Pharoah P D, Watson J M, Sen S
PHLS Communicable Disease Surveillance Centre, London.
Public Health. 1996 May;110(3):179-83. doi: 10.1016/s0033-3506(96)80073-4.
In the United Kingdom, BCG immunization of neonates provides good protection against military and meningeal disease, and probably against other forms of tuberculosis, in all ethnic groups. Serious adverse reactions to BCG immunization are rare. Cost-effectiveness studies of BCG immunization in neonates have not been reported and "universal' BCG immunization is not recommended in the United Kingdom. The Department of Health does recommend immunization for children and infants of immigrants from countries with a high prevalence of tuberculosis. There are problems associated with such a "selective' policy, as determining what is "high' prevalence and thus defining "at risk' groups is difficult, and there may be political and practical difficulties in its implementation. This may result in low coverage in eligible groups. A "universal' policy of BCG immunization for all neonates may be politically more acceptable and easier to implement in districts with high tuberculosis notification rates. Although there is no cost-effectiveness data to determine at what tuberculosis notification rate a universal policy should be adopted, an universal policy has been suggested for districts with overall notification rate of greater than 40 per 100,000. Within districts there may be large variations in tuberculosis notification rates between different areas. This is becoming more common with the amalgamation and merger of smaller districts into new larger purchasing organizations. New River Health Authority is such a district formed by the amalgamation of the former districts of Haringey with a high tuberculosis notification rate, and Enfield with a lower TB notification rate. In order to maximize coverage in the "at risk' neonates, a different neonatal BCG policy has been adopted in the two areas. This has been possible because of the flexibility of the mechanisms for contracting with different provider units. Although the overall notification rate was not thought to be sufficiently high to justify a "universal' neonatal policy throughout the district, a "universal' policy has been instituted in the main provider unit in the former district Haringey. A "selective' policy, subject to ongoing evaluation to ensure high coverage, continues to be operated by the main provider unit in the former district of Enfield.
在英国，对新生儿进行卡介苗免疫接种能为所有种族群体提供针对粟粒性结核病和结核性脑膜炎的良好保护，可能也能预防其他形式的结核病。卡介苗免疫接种的严重不良反应很少见。关于新生儿卡介苗免疫接种的成本效益研究尚未见报道，英国也不建议进行“普遍”的卡介苗免疫接种。卫生部确实建议对来自结核病高流行国家的移民儿童和婴儿进行免疫接种。这种“选择性”政策存在一些问题，因为确定什么是“高”流行率从而界定“高危”群体很困难，而且在实施过程中可能存在政治和实际困难。这可能导致符合条件群体的接种覆盖率较低。对所有新生儿实行“普遍”的卡介苗免疫接种政策在政治上可能更容易被接受，在结核病通报率高的地区也更容易实施。尽管没有成本效益数据来确定应在何种结核病通报率下采用普遍政策，但有人建议对于总体通报率高于每10万人口40例的地区实行普遍政策。在各地区内，不同区域的结核病通报率可能存在很大差异。随着较小地区合并为新的更大的采购组织，这种情况越来越普遍。新河卫生局就是这样一个由结核病通报率高的哈林盖前区和结核病通报率较低的恩菲尔德合并而成的地区。为了使“高危”新生儿的接种覆盖率最大化，这两个地区采用了不同的新生儿卡介苗政策。由于与不同提供单位签约机制的灵活性，这才得以实现。尽管整个地区的总体通报率被认为不足以高到证明应在全区实行“普遍”的新生儿政策，但在原哈林盖区的主要提供单位已实行了“普遍”政策。原恩菲尔德区的主要提供单位继续实行“选择性”政策，并不断进行评估以确保高覆盖率。
