Randomized Trial of BCG Vaccination at Birth to Low-Birth-Weight Children: Beneficial Nonspecific Effects in the Neonatal Period?

Aaby, Péter; Roth, Adam; Ravn, Henrik; Napirna, Bitiguida Mutna; Rodrigues, Amabélia; Lisse, Ida Maria; Stensballe, Lone Graff; Diness, Birgitte Rode; Lausch, Karen Rokkedal; Lund, Najaaraq; Biering-Sørensen, Sofie; Whittle, Hilton; Benn, Christine Stabell

doi:10.1093/infdis/jir240

Cited by 521 publications

(505 citation statements)

References 34 publications

Supporting

Mentioning

470

Contrasting

Unclassified

Order By: Relevance

“…78 Whereas in low birth weight neonates it reduced the mortality by almost 50% as demonstrated by fewer cases of sepsis and respiratory infections. 79,80 This is similar to results in adult mouse models of heterologous immunity where it was demonstrated that BCG-immune mice were more resistant to vaccinia virus infection and that this resistance was mediated by IFNg-producing CD4 T cells. 81 Interestingly, Steenhuis and others showed that in children, by 18 months of age, immunization with BCG resulted in lowered numbers of children with eczema, a Th2-immune mediated disease.…”

Section: Measles Vaccinesupporting

confidence: 82%

“…However, the observational studies in rural Guinea-Bissau indicated that the presence of vaccinia scars were associated with increased survival rates among adults. 79,83 It was also shown that it may decrease the risk of asthma and malignant melanoma. 84 In Danish studies, smallpox immunizations lowered the number of infectious disease hospitalizations.…”

Section: Vaccinia Vaccinationsmentioning

confidence: 99%

See 1 more Smart Citation

Vaccination and heterologous immunity: educating the immune system

Gil¹,

Kenney²,

Mishra³

et al. 2015

Transactions of the Royal Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

This review discusses three inter-related topics: (1) the immaturity of the neonatal and infant immune response; (2) heterologous immunity, where prior infection history with unrelated pathogens alters disease outcome resulting in either enhanced protective immunity or increased immunopathology to new infections, and (3) epidemiological human vaccine studies that demonstrate vaccines can have beneficial or detrimental effects on subsequent unrelated infections. The results from the epidemiological and heterologous immunity studies suggest that the immune system has tremendous plasticity and that each new infection or vaccine that an individual is exposed to during a lifetime will potentially alter the dynamics of their immune system. It also suggests that each new infection or vaccine that an infant receives is not only perturbing the immune system but is educating the immune system and laying down the foundation for all subsequent responses. This leads to the question, is there an optimum way to educate the immune system? Should this be taken into consideration in our vaccination protocols?

show abstract

Section: Measles Vaccinesupporting

confidence: 82%

Section: Vaccinia Vaccinationsmentioning

confidence: 99%

Vaccination and heterologous immunity: educating the immune system

Gil¹,

Kenney²,

Mishra³

et al. 2015

Transactions of the Royal Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

show abstract

“…Previous studies have shown that BCG has beneficial non-specific or heterologous effects, providing protection also against many non-tuberculosis causes of death: in randomized trials of early BCG to low-birth-weight children, BCG at birth versus delayed BCG, as is normal practice, decreased neonatal mortality by 38% (17–54%) [37–39]. With most infant deaths occurring during the neonatal period [40] and with less than half of children vaccinated during the first two weeks of life, most children do not benefit from BCG when they are most at risk.…”

Section: Discussionmentioning

confidence: 99%

Vaccination coverage and factors associated with adherence to the vaccination schedule in young children of a rural area in Burkina Faso

Kagoné

Yé

Nebié

et al. 2017

Global Health Action

View full text Add to dashboard Cite

Background: Vaccination is an important tool for reducing infectious disease morbidity and mortality. In the past, less than 80% of children 12–23 months of age were fully immunized in Burkina Faso. Objectives: To describe coverage and assess factors associated with adherence to the vaccination schedule in rural area Burkina Faso. Methods: The study population was extracted from the Nouna Health and Demographic surveillance system cohort. Data from four rounds of interviews conducted between November 2012 and June 2014 were considered. This study included 4016 children aged 12–23 months. We assessed the effects of several background factors, including sex, factors reflecting access to health care (residence, place of birth), and maternal factors (age, education, marital status), on being fully immunized defined as having received Bacillus Calmette–Guérin (BCG), three doses of diphtheria–tetanus–pertussis and oral polio vaccine, and measles vaccine by 12 months of age. The associations were studied using binomial regression to derive prevalence ratios (PRs) in univariate and multivariate regression models. Results: The full vaccination coverage increased significantly over time (72% in 2012, 79% in 2013, and 81% in 2014, p = 0.003), and the coverage was significantly lower in urban than in rural areas (PR 0.84; 0.80–0.89). Vaccination coverage was neither influenced by sex nor influenced by place of birth or by maternal factors. Conclusion: The study documented a further improvement in full vaccination coverage in Burkina Faso in recent years and better vaccination coverage in rural than in urban areas. The organization of healthcare systems with systematic outreach activities in the rural areas may explain the difference between rural and urban areas.

show abstract

“…Much of the information supporting these ideas has come from observational studies because of the difficulty in conducting placebo controlled trials with established vaccines, but a recent randomized trial of BCG given to low birth weight babies showed a significant reduction in neonatal but not in infant mortality [18]. Acceptance of the results of these studies has, until recently, been met with some scepticism because of the lack of an apparent mechanism through which these effects could be achieved.…”

Section: (C) the Expanded Programme On Immunizationmentioning

confidence: 99%

The contribution of vaccination to global health: past, present and future

Greenwood

2014

Phil. Trans. R. Soc. B

775

516

View full text Add to dashboard Cite

Vaccination has made an enormous contribution to global health. Two major infections, smallpox and rinderpest, have been eradicated. Global coverage of vaccination against many important infectious diseases of childhood has been enhanced dramatically since the creation of WHO's Expanded Programme of Immunization in 1974 and of the Global Alliance for Vaccination and Immunization in 2000. Polio has almost been eradicated and success in controlling measles makes this infection another potential target for eradication. Despite these successes, approximately 6.6 million children still die each year and about a half of these deaths are caused by infections, including pneumonia and diarrhoea, which could be prevented by vaccination. Enhanced deployment of recently developed pneumococcal conjugate and rotavirus vaccines should, therefore, result in a further decline in childhood mortality. Development of vaccines against more complex infections, such as malaria, tuberculosis and HIV, has been challenging and achievements so far have been modest. Final success against these infections may require combination vaccinations, each component stimulating a different arm of the immune system. In the longer term, vaccines are likely to be used to prevent or modulate the course of some non-infectious diseases. Progress has already been made with therapeutic cancer vaccines and future potential targets include addiction, diabetes, hypertension and Alzheimer's disease.

show abstract

Randomized Trial of BCG Vaccination at Birth to Low-Birth-Weight Children: Beneficial Nonspecific Effects in the Neonatal Period?

Abstract: Though early BCG did not reduce infant mortality significantly, it may have a beneficial effect in the neonatal period. This could be important for public health because BCG is often delayed in low-income countries.

Cited by 521 publications

References 34 publications

Vaccination and heterologous immunity: educating the immune system

Vaccination and heterologous immunity: educating the immune system

Vaccination coverage and factors associated with adherence to the vaccination schedule in young children of a rural area in Burkina Faso

The contribution of vaccination to global health: past, present and future

Contact Info

Product

Resources

About