title: Effectiveness of routine BCG vaccination on buruli ulcer disease: a case-control study in the Democratic Republic of Congo, Ghana and Togo.
abstract: BACKGROUND
  The only available vaccine that could be potentially beneficial against mycobacterial diseases contains live attenuated bovine tuberculosis bacillus (Mycobacterium bovis) also called Bacillus Calmette-Guérin (BCG). Even though the BCG vaccine is still widely used, results on its effectiveness in preventing mycobacterial diseases are partially contradictory, especially regarding Buruli Ulcer Disease (BUD). The aim of this case-control study is to evaluate the possible protective effect of BCG vaccination on BUD.
  
  
  METHODS
  The present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors.
  
  
  RESULTS
  After stratification by the three countries, two sexes and four age groups, no significant correlation was found between the presence of BCG scar and BUD status of individuals. Multivariate analysis has shown that the independent variables country (p = 0.31), sex (p = 0.24), age (p = 0.96), and presence of a BCG scar (p = 0.07) did not significantly influence the development of BUD category I or category II/III. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or time to healing of lesions.
  
  
  CONCLUSIONS
  In our study, we did not observe significant evidence of a protective effect of routine BCG vaccination on the risk of developing either BUD or severe forms of BUD. Since accurate data on BCG strains used in these three countries were not available, no final conclusion can be drawn on the effectiveness of BCG strain in protecting against BUD. As has been suggested for tuberculosis and leprosy, well-designed prospective studies on different existing BCG vaccine strains are needed also for BUD.
authors.affiliation: Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
authors.forename: Richard Odame
authors.initials: RO
authors.lastname: Phillips
authors.affiliation: Institut Médical Evangélique (IME) de Kimpese, Projet Ulcère de Buruli, Kimpese, Democratic Republic of the Congo.
authors.forename: Delphin Mavinga
authors.initials: DM
authors.lastname: Phanzu
authors.affiliation: Department of Infectious Diseases and Tropical Medicine (DITM), University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Beissner
authors.affiliation: Institut National d'Hygiène (INH), Ministry of Health, Lomé, Togo.
authors.forename: Kossi
authors.initials: K
authors.lastname: Badziklou
authors.affiliation: Institut Médical Evangélique (IME) de Kimpese, Projet Ulcère de Buruli, Kimpese, Democratic Republic of the Congo.
authors.forename: Elysée Kalundieko
authors.initials: EK
authors.lastname: Luzolo
authors.affiliation: Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
authors.forename: Fred Stephen
authors.initials: FS
authors.lastname: Sarfo
authors.affiliation: Institut National d'Hygiène (INH), Ministry of Health, Lomé, Togo.
authors.forename: Wemboo Afiwa
authors.initials: WA
authors.lastname: Halatoko
authors.affiliation: Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
authors.forename: Yaw
authors.initials: Y
authors.lastname: Amoako
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
authors.forename: Michael
authors.initials: M
authors.lastname: Frimpong
authors.affiliation: Agogo Presbyterian Hospital, Agogo, Ghana.
authors.forename: Abass Mohammed
authors.initials: AM
authors.lastname: Kabiru
authors.affiliation: Centre Hospitalier Régional Maritime (CHR Maritime), Tsévié, Togo.
authors.forename: Ebekalisai
authors.initials: E
authors.lastname: Piten
authors.affiliation: Institut National d'Hygiène (INH), Ministry of Health, Lomé, Togo.
authors.forename: Issaka
authors.initials: I
authors.lastname: Maman
authors.affiliation: Institut National d'Hygiène (INH), Ministry of Health, Lomé, Togo.
authors.forename: Bawimodom
authors.initials: B
authors.lastname: Bidjada
authors.affiliation: Institut National d'Hygiène (INH), Ministry of Health, Lomé, Togo.
authors.forename: Adjaho
authors.initials: A
authors.lastname: Koba
authors.affiliation: Institut National d'Hygiène (INH), Ministry of Health, Lomé, Togo.
authors.forename: Koffi Somenou
authors.initials: KS
authors.lastname: Awoussi
authors.affiliation: Programme National de Lutte contre l'Ulcère de Buruli - Lèpre et Pian (PNLUB-LP), Ministry of Health, Lomé, Togo.
authors.forename: Basile
authors.initials: B
authors.lastname: Kobara
authors.affiliation: Department of Infectious Diseases and Tropical Medicine (DITM), University Hospital, Ludwig-Maximilians-University, Munich, Germany; German Leprosy and Tuberculosis Relief Association, Togo office (DAHWT), Lomé, Togo.
authors.forename: Jörg
authors.initials: J
authors.lastname: Nitschke
authors.affiliation: German Leprosy and Tuberculosis Relief Association, Togo office (DAHWT), Lomé, Togo.
authors.forename: Franz Xaver
authors.initials: FX
authors.lastname: Wiedemann
authors.affiliation: Institut National d'Hygiène (INH), Ministry of Health, Lomé, Togo.
authors.forename: Abiba Banla
authors.initials: AB
authors.lastname: Kere
authors.affiliation: Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
authors.forename: Ohene
authors.initials: O
authors.lastname: Adjei
authors.affiliation: Department of Infectious Diseases and Tropical Medicine (DITM), University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Löscher
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Fleischer
authors.affiliation: Department of Infectious Diseases and Tropical Medicine (DITM), University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Gisela
authors.initials: G
authors.lastname: Bretzel
authors.affiliation: Department of Infectious Diseases and Tropical Medicine (DITM), University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Herbinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000276:immunology*; D054312:Buruli Ulcer / Q000517:prevention & control*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014037:Togo / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001500:BCG Vaccine