BCG vaccination is associated with reduced malaria prevalence in children under the age of 5 years in sub-Saharan Africa

Mike L.T. Berendsen*, Sjors W.L. Van Gijzel, Jeroen Smits, Quirijn De Mast, Peter Aaby, Christine S. Benn, Mihai G. Netea, Andre J.A.M. Van Der Ven

*Kontaktforfatter for dette arbejde

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Introduction Malaria continues to be a major cause of morbidity and mortality in sub-Saharan Africa (SSA) without effective interventions. Bacillus Calmette-Guérin (BCG) vaccine possesses protective non-specific effects, which extend beyond protection against tuberculosis. This study explores whether BCG is associated with protection against malaria in children under the age of 5 years in SSA. Methods We used data from the Demographic Health Survey programme, including 34 206 children from 13 SSA countries. BCG status was taken from vaccination cards when present; if not, mother's recall was used. Presence of malaria was defined as a positive rapid diagnostic test. Maternally reported presence or absence of fever in the previous 2 weeks defined symptomatic status. Multilevel logistic regression was used to account for the two-stage cluster sampling method. Results Of the 34 206 children, 12 325 (36.0%) children were malaria positive and 29 766 (87.0%) were BCG vaccinated. After correction for relevant child, maternal and household factors, BCG vaccination was associated with a lower malaria prevalence (adjusted OR (aOR)=0.94, 95% CI 0.90 to 0.98), especially among children of whom BCG information was retrieved from a vaccination card (aOR card =0.88, 95% CI 0.82 to 0.94). Restricting the analysis to children from regions with suboptimal BCG coverage increased the association (aOR card =0.81, 95% CI 0.73 to 0.89). We observed an increasingly beneficial association with each mont of age of the child (aOR card =0.996, 95% CI 0.993 to 0.999). BCG associations were similar for asymptomatic (aOR card =0.86, 95% CI 0.81 to 0.92) and symptomatic (aOR card =0.89, 95% CI 0.78 to 1.01) malaria. Conclusions BCG vaccination is associated with protection against malaria. This protection is highest in regions with suboptimal BCG coverage. These results indicate a possible role for timely BCG vaccination in the protection of malaria and its elimination by reducing the transmission reservoir. If confirmed in further research, our findings have substantial implications for global efforts to reduce malaria burden.

OriginalsprogEngelsk
Artikelnummere001862
TidsskriftBMJ Global Health
Vol/bind4
Udgave nummer6
Antal sider11
DOI
StatusUdgivet - 1. nov. 2019

Fingeraftryk

Africa South of the Sahara
Malaria
Mothers
Routine Diagnostic Tests
Logistic Models

Citer dette

Berendsen, Mike L.T. ; Van Gijzel, Sjors W.L. ; Smits, Jeroen ; De Mast, Quirijn ; Aaby, Peter ; Benn, Christine S. ; Netea, Mihai G. ; Van Der Ven, Andre J.A.M. / BCG vaccination is associated with reduced malaria prevalence in children under the age of 5 years in sub-Saharan Africa. I: BMJ Global Health. 2019 ; Bind 4, Nr. 6.
@article{4106d509746f4b6bbb04a26bfa0fde44,
title = "BCG vaccination is associated with reduced malaria prevalence in children under the age of 5 years in sub-Saharan Africa",
abstract = "Introduction Malaria continues to be a major cause of morbidity and mortality in sub-Saharan Africa (SSA) without effective interventions. Bacillus Calmette-Gu{\'e}rin (BCG) vaccine possesses protective non-specific effects, which extend beyond protection against tuberculosis. This study explores whether BCG is associated with protection against malaria in children under the age of 5 years in SSA. Methods We used data from the Demographic Health Survey programme, including 34 206 children from 13 SSA countries. BCG status was taken from vaccination cards when present; if not, mother's recall was used. Presence of malaria was defined as a positive rapid diagnostic test. Maternally reported presence or absence of fever in the previous 2 weeks defined symptomatic status. Multilevel logistic regression was used to account for the two-stage cluster sampling method. Results Of the 34 206 children, 12 325 (36.0{\%}) children were malaria positive and 29 766 (87.0{\%}) were BCG vaccinated. After correction for relevant child, maternal and household factors, BCG vaccination was associated with a lower malaria prevalence (adjusted OR (aOR)=0.94, 95{\%} CI 0.90 to 0.98), especially among children of whom BCG information was retrieved from a vaccination card (aOR card =0.88, 95{\%} CI 0.82 to 0.94). Restricting the analysis to children from regions with suboptimal BCG coverage increased the association (aOR card =0.81, 95{\%} CI 0.73 to 0.89). We observed an increasingly beneficial association with each mont of age of the child (aOR card =0.996, 95{\%} CI 0.993 to 0.999). BCG associations were similar for asymptomatic (aOR card =0.86, 95{\%} CI 0.81 to 0.92) and symptomatic (aOR card =0.89, 95{\%} CI 0.78 to 1.01) malaria. Conclusions BCG vaccination is associated with protection against malaria. This protection is highest in regions with suboptimal BCG coverage. These results indicate a possible role for timely BCG vaccination in the protection of malaria and its elimination by reducing the transmission reservoir. If confirmed in further research, our findings have substantial implications for global efforts to reduce malaria burden.",
keywords = "bacillus Calmette-Gu{\'e}rin, DHS, heterologous effects, malaria",
author = "Berendsen, {Mike L.T.} and {Van Gijzel}, {Sjors W.L.} and Jeroen Smits and {De Mast}, Quirijn and Peter Aaby and Benn, {Christine S.} and Netea, {Mihai G.} and {Van Der Ven}, {Andre J.A.M.}",
year = "2019",
month = "11",
day = "1",
doi = "10.1136/bmjgh-2019-001862",
language = "English",
volume = "4",
journal = "BMJ Global Health",
issn = "2059-7908",
publisher = "BMJ Publishing Group",
number = "6",

}

BCG vaccination is associated with reduced malaria prevalence in children under the age of 5 years in sub-Saharan Africa. / Berendsen, Mike L.T.; Van Gijzel, Sjors W.L.; Smits, Jeroen; De Mast, Quirijn; Aaby, Peter; Benn, Christine S.; Netea, Mihai G.; Van Der Ven, Andre J.A.M.

