TY - JOUR
T1 - Effect of BCG vaccination against Mycobacterium tuberculosis infection in children
T2 - Systematic review and meta-analysis
AU - Roy, A.
AU - Eisenhut, M.
AU - Harris, R. J.
AU - Rodrigues, L. C.
AU - Sridhar, S.
AU - Habermann, S.
AU - Snell, L.
AU - Mangtani, P.
AU - Adetifa, I.
AU - Lalvani, A.
AU - Abubakar, I.
PY - 2014/8/5
Y1 - 2014/8/5
N2 - Objectives: To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children. Design: Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts. Setting: Community congregate settings and households. Inclusion criteria: Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays. Data extraction: Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis. Results: The primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77). Conclusions: BCG protects against M tuberculosis infection as well as progression from infection to disease. Trial registration: PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/).
AB - Objectives: To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children. Design: Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts. Setting: Community congregate settings and households. Inclusion criteria: Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays. Data extraction: Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis. Results: The primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77). Conclusions: BCG protects against M tuberculosis infection as well as progression from infection to disease. Trial registration: PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/).
UR - http://www.scopus.com/inward/record.url?scp=84905509152&partnerID=8YFLogxK
U2 - 10.1136/bmj.g4643
DO - 10.1136/bmj.g4643
M3 - Article
C2 - 25097193
AN - SCOPUS:84905509152
VL - 349
JO - British Medical Journal
JF - British Medical Journal
SN - 0959-8146
M1 - g4643
ER -
