Tala E O, Tala-Heikkilä M M
University Central Hospital, Department of Diseases of the Chest, Turku, Finland.
Infect Control Hosp Epidemiol. 1994 Jul;15(7):497-9. doi: 10.1086/646958.
Preventive bacille Calmette-Guérin (BCG) vaccination, together with case finding and effective chemotherapy, has formed an integral part of the tuberculosis (TB) control program in most countries. In some low-incidence countries the balance of prevention has been more on the side of chemoprophylaxis than of BCG vaccination. The time clearly has come when the strategy of mass BCG vaccination no longer is indicated medically, nor is it cost-effective. The pros and cons of the programs need to be critically evaluated against the present epidemiological background, taking into account the facts that TB, the killer disease, is recovering strength, human immunodeficiency virus infection is on the increase, and multidrug-resistant TB has changed the outcome of this previously fully curable disease. Although no longer appropriate for mass programs, BCG vaccination still should be considered for the protection of selected risk groups in low-incidence countries. The overall efficacy may be of the order 50% to 80%, but the variation is great. Therefore, further research urgently is needed on the effectiveness of BCG as an intervention in local TB programs.
预防性卡介苗接种，连同病例发现和有效的化疗，已成为大多数国家结核病控制项目的一个组成部分。在一些低发病率国家，预防措施更多地侧重于化学预防而非卡介苗接种。显然，大规模卡介苗接种策略在医学上已不再适用，在成本效益方面也不可行。鉴于结核病这一致命疾病正在卷土重来、人类免疫缺陷病毒感染不断增加以及耐多药结核病改变了这种以往完全可治愈疾病的治疗结果等事实，需要根据当前的流行病学背景对这些项目的利弊进行严格评估。虽然不再适用于大规模项目，但在低发病率国家，仍应考虑为选定的风险群体接种卡介苗以提供保护。总体有效率可能在50%至80%之间，但差异很大。因此，迫切需要进一步研究卡介苗作为地方结核病项目干预措施的有效性。
