Frequency of BCG Vaccination in Patients of Tuberculosis Meningitis (original) (raw)
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Does BCG vaccine prevent tuberculous meningitis?
The reported efficacy of BCG vaccine in preventing pulmonary tuberculosis varies from 0-80%; however, its efficacy in preventing tuberculous meningitis ranges from 520/%-84%. A case-control study was conducted to assess the efficacy of BCG in preventing tuberculous meningitis in children. New cases oftuberculous meningitis, confirmed bacteriologically, were registered as cases. Controls were children suffering from febrile convulsions attending the same hospital. A total of 107 cases and 321 controls, block matched for age, were registered. Vaccination status was determined from the history reported by the mother and by BCG scar reading. Data regarding socioeconomic status, crowding, and nutritional status were collected. Using multiple logistic regression analysis the odds ratio obtained for the presence of BCG scar was 0-23 (95% confidence interval (CI) 0-14 to 0.37) and the protective efficacy of BCG vaccine in preventing tuberculous meningitis in children was found to be 77% (95% CI 71 to 83%).
Tuberculous meningitis in BCG vaccinated and unvaccinated children
Journal of Neurology, Neurosurgery & Psychiatry, 2005
Background: A modified clinical presentation of tuberculous meningitis (TBM) in children vaccinated with BCG has been described in the literature. However, most reports are old and not based on actual comparisons and tests of significance. Also, neuroimaging features were not compared. With large scale BCG coverage, it becomes pertinent to describe the ''modified'' presentation and identify any significant differences between vaccinated and unvaccinated children with TBM. Methods: A total of 150 consecutive hospitalised children (96 unvaccinated, 54 vaccinated) were enrolled. They all satisfied predefined criteria for diagnosis of TBM. Clinical and radiological features of children with/without a BCG scar were compared. Results: Univariate analysis revealed that the vaccinated children with TBM had significantly lower rates of altered sensorium (68.5% v 85.4% unvaccinated; OR 2.2 (1.1 to 6.2); p = 0.019) and focal neurological deficits (20.3% v 39.5% unvaccinated; OR 2.6 (1.1 to 6.0); p = 0.016), and higher mean (SD) Glasgow Coma Scale score (10.2 (3.4) v 8.76 (2.7) unvaccinated; p = 0.010) and cerebrospinal fluid cell count (210.9 v 140.9 unvaccinated; p = 0.019). No significant radiological differences were seen. Short term outcome was significantly better in the vaccinated group with 70% of the total severe sequelae and 75% of the total deaths occurring in the unvaccinated group (p = 0.018). Conclusion: Children with TBM who have been vaccinated with BCG appear to maintain better mentation and have a superior outcome. This may in part be explained by the better immune response to infection, as reflected in the higher CSF cell counts in this group in the present study.
Tuberculous meningitis in France in 1990: characteristics and impact of BCG vaccination
Tubercle and Lung Disease, 1994
To measure the incidence and describe the characteristics of bacteriologically-confirmed tuberculous meningitis (TBM) and to estimate the protective efficacy of BCG vaccination in children aged less than 5 years. Design: An active surveillance of TBM cases confirmed by positive cerebrospinal fluid (CSF) culture was conducted through a network of microbiology laboratories serving 99.8% of regional and district general hospitals and other large private hospitals. Results: A total of 70 cases were reported: 61% were adults over 44 years, 64% were males and 77% were born in France. 7 patients were known to be infected with HIV. 6 cases were observed in children aged less than 5 years, 2 of whom had been vaccinated with BCG. 3 of the 6 children died (one had been BCGvaccinated). Given the 80% coverage of BCG in this age group, the protective efficacy of BCG vaccination was estimated to be 87.5% (95% CI: 30-98), which indicates that 14 TBM cases may have been prevented by BCG vaccination in 1990. Conclusion: Results are consistent with the number of TBM cases expected on the basis of a 0.04% annual risk of infection. Current BCG vaccination policy in France still has a measurable impact on the incidence of tuberculous meningitis in children under 5 years of age. Given the probable continuous decrease of the annual risk of infection in future years, alternative policies should be considered.
The Lancet, 2006
Study designs and other criteria for inclusion in the review It was unclear whether a systematic review of the literature was undertaken to identify the primary studies. The primary studies may therefore have been identified selectively. Vaccine efficacy was derived from case-control studies. Data on births and yearly risk of infection were derived from international sources and national surveys. DALYs lost were obtained from a World Health Organization (WHO) standard life table. Sources searched to identify primary studies Not reported. Criteria used to ensure the validity of primary studies Not reported. Methods used to judge relevance and validity, and for extracting data Not reported. Number of primary studies included Forty-four primary studies provided the clinical data. Methods of combining primary studies Estimates of vaccine efficacy were aggregated using a meta-analysis. Other estimates appear to have been combined using a narrative approach. Investigation of differences between primary studies The heterogeneity of studies that were used to derive vaccine efficacy was tested. Results of the review The number of children born in 2002 was 132.8 million.
National Journal of Community Medicine, 2013
Introduction: BCG vaccine has shown consistently high efficacy against childhood tubercular meningitis and miliary tuberculosis and other mycobacterial diseases. It is considered to be a safe vaccine with a low incidence of adverse effects. Efficacy of BCG vaccine found in different clinical trials is variable in different geography. Objectives: Study was done to assess the efficacy of BCG vaccine. Materials and Methods: All the children who were less than three years of age and were previously BCG vaccinated and not-vaccinated, were included in this study. A total of sixty (60) vaccinated children and sixty non-vaccinated children were selected. These children were followed up prospectively for 24 months, at the end of which, it was seen whether they developed tuberculosis or not. Results: Out of these 60 children in both the cases and control groups, total number of BCG vaccinated children who developed TB were 4 (i.e. 6.6%) and total number of Non-BCG vaccinated children who developed TB were 12 (i.e. 20%). Thus, the efficacy of BCG vaccine calculated in our study was 67%. Conclusion: Most studies in different parts of the world have shown that the efficacy of BCG vaccine varies from zero to eighty percent. This study favors the efficacy of BCG vaccine. This vaccination strategy will be favorable for our children. Creation of awareness among the parents and family members for an early administration of BCG vaccine after child birth can be recommended.
