Tidjani O, Amedome A, ten Dam H G
Service de Pneumophtisiologie, Centre Hospitalier Universitaire, Lomé, Togo.
Tubercle. 1986 Dec;67(4):269-81. doi: 10.1016/0041-3879(86)90016-4.
The latest controlled trial of BCG vaccination in southern India showed that two vaccines failed to confer protection against pulmonary tuberculosis. This result cast serious doubt on the effectiveness of BCG vaccination of the newborn, which is widely applied in developing countries. Therefore, WHO initiated a global research study to evaluate current programmes in developing countries. Part of this study was carried out in Lomé, Togo, in which child contacts of newly detected patients were followed up with clinical and radiological examinations. All observations were recorded according to a scoring system. Concomitant observations were made to verify the comparability of the vaccinated and unvaccinated children. Of the child contacts of 352 index cases, 1421 completed the examinations. The distribution of the final score made it possible to distinguish 175 children likely to suffer from tuberculosis: 113 among the 546 unvaccinated and 62 among the 875 vaccinated children. Significant incomparability was observed in respect of intensity of exposure: the vaccination coverage was relatively low, and the risk of disease relatively high, if a parent was the index case or the child shared the bedroom of the index case (which very often coincided). The other variables studied, including age and sex, turned out to be practically irrelevant as regards comparability. The estimate of the protective effect against all types of tuberculosis combined is 61.5%, which is slightly lower than suggested by the raw data (66%). The protective effect, however, appeared to increase considerably with severity of disease. In children of 5 years and older it was lower than in the younger children. Tuberculin testing failed to reveal any sensitivity induced by BCG in the vaccinated children. The distribution of the tuberculin reactions correlated poorly with the other diagnostic findings. Small reactions were only slightly more frequent in healthy than in sick children; only the very large reactions were associated with a higher risk of disease. This confirms that the tuberculin test is of very limited diagnostic value in young children.
印度南部最新的卡介苗接种对照试验表明，两种疫苗未能提供针对肺结核的保护作用。这一结果严重质疑了在发展中国家广泛应用的新生儿卡介苗接种的有效性。因此，世界卫生组织发起了一项全球研究，以评估发展中国家目前的接种计划。该研究的一部分在多哥的洛美进行，对新发现患者的儿童接触者进行了临床和放射学检查随访。所有观察结果均根据评分系统进行记录。同时进行观察以验证接种疫苗和未接种疫苗儿童的可比性。在352例索引病例的儿童接触者中，1421人完成了检查。最终评分的分布情况使得区分出175名可能患结核病的儿童成为可能：在546名未接种疫苗的儿童中有113名，在875名接种疫苗的儿童中有62名。在接触强度方面观察到显著的不可比性：如果父母是索引病例或儿童与索引病例共用卧室（这种情况经常同时出现），则疫苗接种覆盖率相对较低，患病风险相对较高。研究的其他变量，包括年龄和性别，在可比性方面实际上无关紧要。针对所有类型结核病综合计算的保护效果估计为61.5%，略低于原始数据显示的66%。然而，保护效果似乎随着疾病严重程度的增加而显著提高。在5岁及以上的儿童中，保护效果低于年幼儿童。结核菌素试验未能揭示接种疫苗儿童中卡介苗诱导的任何敏感性。结核菌素反应的分布与其他诊断结果的相关性很差。健康儿童中出现小反应的频率仅略高于患病儿童；只有非常大的反应与较高的患病风险相关。这证实了结核菌素试验在幼儿中的诊断价值非常有限。
