The duration of protection of school-aged BCG vaccination in England: a population-based case-control study
Open accessAbstract
Background: Evidence of protection from childhood Bacillus Calmette-Guerin (BCG) against tuberculosis (TB) in adulthood, when most transmission occurs, is important for TB control and resource allocation. Methods: We conducted a population-based case-control study of protection by BCG given to children aged 12-13 years against tuberculosis occurring 10-29 years later. We recruited UK-born White subjects with tuberculosis and randomly sampled White community controls. Hazard ratios and 95% confidence intervals (CIs) were estimated using case-cohort Cox regression, adjusting for potential confounding factors, including socio-economic status, smoking, drug use, prison and homelessness. Vaccine effectiveness (VE = 1 - hazard ratio) was assessed at successive intervals more than 10 years following vaccination. Results: We obtained 677 cases and 1170 controls after a 65% response rate in both groups. Confounding by deprivation, education and lifestyle factors was slight 10-20 years after vaccination, and more evident after 20 years. VE 10-15 years after vaccination was 51% (95% CI 21, 69%) and 57% (CI 33, 72%) at 15-20 years. Subsequently, BCG protection appeared to wane; 20-25 years VE = 25% (CI -14%, 51%) and 25-29 years VE = 1% (CI -84%, 47%). Based on multiple imputation of missing data (in 17% subjects), VE estimated in the same intervals after vaccination were similar [56% (CI 33, 72%), 57% (CI 36, 71%), 25% (-10, 48%), 21% (-39, 55%)]. Conclusions: School-aged BCG vaccination offered moderate protection against tuberculosis for at least 20 years, which is longer than previously thought. This has implications for assessing the cost-effectiveness of BCG vaccination and when evaluating new TB vaccines.
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The heterologous effects of BCG vaccination tend to fade after 15 to 20 years.
“While this mechanism is still under investigation, most studies show that these effects tend to wane after 15 to 20 years [5,6].”
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- Authors
- Mangtani, P., Nguipdop-Djomo, P., Keogh, R. H., Sterne, J. A., Abubakar, I., Smith, P. G., Fine, P. E., Vynnycky, E., Watson, J. M., Elliman, D., Lipman, M., & Rodrigues, L. C.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- University of Bristol (GB)
- University College London (GB)
- Public Health England (GB)
- Whittington Health NHS Trust (GB)
- Royal Free London NHS Foundation Trust (GB)
- Corresponding author
- Mangtani, Punam
- ORCID
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-08-31
- Volume
- 47
- Issue
- 1
- Pages
- 193-201
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- OpenAlex
- W2751693207
- Cited by
- 57
- References
- 25
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 9 · 2023: 4 · 2022: 4 · 2021: 8 · 2020: 13 · 2019: 11 · 2018: 3
- FWCI
- 5.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (acceptedVersion, other-oa)
- Explore Bristol Research (acceptedVersion, other-oa)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- NIHR (NF-SI-0616–10037)
- HTA (08/17/01)
- National Institute for Health Research
- MRC
- BBSRC
- PHE
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Life Sciences › Immunology and Microbiology › Immunology › Immune responses and vaccinations
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- BCG vaccine, tuberculosis, vaccine effectiveness, waning vaccine protection, school-aged children, childhood immunization, tuberculosis control, cost-effectiveness
- MeSH terms
- Adolescent, BCG Vaccine, Child, Cost-Benefit Analysis, England, Female, Humans, Male, School Health Services, Time Factors, Tuberculosis, Cohort Studies, Program Evaluation, Incidence, Proportional Hazards Models, Case-Control Studies
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