常规卡介苗接种对布鲁里溃疡病的有效性：在刚果民主共和国、加纳和多哥开展的一项病例对照研究
Effectiveness of routine BCG vaccination on buruli ulcer disease: a case-control study in the Democratic Republic of Congo, Ghana and Togo.
作者信息
Phillips Richard Odame, Phanzu Delphin Mavinga, Beissner Marcus, Badziklou Kossi, Luzolo Elysée Kalundieko, Sarfo Fred Stephen, Halatoko Wemboo Afiwa, Amoako Yaw, Frimpong Michael, Kabiru Abass Mohammed, Piten Ebekalisai, Maman Issaka, Bidjada Bawimodom, Koba Adjaho, Awoussi Koffi Somenou, Kobara Basile, Nitschke Jörg, Wiedemann Franz Xaver, Kere Abiba Banla, Adjei Ohene, Löscher Thomas, Fleischer Bernhard, Bretzel Gisela, Herbinger Karl-Heinz
机构信息
Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
Institut Médical Evangélique (IME) de Kimpese, Projet Ulcère de Buruli, Kimpese, Democratic Republic of the Congo.
出版信息
PLoS Negl Trop Dis. 2015 Jan 8;9(1):e3457. doi: 10.1371/journal.pntd.0003457. eCollection 2015 Jan.
BACKGROUND
The only available vaccine that could be potentially beneficial against mycobacterial diseases contains live attenuated bovine tuberculosis bacillus (Mycobacterium bovis) also called Bacillus Calmette-Guérin (BCG). Even though the BCG vaccine is still widely used, results on its effectiveness in preventing mycobacterial diseases are partially contradictory, especially regarding Buruli Ulcer Disease (BUD). The aim of this case-control study is to evaluate the possible protective effect of BCG vaccination on BUD.
METHODOLOGY
The present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors.
PRINCIPAL FINDINGS
After stratification by the three countries, two sexes and four age groups, no significant correlation was found between the presence of BCG scar and BUD status of individuals. Multivariate analysis has shown that the independent variables country (p = 0.31), sex (p = 0.24), age (p = 0.96), and presence of a BCG scar (p = 0.07) did not significantly influence the development of BUD category I or category II/III. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or time to healing of lesions.
CONCLUSIONS
In our study, we did not observe significant evidence of a protective effect of routine BCG vaccination on the risk of developing either BUD or severe forms of BUD. Since accurate data on BCG strains used in these three countries were not available, no final conclusion can be drawn on the effectiveness of BCG strain in protecting against BUD. As has been suggested for tuberculosis and leprosy, well-designed prospective studies on different existing BCG vaccine strains are needed also for BUD.
背景
唯一可能对分枝杆菌病有益的现有疫苗含有减毒活牛结核杆菌（牛分枝杆菌），也称为卡介苗（BCG）。尽管卡介苗仍被广泛使用，但其预防分枝杆菌病的效果结果存在部分矛盾，特别是对于布鲁里溃疡病（BUD）。本病例对照研究的目的是评估卡介苗接种对布鲁里溃疡病的可能保护作用。
方法
本研究在布鲁里溃疡病流行的三个不同国家和地点进行：2010年至2013年期间在刚果民主共和国、加纳和多哥。大量研究人群包括401例经实验室确诊的布鲁里溃疡病病例和826名对照，大多是家庭成员或邻居。
主要发现
在按三个国家、两种性别和四个年龄组进行分层后，未发现卡介苗疤痕的存在与个体的布鲁里溃疡病状况之间存在显著相关性。多变量分析表明，国家（p = 0.31）、性别（p = 0.24）、年龄（p = 0.96）和卡介苗疤痕的存在（p = 0.07）等自变量并未显著影响I类或II/III类布鲁里溃疡病的发生。此外，卡介苗接种状况也与布鲁里溃疡病的病程或病变愈合时间无显著相关性。
结论
在我们的研究中，我们没有观察到常规卡介苗接种对发生布鲁里溃疡病或严重形式的布鲁里溃疡病风险具有保护作用的显著证据。由于这三个国家使用的卡介苗菌株的准确数据不可用，因此无法就卡介苗菌株预防布鲁里溃疡病的有效性得出最终结论。正如针对结核病和麻风病所建议的那样，对于布鲁里溃疡病也需要对不同现有的卡介苗菌株进行精心设计的前瞻性研究。
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