Assessing the impact of different BCG vaccination strategies on severe childhood TB in low-intermediate prevalence settings.
The decrease in overall incidence of TB in industrialised countries, together with the increasing concern for adverse events following BCG immunization, has led to important modifications of BCG policies in the last decades. This article adapts and validates--with surveillance data--a theoretical model estimating the impact of different national BCG vaccination policies on severe childhood TB in low to intermediate TB prevalent countries. The model shows that a universal BCG programme could be beneficial in settings with prevalence levels around 30 sputum smear positive per 100,000. In settings with prevalence levels below 15 per 100,000 the benefit of universal BCG vaccination should be carefully assessed, particularly where prevalence is below 5 per 100,000 and universal vaccination might lead to an excess of adverse events per case prevented. To this purpose the model also provides a tool to assess the theoretical impact of a policy change towards selective 'high-risk groups' vaccination.
Manissero
Davide
D
Scientific Advice Unit, European Centre for Disease Prevention and Control, 171 83 Stockholm Sweden. davide.manissero@ecdc.europa.eu
Lopalco
Pier Luigi
PL
Levy-Bruhl
Daniel
D
Ciofi Degli Atti
Marta Luisa
ML
Giesecke
Johan
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006291:Health Policy; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D015233:Models, Statistical; D009163:Mycobacterium bovis / Q000276:immunology*; D015995:Prevalence; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control*; D032581:Tuberculosis Vaccines / Q000009:adverse effects* / Q000276:immunology*
D032581:Tuberculosis Vaccines