BCG vaccination is associated with decreased severity of tuberculosis in Pakistan
International Journal of Mycobacteriology, 2012
Vaccination with Bacille Calmette-Gué rin (BCG) is given at birth to protect against tuberculosis (TB) in Pakistan. The country ranks 6th amongst high-burden countries worldwide and has an incidence of 231/100,000 population. This was a cross-sectional multi-center hospital-based study. TB patients (n = 218) with pulmonary (PTB, n = 120) or extrapulmonary (ETB, 98) were recruited, and the presence of a BCG vaccination scar was documented.
Prospective Analysis of 55 Cases of Tuberculosis Meningitis (TBM) in North India
Journal of clinical and diagnostic research : JCDR, 2015
To assess the clinical profile, laboratory and neuroimaging data of adult tuberculous meningitis (TBM) patients and to determine the predictors of mortality. A total of 55 TBM patients and 60 controls were enrolled in this prospective study. Detailed clinical, radiological, biochemical and microbiological evaluation was performed. Done using SPSS 15.0 for Windows. P value of <0.05 was considered to be significant. 61.8% were males and majority of the study subjects belonged to age group of 21-40 years. Duration of symptoms in all cases was >14 days and commonly included fever, headache, neck rigidity, altered sensorium and vomiting. Biochemical features of cerebrospinal fluid (CSF) showed significant results where 94.5%, 85.45%,83.63% and 81.81% of patients showed CSF sugar levels <2/3 corresponding blood sugar, proteins>100mg%, CSF total leucocyte count of >20 cells/mm(3) and ADA >9.5IU/L respectively while neuroimaging revealed hydrocephalus, basal exudates and m...
Spectrum of childhood tuberculosis in BCG vaccinated and unvaccinated children
Medical Journal Armed Forces India, 2009
Background: Childhood tuberculosis remains a major public health problem in India. We evaluated the impact of BCG vaccination on childhood tuberculosis and the underlying risk factors. Methods: 100 consecutive children below 12 years diagnosed to have tuberculosis based on the WHO and IAP consensus statement were included in the study. Result: Majority(42%) of children with tuberculosis were below four years of age. History of contact with a case of tuberculosis was present in 41 cases. BCG scar was present in 77 cases indicating a poor coverage/uptake of BCG vaccination. Pulmonary form of tuberculosis was seen in 52 and extra pulmonary form in 41 cases. Tubercular lymphadenitis was seen in seven cases, of which more than 70 % were in BCG vaccinated group. There was no statistically significant difference in the type of tuberculosis (pulmonary or extra pulmonary) and BCG vaccination. In the extra pulmonary form, 13 children had neuro-tuberculosis, of which 66% were in BCG unvaccinated group, which was statistically significant (p=0.011). The underlying risk factors were poor socioeconomic status (62%), malnutrition (61%) and poor immunization coverage. Conclusion: Higher incidence of pulmonary tuberculosis in BCG vaccinated group was not statistically significant. However, high incidence of neuro-tuberculosis in BCG unvaccinated group was statistically significant. The underlying risk factors were poor socioeconomic status, malnutrition and poor immunization coverage and should be taken into consideration in order to prevent morbidity and mortality due to tuberculosis in children.
Wellcome Open Research, 2019
Tuberculous meningitis (TBM) results from dissemination of M. tuberculosis to the cerebrospinal fluid (CSF) and meninges. Ischaemia, hydrocephalus and raised intracranial pressure frequently result, leading to extensive brain injury and neurodisability. The global burden of TBM is unclear and it is likely that many cases are undiagnosed, with many treated cases unreported. Untreated, TBM is uniformly fatal, and even if treated, mortality and morbidity are high. Young age and human immunodeficiency virus (HIV) infection are potent risk factors for TBM, while Bacillus Calmette–Guérin (BCG) vaccination is protective, particularly in young children. Diagnosis of TBM usually relies on characteristic clinical symptoms and signs, together with consistent neuroimaging and CSF parameters. The ability to confirm the TBM diagnosis via CSF isolation of M. tuberculosis depends on the type of diagnostic tests available. In most cases, the diagnosis remains unconfirmed. GeneXpert MTB/RIF and the n...
Transactions of The Royal Society of Tropical Medicine and Hygiene
Background Tuberculous meningitis (TBM) is the most severe form of TB. We prospectively documented the treatment outcomes and the risk factors for death in children with TBM from Kandahar, Afghanistan. Methods This prospective observational cohort study was conducted from February 2017 to January 2020 in hospitalised TBM children. All the patients were prospectively followed up for 12 mo. Data were analysed by using descriptive statistics, χ2 and multivariate logistic regression. Results A total of 818 TBM hospitalised patients with median age 4.8 (0.8–14.5) y were recruited. Females accounted for 60.9% (498/818). Upon admission 53.9% (n=441) and 15.2% (n=124) had TBM stages II and III, respectively, and 23.2% (n=190) had focal neurological signs. The case fatality rate was 20.2% (160/794) and 30.6% (243/794) survived with neurological sequelae. Independent risk factors for death were being unvaccinated for BCG (adjusted OR [AOR] 3.8, 95% CI 1.8 to 8.1), not receiving dexamethasone ...