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Effectiveness of BCG vaccination against tuberculous meningitis: a case-control study in São Paulo, Brazil
V Wünsch Filho1, E A de Castilho, L C Rodrigues
1Department of Epidemiology, Faculdade de Saúde Publica, Universidade de São Paulo, Brazil.
Insights
The Bacillus Calmette-Guérin (BCG) vaccine provides significant protection against tuberculous meningitis in children under five. This study found BCG efficacy rates of over 80% in preventing this severe childhood disease.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting children.
- BCG vaccination is a primary preventive measure against TBM, but its efficacy requires ongoing evaluation.
- Understanding BCG's protective effect is crucial for public health strategies in high-burden areas.
Purpose of the Study:
- To assess the effectiveness of BCG vaccination in preventing tuberculous meningitis in children under five years old.
- To determine BCG efficacy using both neighborhood and hospital-based control groups.
Main Methods:
- A matched case-control study design was employed in São Paulo, Brazil.
- Cases comprised 72 children diagnosed with tuberculous meningitis.
- Controls included 505 neighborhood and 81 hospital-based individuals.
Main Results:
- BCG vaccination demonstrated substantial protection against tuberculous meningitis.
- Estimated vaccine efficacy was 84.5% using neighborhood controls and 80.2% using hospital controls.
- No significant interactions were observed between BCG vaccination status and child's sex, age, or socioeconomic status.
Conclusions:
- BCG vaccination is highly effective in preventing tuberculous meningitis in young children.
- The study confirms the protective role of BCG vaccination in a real-world setting.
- Findings support continued high BCG vaccination coverage to reduce TBM incidence.
Abstract:
A case-control study was carried out in the Metropolitan Region of São Paulo, Brazil, to determine the protection against tuberculous meningitis conferred by BCG vaccination to children aged less than 5 years. The BCG vaccination coverage in the study area was about 88%. A total of 72 tuberculous meningitis patients were studied as well as 505 neighbourhood and 81 hospital controls. Analysis of the data using a conditional logistic regression for matched case-control studies indicated that the efficacy of BCG was similar for both groups of controls, that for neighbourhood controls (84.5%) being slightly greater than that for hospital controls (80.2%). No significant interactions were found between vaccination status and sex, age, or socioeconomic status.