I: BMJ Global Health, Bind 4, Nr. 6, e001862, 01.11.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - BCG vaccination is associated with reduced malaria prevalence in children under the age of 5 years in sub-Saharan Africa

AU - Berendsen, Mike L.T.

AU - Van Gijzel, Sjors W.L.

AU - Smits, Jeroen

AU - De Mast, Quirijn

AU - Aaby, Peter

AU - Benn, Christine S.

AU - Netea, Mihai G.

AU - Van Der Ven, Andre J.A.M.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Introduction Malaria continues to be a major cause of morbidity and mortality in sub-Saharan Africa (SSA) without effective interventions. Bacillus Calmette-Guérin (BCG) vaccine possesses protective non-specific effects, which extend beyond protection against tuberculosis. This study explores whether BCG is associated with protection against malaria in children under the age of 5 years in SSA. Methods We used data from the Demographic Health Survey programme, including 34 206 children from 13 SSA countries. BCG status was taken from vaccination cards when present; if not, mother's recall was used. Presence of malaria was defined as a positive rapid diagnostic test. Maternally reported presence or absence of fever in the previous 2 weeks defined symptomatic status. Multilevel logistic regression was used to account for the two-stage cluster sampling method. Results Of the 34 206 children, 12 325 (36.0%) children were malaria positive and 29 766 (87.0%) were BCG vaccinated. After correction for relevant child, maternal and household factors, BCG vaccination was associated with a lower malaria prevalence (adjusted OR (aOR)=0.94, 95% CI 0.90 to 0.98), especially among children of whom BCG information was retrieved from a vaccination card (aOR card =0.88, 95% CI 0.82 to 0.94). Restricting the analysis to children from regions with suboptimal BCG coverage increased the association (aOR card =0.81, 95% CI 0.73 to 0.89). We observed an increasingly beneficial association with each mont of age of the child (aOR card =0.996, 95% CI 0.993 to 0.999). BCG associations were similar for asymptomatic (aOR card =0.86, 95% CI 0.81 to 0.92) and symptomatic (aOR card =0.89, 95% CI 0.78 to 1.01) malaria. Conclusions BCG vaccination is associated with protection against malaria. This protection is highest in regions with suboptimal BCG coverage. These results indicate a possible role for timely BCG vaccination in the protection of malaria and its elimination by reducing the transmission reservoir. If confirmed in further research, our findings have substantial implications for global efforts to reduce malaria burden.

AB - Introduction Malaria continues to be a major cause of morbidity and mortality in sub-Saharan Africa (SSA) without effective interventions. Bacillus Calmette-Guérin (BCG) vaccine possesses protective non-specific effects, which extend beyond protection against tuberculosis. This study explores whether BCG is associated with protection against malaria in children under the age of 5 years in SSA. Methods We used data from the Demographic Health Survey programme, including 34 206 children from 13 SSA countries. BCG status was taken from vaccination cards when present; if not, mother's recall was used. Presence of malaria was defined as a positive rapid diagnostic test. Maternally reported presence or absence of fever in the previous 2 weeks defined symptomatic status. Multilevel logistic regression was used to account for the two-stage cluster sampling method. Results Of the 34 206 children, 12 325 (36.0%) children were malaria positive and 29 766 (87.0%) were BCG vaccinated. After correction for relevant child, maternal and household factors, BCG vaccination was associated with a lower malaria prevalence (adjusted OR (aOR)=0.94, 95% CI 0.90 to 0.98), especially among children of whom BCG information was retrieved from a vaccination card (aOR card =0.88, 95% CI 0.82 to 0.94). Restricting the analysis to children from regions with suboptimal BCG coverage increased the association (aOR card =0.81, 95% CI 0.73 to 0.89). We observed an increasingly beneficial association with each mont of age of the child (aOR card =0.996, 95% CI 0.993 to 0.999). BCG associations were similar for asymptomatic (aOR card =0.86, 95% CI 0.81 to 0.92) and symptomatic (aOR card =0.89, 95% CI 0.78 to 1.01) malaria. Conclusions BCG vaccination is associated with protection against malaria. This protection is highest in regions with suboptimal BCG coverage. These results indicate a possible role for timely BCG vaccination in the protection of malaria and its elimination by reducing the transmission reservoir. If confirmed in further research, our findings have substantial implications for global efforts to reduce malaria burden.

KW - bacillus Calmette-Guérin

KW - DHS

KW - heterologous effects

KW - malaria

U2 - 10.1136/bmjgh-2019-001862

DO - 10.1136/bmjgh-2019-001862

M3 - Journal article

AN - SCOPUS:85075171796

VL - 4

JO - BMJ Global Health

JF - BMJ Global Health

SN - 2059-7908

IS - 6

M1 - e001862

ER -