英格兰学龄期卡介苗接种保护期的研究：基于人群的病例对照研究。

The duration of protection of school-aged BCG vaccination in England: a population-based case-control study.

机构信息

Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.

Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.

出版信息

Int J Epidemiol. 2018 Feb 1;47(1):193-201. doi: 10.1093/ije/dyx141.

DOI:10.1093/ije/dyx141

PMID:29025083

Abstract

BACKGROUND

Evidence of protection from childhood Bacillus Calmette-Guerin (BCG) against tuberculosis (TB) in adulthood, when most transmission occurs, is important for TB control and resource allocation.

METHODS

We conducted a population-based case-control study of protection by BCG given to children aged 12-13 years against tuberculosis occurring 10-29 years later. We recruited UK-born White subjects with tuberculosis and randomly sampled White community controls. Hazard ratios and 95% confidence intervals (CIs) were estimated using case-cohort Cox regression, adjusting for potential confounding factors, including socio-economic status, smoking, drug use, prison and homelessness. Vaccine effectiveness (VE = 1 - hazard ratio) was assessed at successive intervals more than 10 years following vaccination.

RESULTS

We obtained 677 cases and 1170 controls after a 65% response rate in both groups. Confounding by deprivation, education and lifestyle factors was slight 10-20 years after vaccination, and more evident after 20 years. VE 10-15 years after vaccination was 51% (95% CI 21, 69%) and 57% (CI 33, 72%) at 15-20 years. Subsequently, BCG protection appeared to wane; 20-25 years VE = 25% (CI -14%, 51%) and 25-29 years VE = 1% (CI -84%, 47%). Based on multiple imputation of missing data (in 17% subjects), VE estimated in the same intervals after vaccination were similar [56% (CI 33, 72%), 57% (CI 36, 71%), 25% (-10, 48%), 21% (-39, 55%)].

CONCLUSIONS

School-aged BCG vaccination offered moderate protection against tuberculosis for at least 20 years, which is longer than previously thought. This has implications for assessing the cost-effectiveness of BCG vaccination and when evaluating new TB vaccines.

摘要

背景

在大多数传播发生的成年期，儿童期接种卡介苗（BCG）对结核病（TB）的保护作用的证据对于结核病控制和资源分配很重要。

方法

我们进行了一项基于人群的病例对照研究，研究了 12-13 岁儿童接种 BCG 对 10-29 年后发生的结核病的保护作用。我们招募了英国出生的白人结核病患者和随机抽样的白人社区对照者。使用病例-队列 Cox 回归估计危险比和 95%置信区间（CI），并调整了潜在的混杂因素，包括社会经济地位、吸烟、药物使用、监禁和无家可归。在接种疫苗后超过 10 年的连续间隔评估疫苗效力（VE=1-危险比）。

结果

在两组人群的回复率为 65%后，我们获得了 677 例病例和 1170 例对照者。接种疫苗后 10-20 年，社会经济地位、教育和生活方式等因素的混杂作用较小，20 年后则更为明显。接种疫苗后 10-15 年 VE 为 51%（95%CI 21%，69%），15-20 年 VE 为 57%（CI 33%，72%）。此后，BCG 的保护作用似乎逐渐减弱；20-25 年 VE=25%（CI-14%，51%），25-29 年 VE=1%（CI-84%，47%）。基于对 17%的缺失数据进行多重插补（在 17%的受试者中），接种疫苗后在相同间隔内估计的 VE 相似[56%（CI 33%，72%），57%（CI 36%，71%），25%（-10%，48%），21%（-39%，55%）]。