doi:10.1136/bmjopen-2012-001303

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…Details of the survey are published as a peer-reviewed paper. 26 We also obtained the source data (original questionnaires/tables) from previous BCG policy surveys 16,27 from the investigators to complement information on historical infant vaccination policies.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the findings are provided elsewhere. 26 In summary, the new policy for the delivery of infant BCG in high-risk groups had been implemented in all PCTs, but with considerable heterogeneity with regard to the organisation of the delivery of the vaccine and some difficulties experienced in the identification of eligible children. Sixteen of the 127 (13%) PCTs reported universal infant vaccination and 111 (87%) reported selective infant vaccination.…”

Section: Current Bacillus Calmette-guérin Vaccination Policymentioning

confidence: 99%

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Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Mangtani

Nguipdop-Djomo

Keogh

et al. 2017

Health Technol Assess

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Background Until recently, evidence that protection from the bacillus Calmette–Guérin (BCG) vaccination lasted beyond 10 years was limited. In the past few years, studies in Brazil and the USA (in Native Americans) have suggested that protection from BCG vaccination against tuberculosis (TB) in childhood can last for several decades. The UK’s universal school-age BCG vaccination programme was stopped in 2005 and the programme of selective vaccination of high-risk (usually ethnic minority) infants was enhanced. Objectives To assess the duration of protection of infant and school-age BCG vaccination against TB in the UK. Methods Two case–control studies of the duration of protection of BCG vaccination were conducted, the first on minority ethnic groups who were eligible for infant BCG vaccination 0–19 years earlier and the second on white subjects eligible for school-age BCG vaccination 10–29 years earlier. TB cases were selected from notifications to the UK national Enhanced Tuberculosis Surveillance system from 2003 to 2012. Population-based control subjects, frequency matched for age, were recruited. BCG vaccination status was established from BCG records, scar reading and BCG history. Information on potential confounders was collected using computer-assisted interviews. Vaccine effectiveness was estimated as a function of time since vaccination, using a case–cohort analysis based on Cox regression. Results In the infant BCG study, vaccination status was determined using vaccination records as recall was poor and concordance between records and scar reading was limited. A protective effect was seen up to 10 years following infant vaccination [< 5 years since vaccination: vaccine effectiveness (VE) 66%, 95% confidence interval (CI) 17% to 86%; 5–10 years since vaccination: VE 75%, 95% CI 43% to 89%], but there was weak evidence of an effect 10–15 years after vaccination (VE 36%, 95% CI negative to 77%; p = 0.396). The analyses of the protective effect of infant BCG vaccination were adjusted for confounders, including birth cohort and ethnicity. For school-aged BCG vaccination, VE was 51% (95% CI 21% to 69%) 10–15 years after vaccination and 57% (95% CI 33% to 72%) 15–20 years after vaccination, beyond which time protection appeared to wane. Ascertainment of vaccination status was based on self-reported history and scar reading. Limitations The difficulty in examining vaccination sites in older women in the high-risk minority ethnic study population and the sparsity of vaccine record data in the later time periods precluded robust assessment of protection from infant BCG vaccination > 10 years after vaccination. Conclusions Infant BCG vaccination in a population at high risk for TB was shown to provide protection for at least 10 years, whereas in the white population school-age vaccination was shown to provide protection for at least 20 years. This evidence may inform TB vaccination programmes (e.g. the timing of administration of improved TB vaccines, if they become available) and cost-effectiveness studies. Methods to deal with missing record data in the infant study could be explored, including the use of scar reading. Funding The National Institute for Health Research Health Technology Assessment programme. During the conduct of the study, Jonathan Sterne, Ibrahim Abubakar and Laura C Rodrigues received other funding from NIHR; Ibrahim Abubakar and Laura C Rodrigues have also received funding from the Medical Research Council. Punam Mangtani received funding from the Biotechnology and Biological Sciences Research Council.

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Section: Methodsmentioning

confidence: 99%

Section: Current Bacillus Calmette-guérin Vaccination Policymentioning

confidence: 99%

Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Mangtani

Nguipdop-Djomo

Keogh

et al. 2017

Health Technol Assess

Self Cite

View full text Add to dashboard Cite

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“…The rationale for this practice is difficult to reference appropriately. The BCG has an accepted role in the prevention of disseminated tuberculosis infection in children born in populations with general annual TB incidence >40/ 100,000 [17]. Only Latvia (42 in 2011), Lithuania (58.2 in 2011) and Romania (90.5 in 2010) of the CEVAG countries have a higher incidence (data communicated by the CEVAG panel members).…”

Section: Premature and Low Birth-weight Infantsmentioning

confidence: 95%

“…16 Hexavalent vaccine; second and third doses administered ‡1 month after preceding dose but within first year of life; fourth dose administered 6 months after third dose and before 18 months of age. 17 Administered at 12 years if child born between 1995 and 2003 and not previously vaccinated (catch-up). 18 Administered to infants of HBsAg-positive mothers and to mothers with unknown HBsAg status: three doses starting within 12 h postpartum, second dose 1 month later and third dose 6 months after first dose.…”

Section: Children With Chronic Medical Conditionsmentioning

confidence: 99%

Immunization of high-risk paediatric populations: Central European Vaccination Awareness Group recommendations

Richter

Anca

André

et al. 2014

Expert Review of Vaccines

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Over the last decade, childhood immunization has substantially reduced morbidity and mortality from vaccine-preventable diseases. However, particular paediatric risk groups, such as those with comorbidities, may not be adequately vaccinated despite being more susceptible to complications and death from certain infectious diseases. This may be due to lack of immunization recommendations, lack of awareness, or incomplete adherence to existing guidelines. Furthermore, recommendations for immunization can be inconsistent across Europe. An expanded initiative from the Central European Vaccination Awareness Group aims to raise awareness of the different high-risk paediatric groups, differentiate them according to their specific risk, and formalise a guidance statement for the immunization of each population.

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“…[2] Global usage of the BCG varies between no vaccination, universal vaccination, and high-risk group vaccination and may target either neonates or school-aged children. [3,4] The World Health Organization (WHO) recommends vaccination for all neonates as early as possible after birth in high burden settings, with vaccination in low burden settings being dependent on the country specific epidemiology of TB. [5] This recommendation is based on the strong evidence that the BCG is highly protective in children, [6,7] whilst its effectiveness has been shown to vary with latitude when given later in life.…”

Section: Introductionmentioning

confidence: 99%

Reassessing the Evidence for Universal School-age Bacillus Calmette Guerin (BCG) Vaccination in England and Wales

Abbott

Christensen

Brooks-Pollock

2019

Preprint

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Words: Title: 15 Abstract: 250 Paper: 2885 •This study highlights the need for a more detailed evaluation of the 2005 change in BCG policy. In particular, the impact of including the introduction of targeted neonatal vaccination and capturing the long term, indirect, effects needs further study. ConclusionsOur estimates of the impact of ending the BCG schools' scheme were highly sensitive to the annual decrease in incidence rates. The impact of ending the BCG schools' scheme was found to be greater than previously thought when parameter values were updated and notification data were used. Our results highlight the importance of including uncertainty when forecasting the impact of changes in vaccination policy.

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BCG vaccination in England since 2005: a survey of policy and practice

Cited by 8 publications

References 15 publications

Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Immunization of high-risk paediatric populations: Central European Vaccination Awareness Group recommendations

Reassessing the Evidence for Universal School-age Bacillus Calmette Guerin (BCG) Vaccination in England and Wales

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