Small Randomized Trial Among Low–birth-weight Children Receiving Bacillus Calmette-Guéerin Vaccination at First Health Center Contact

Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
The Pediatric Infectious Disease Journal (Impact Factor: 2.72). 12/2011; 31(3):306-8. DOI: 10.1097/INF.0b013e3182458289
Source: PubMed


Childhood tuberculosis accounts for a significant proportion of the global tuberculosis disease burden. However, tuberculosis in children is difficult to diagnose, because disease tends to be paucibacillary and sputum samples are often not easy to obtain. The diagnosis of tuberculosis in children is traditionally based on chest radiography, tuberculin skin testing, and mycobacterial staining/culture from appropriate samples. Newer diagnostic strategies have included improved bacteriologic and molecular methods, as well as new methods for sample collection from children. Recently, immune-based diagnostics, such as the interferon-gamma release assays, have been introduced for clinical use. These tests do not offer substantial improvements in sensitivity over tuberculin skin testing for the diagnosis of active disease but may be useful in excluding false-positive tuberculin skin tests. Further research is needed to develop better diagnostic tests for tuberculosis in children.

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    • "vaccines like bacille Calmette–Guérin (BCG) against tuberculosis and measles vaccine have beneficial effects on all-cause child mortality [4] [5] [6] [7] [8]. In contrast, inactivated vaccines including diphtheria–tetanus–pertussis (DTP) vaccine may increase all-cause child mortality [9] [10] [11]. "
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    ABSTRACT: Background The live measles vaccine has been associated with lower non-measles mortality and admissions in low-income countries. The live measles–mumps–rubella vaccine has also been associated with lower rate of admissions with any type of infection in Danish children; the association was strongest for admissions with lower respiratory infections. Objective To examine whether measles, mumps, and rubella (MMR) vaccination was associated with reduced rate of hospital contact related to respiratory syncytial virus (RSV) in a high-income country. Methods Nationwide cohort study of laboratory-confirmed RSV hospital contacts at age 14–23 months in all children born in Denmark 1997–2002 who had already received the vaccine against diphtheria, tetanus, pertussis (acellular), polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) at the recommended ages of 3, 5, and 12 months. Results The study included 888 RSV hospital contacts in 128,588 person years of follow up (rate 6.8/1000 person years). Having MMR as the most recent vaccine was associated with a reduced rate of RSV hospital contacts compared with having DTaP-IPV-Hib as the most recent vaccine (Incidence rate ratio (IRR), 0.75; 95% confidence interval (CI), 0.63–0.89). After adjustment for potential confounders including exact age in days the IRR was 0.78 (95% CI, 0.66–0.93). The adjusted IRR was 0.74 (95% CI, 0.60–0.92) in males and 0.84 (95% CI, 0.66–1.06) in females (P Interaction, 0.42). There was no association in the first month after MMR vaccination (adjusted IRR, 0.97; 95% CI, 0.76–1.24) but the adjusted IRR was 0.70 (95% CI, 0.58–0.85) from one month after MMR vaccination. Conclusions MMR vaccination was associated with reduced rate of hospital contacts related to laboratory-confirmed RSV infection. Further research on the association between MMR vaccination and other unrelated pathogens are warranted.
    Full-text · Article · Nov 2014 · Vaccine
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    • "Despite contrary results for the protective effects of BCG against tuberculosis, vaccination is recommended to continue due to reduced infection from other mycobacteria as well as astonishing non-specific effects that have been recently noted in a randomized clinical trial in premature births in Guinea-Bissau. Overall child mortality was reduced by over 50% when low birth-weight children who received BCG earlier than currently recommended (166). It is important to note that though BCG vaccination may have beneficial non-specific effects, it can also modulate immune responses to subsequent vaccination (167). "
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    ABSTRACT: The concept of immunological memory stipulates that past exposures shape present immune function. These exposures include not only specific antigens impacting adaptive immune memory but also conserved pathogen or danger associated molecular patterns that mold innate immune responses for prolonged periods of time. It should thus not come as a surprise that there is a vast range of external or environmental factors that impact immunity. The importance of environmental factors modulating immunity is most readily recognized in early life, a period of rapidly changing environments. We here summarize available data on the role of environment shaping immune development and from it derive an overarching hypothesis relating the underlying molecular mechanisms and evolutionary principles involved.
    Full-text · Article · Sep 2014 · Frontiers in Immunology

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