Tuberculous meningitis in France in 1990: characteristics and impact of BCG vaccination.
METHODS
France, 1990.


OBJECTIVE
To measure the incidence and describe the characteristics of bacteriologically-confirmed tuberculous meningitis (TBM) and to estimate the protective efficacy of BCG vaccination in children aged less than 5 years.


METHODS
An active surveillance of TBM cases confirmed by positive cerebrospinal fluid (CSF) culture was conducted through a network of microbiology laboratories serving 99.8% of regional and district general hospitals and other large private hospitals.


RESULTS
A total of 70 cases were reported: 61% were adults over 44 years, 64% were males and 77% were born in France. 7 patients were known to be infected with HIV. 6 cases were observed in children aged less than 5 years, 2 of whom had been vaccinated with BCG. 3 of the 6 children died (one had been BCG-vaccinated). Given the 80% coverage of BCG in this age group, the protective efficacy of BCG vaccination was estimated to be 87.5% (95% CI: 30-98), which indicates that 14 TBM cases may have been prevented by BCG vaccination in 1990.


CONCLUSIONS
Results are consistent with the number of TBM cases expected on the basis of a 0.04% annual risk of infection. Current BCG vaccination policy in France still has a measurable impact on the incidence of tuberculous meningitis in children under 5 years of age. Given the probable continuous decrease of the annual risk of infection in future years, alternative policies should be considered.
Schwoebel
V
V
Centre National de Référence pour la Surveillance de la Tuberculose et des Infections à Mycobactéries Atypiques, Hôpital de la Pitié-Salpêtrière, Paris, France.
Hubert
B
B
Grosset
J
J
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001500:BCG Vaccine; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D014390:Tuberculosis, Meningeal / Q000453:epidemiology* / Q000517:prevention & control
D001500:BCG Vaccine