Abstract
Background
Bacillus Calmette-Guérin (BCG) vaccination has recently been found to have beneficial effects among children infected other than Mycobacterium tuberculosis. Due to the paucity of data on the outcomes of children who had successful BCG vaccination following Expanded Programme on Immunization (EPI) schedule, we aimed to investigate the characteristics of such children and their outcomes who were hospitalized for severe malnutrition.
Methods
A prospective observational study was conducted to determine the viral etiology of pneumonia in severely malnourished children those were admitted to the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between April 2015 and December 2017, constituted the study population. Using a case-control design for the analysis, children having BCG vaccination prior hospital admission were treated as cases (n = 611) and those without vaccination, constituted as controls (n = 83). Bi-variate analysis was conducted using socio-demographic, clinical, laboratory, and treatment characteristics on admission and outcomes during hospitalization. Finally, log-linear binomial regression analysis was done to identify independent impact of BCG vaccination.
Results
The cases more often presented with older age, have had lower proportion of maternal illiteracy, higher rate of breastfeeding, severe wasting and lower rate of hypoglycemia, compared to the controls. The cases were also found to have lower risk of severe sepsis and deaths, compared to the controls (for all, p<0.05). However, in log-linear binomial regression analysis, after adjusting for potential confounders, BCG vaccination following EPI schedule (RR:0.54; 95%CI = 0.33–0.89; p = 0.015) and breastfeeding (RR:0.53; 95%CI = 0.35–0.81; p = 0.003) were found to be protective for the development of severe sepsis.
Conclusion
BCG vaccination and breastfeeding were found to be protective for the development of severe sepsis in hospitalized severely malnourished under-five children which underscores the importance of continuation of BCG vaccination at birth and breastfeeding up to two years of age.
Funder
Centers for Disease Control and Prevention
Publisher
Public Library of Science (PLoS)
Reference50 articles.
1. Bacille Calmette Guérin (BCG) and new TB vaccines: specific, cross-mycobacterial and off-target effects.;N Fritschi,2020
2. Socioeconomic factors associated with full childhood vaccination in Bangladesh, 2014.;ML Boulton,2018
3. Co-administration of BCG and diphtheria-tetanus-pertussis (DTP) vaccinations may reduce infant mortality more than the WHO-schedule of BCG first and then DTP.;P Aaby;A re-analysis of demographic surveillance data from rural Bangladesh.,2017
4. Protective vaccination against tuberculosis with special reference to BCG vaccination.;JDJArot Aronson,1948
5. BCG Vaccination of Indian Infants in Saskatchewan.;R Ferguson;(A Study carried out with Financial Assistance from the National Research Council of Canada.).,1949