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Does BCG Vaccination Protect Against Nontuberculous Mycobacterial Infection? A Systematic Review and Meta-Analysis

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Does BCG Vaccination Protect Against Nontuberculous Mycobacterial Infection? A Systematic Review and Meta-Analysis. / Zimmermann, Petra; Finn, Adam; Curtis, Nigel.

In: Journal of Infectious Diseases, 07.04.2018.

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@article{67f9da43e6334b28bb6768d50f8117c4,
title = "Does BCG Vaccination Protect Against Nontuberculous Mycobacterial Infection? A Systematic Review and Meta-Analysis",
abstract = "The incidence of non-tuberculous mycobacterial (NTM) infections is increasing worldwide, particularly NTM lymphadenitis and skin infections (Buruli ulcer). This review summarises the evidence for the protective effectiveness of Bacillus Calmette–Gu{\'e}rin (BCG) vaccination against NTM disease. A systematic search using PRISMA guidelines was done for controlled studies investigating the protective effectiveness of BCG vaccination against NTM disease in immunocompetent individuals. This revealed ten studies, including almost 12 million participants. Three cohort studies in industrialised countries suggest that the incidence of NTM lymphadenitis is greatly reduced among BCG-vaccinated children compared to BCG-unvaccinated children, with a risk ratio (RR) of 0.04 (95{\%} confidence interval (CI) 0.01 to 0.21). In two randomised trials in low-income countries, BCG protected against Buruli ulcer for the first 12 months following vaccination, RR 0.50 (95{\%} CI 0.37 to 0.69). Four case control studies had conflicting results. One cohort study found that individuals with Buruli ulcer are less likely to develop osteomyelitis if they have a BCG scar, RR 0.36 (95{\%} CI 0.22 to 0.58). No studies have compared different BCG vaccine strains or the effect of revaccination in this setting.The protective effect of BCG vaccination against NTM should be taken into consideration when deciding on recommendations for discontinuation of universal BCG vaccination programs and in assessing new vaccines designed to replace BCG.",
keywords = "NTM, nontuberculous, atypical, mycobacteria, lymphadenitis, epidemiology, prevention, Buruli ulcer, M. ulcerans, M. avium, MAC",
author = "Petra Zimmermann and Adam Finn and Nigel Curtis",
year = "2018",
month = "4",
day = "7",
doi = "10.1093/infdis/jiy207",
language = "English",
journal = "Journal of Infectious Diseases",
issn = "0022-1899",
publisher = "Oxford University Press",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Does BCG Vaccination Protect Against Nontuberculous Mycobacterial Infection? A Systematic Review and Meta-Analysis

AU - Zimmermann, Petra

AU - Finn, Adam

AU - Curtis, Nigel

PY - 2018/4/7

Y1 - 2018/4/7

N2 - The incidence of non-tuberculous mycobacterial (NTM) infections is increasing worldwide, particularly NTM lymphadenitis and skin infections (Buruli ulcer). This review summarises the evidence for the protective effectiveness of Bacillus Calmette–Guérin (BCG) vaccination against NTM disease. A systematic search using PRISMA guidelines was done for controlled studies investigating the protective effectiveness of BCG vaccination against NTM disease in immunocompetent individuals. This revealed ten studies, including almost 12 million participants. Three cohort studies in industrialised countries suggest that the incidence of NTM lymphadenitis is greatly reduced among BCG-vaccinated children compared to BCG-unvaccinated children, with a risk ratio (RR) of 0.04 (95% confidence interval (CI) 0.01 to 0.21). In two randomised trials in low-income countries, BCG protected against Buruli ulcer for the first 12 months following vaccination, RR 0.50 (95% CI 0.37 to 0.69). Four case control studies had conflicting results. One cohort study found that individuals with Buruli ulcer are less likely to develop osteomyelitis if they have a BCG scar, RR 0.36 (95% CI 0.22 to 0.58). No studies have compared different BCG vaccine strains or the effect of revaccination in this setting.The protective effect of BCG vaccination against NTM should be taken into consideration when deciding on recommendations for discontinuation of universal BCG vaccination programs and in assessing new vaccines designed to replace BCG.

AB - The incidence of non-tuberculous mycobacterial (NTM) infections is increasing worldwide, particularly NTM lymphadenitis and skin infections (Buruli ulcer). This review summarises the evidence for the protective effectiveness of Bacillus Calmette–Guérin (BCG) vaccination against NTM disease. A systematic search using PRISMA guidelines was done for controlled studies investigating the protective effectiveness of BCG vaccination against NTM disease in immunocompetent individuals. This revealed ten studies, including almost 12 million participants. Three cohort studies in industrialised countries suggest that the incidence of NTM lymphadenitis is greatly reduced among BCG-vaccinated children compared to BCG-unvaccinated children, with a risk ratio (RR) of 0.04 (95% confidence interval (CI) 0.01 to 0.21). In two randomised trials in low-income countries, BCG protected against Buruli ulcer for the first 12 months following vaccination, RR 0.50 (95% CI 0.37 to 0.69). Four case control studies had conflicting results. One cohort study found that individuals with Buruli ulcer are less likely to develop osteomyelitis if they have a BCG scar, RR 0.36 (95% CI 0.22 to 0.58). No studies have compared different BCG vaccine strains or the effect of revaccination in this setting.The protective effect of BCG vaccination against NTM should be taken into consideration when deciding on recommendations for discontinuation of universal BCG vaccination programs and in assessing new vaccines designed to replace BCG.

KW - NTM

KW - nontuberculous

KW - atypical

KW - mycobacteria

KW - lymphadenitis

KW - epidemiology

KW - prevention

KW - Buruli ulcer

KW - M. ulcerans

KW - M. avium

KW - MAC

U2 - 10.1093/infdis/jiy207

DO - 10.1093/infdis/jiy207

M3 - Article

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

SN - 0022-1899

ER -