Maternal Priming

Bacillus Calmette-Guérin (BCG) Vaccine Scarring in Mothers Enhances the Survival of Their Child With a BCG Vaccine Scar

Mike Berendsen, Christian Øland, Pauli Bles, Aksel Karl Georg Jensen, Poul-Erik Kofoed, Hilton Whittle, Charlotte De Bree, Mihai Netea, Cesario Martins, Christine Stabell Benn, Peter Aaby*

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background and Hypothesis
Maternal priming might enhance the beneficial nonspecific effects (NSEs) of live measles vaccination (MV). Children with a bacillus Calmette-Guérin (BCG) vaccine scar have a lower mortality rate than those without a scar that is not explained by protection against tuberculosis. We examined the hypothesis that BCG scarring would have a stronger effect on a child if the mother also had a BCG scar.

Methods
In a randomized controlled trial (RCT) of early MV in children aged 4.5 months, the BCG-scar status of the children and their mother were registered at enrollment at 4.5 months of age. The children were followed up until they were 36 months of age. Using a Cox proportional hazards model, we compared mortality rate ratios according to maternal and child BCG-scar status after adjusting for where the BCG vaccine was given (the national hospital or elsewhere). We censored for other interventions that have immunomodulating effects on child survival, including neonatal vitamin A supplementation and early MV.

Results
A total of 2213 children had not received neonatal vitamin A supplementation and early MV; 83% of these children and 44% of the mothers had a BCG scar. Children whose mother had a BCG scar were not more likely to have a BCG scar than those whose mother did not have a BCG scar (risk ratio, 1.01 [95% confidence interval (CI), 0.98–1.05]). Among the children, having a BCG scar was associated with a 41% (95% CI, 5%–64%) lower mortality between the ages of 4.5 and 36 months. The reduction in mortality was 66% (95% CI, 33%–83%) if the mother also had a BCG scar but only 8% (95% CI, −83% to 53%) if the mother had no BCG scar (test of interaction, P = .04).

Conclusions
Maternal BCG priming might be important for the effect of BCG vaccination on child survival. Ensuring better BCG vaccine scarring among mothers and children could have a considerable effect on child mortality levels.
OriginalsprogEngelsk
TidsskriftPediatric Infectious Diseases Society. Journal
ISSN2048-7193
DOI
StatusE-pub ahead of print - 3. feb. 2019

Fingeraftryk

Mothers
Measles
Confidence Intervals
Child Mortality
Proportional Hazards Models
Randomized Controlled Trials
Odds Ratio

Citer dette

@article{43a7651cafca4fcfb831cf09c2ef029c,
title = "Maternal Priming: Bacillus Calmette-Gu{\'e}rin (BCG) Vaccine Scarring in Mothers Enhances the Survival of Their Child With a BCG Vaccine Scar",
abstract = "Background and HypothesisMaternal priming might enhance the beneficial nonspecific effects (NSEs) of live measles vaccination (MV). Children with a bacillus Calmette-Gu{\'e}rin (BCG) vaccine scar have a lower mortality rate than those without a scar that is not explained by protection against tuberculosis. We examined the hypothesis that BCG scarring would have a stronger effect on a child if the mother also had a BCG scar.MethodsIn a randomized controlled trial (RCT) of early MV in children aged 4.5 months, the BCG-scar status of the children and their mother were registered at enrollment at 4.5 months of age. The children were followed up until they were 36 months of age. Using a Cox proportional hazards model, we compared mortality rate ratios according to maternal and child BCG-scar status after adjusting for where the BCG vaccine was given (the national hospital or elsewhere). We censored for other interventions that have immunomodulating effects on child survival, including neonatal vitamin A supplementation and early MV.ResultsA total of 2213 children had not received neonatal vitamin A supplementation and early MV; 83{\%} of these children and 44{\%} of the mothers had a BCG scar. Children whose mother had a BCG scar were not more likely to have a BCG scar than those whose mother did not have a BCG scar (risk ratio, 1.01 [95{\%} confidence interval (CI), 0.98–1.05]). Among the children, having a BCG scar was associated with a 41{\%} (95{\%} CI, 5{\%}–64{\%}) lower mortality between the ages of 4.5 and 36 months. The reduction in mortality was 66{\%} (95{\%} CI, 33{\%}–83{\%}) if the mother also had a BCG scar but only 8{\%} (95{\%} CI, −83{\%} to 53{\%}) if the mother had no BCG scar (test of interaction, P = .04).ConclusionsMaternal BCG priming might be important for the effect of BCG vaccination on child survival. Ensuring better BCG vaccine scarring among mothers and children could have a considerable effect on child mortality levels.",
author = "Mike Berendsen and Christian {\O}land and Pauli Bles and Jensen, {Aksel Karl Georg} and Poul-Erik Kofoed and Hilton Whittle and {De Bree}, Charlotte and Mihai Netea and Cesario Martins and Benn, {Christine Stabell} and Peter Aaby",
year = "2019",
month = "2",
day = "3",
doi = "10.1093/jpids/piy142",
language = "English",
journal = "Pediatric Infectious Diseases Society. Journal",
issn = "2048-7193",
publisher = "Heinemann",

}

Maternal Priming : Bacillus Calmette-Guérin (BCG) Vaccine Scarring in Mothers Enhances the Survival of Their Child With a BCG Vaccine Scar. / Berendsen, Mike; Øland, Christian; Bles, Pauli; Jensen, Aksel Karl Georg; Kofoed, Poul-Erik; Whittle, Hilton; De Bree, Charlotte; Netea, Mihai; Martins, Cesario; Benn, Christine Stabell; Aaby, Peter.

I: Pediatric Infectious Diseases Society. Journal, 03.02.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Maternal Priming

T2 - Bacillus Calmette-Guérin (BCG) Vaccine Scarring in Mothers Enhances the Survival of Their Child With a BCG Vaccine Scar

AU - Berendsen, Mike

AU - Øland, Christian

AU - Bles, Pauli

AU - Jensen, Aksel Karl Georg

AU - Kofoed, Poul-Erik

AU - Whittle, Hilton

AU - De Bree, Charlotte

AU - Netea, Mihai

AU - Martins, Cesario

AU - Benn, Christine Stabell

AU - Aaby, Peter

PY - 2019/2/3

Y1 - 2019/2/3

N2 - Background and HypothesisMaternal priming might enhance the beneficial nonspecific effects (NSEs) of live measles vaccination (MV). Children with a bacillus Calmette-Guérin (BCG) vaccine scar have a lower mortality rate than those without a scar that is not explained by protection against tuberculosis. We examined the hypothesis that BCG scarring would have a stronger effect on a child if the mother also had a BCG scar.MethodsIn a randomized controlled trial (RCT) of early MV in children aged 4.5 months, the BCG-scar status of the children and their mother were registered at enrollment at 4.5 months of age. The children were followed up until they were 36 months of age. Using a Cox proportional hazards model, we compared mortality rate ratios according to maternal and child BCG-scar status after adjusting for where the BCG vaccine was given (the national hospital or elsewhere). We censored for other interventions that have immunomodulating effects on child survival, including neonatal vitamin A supplementation and early MV.ResultsA total of 2213 children had not received neonatal vitamin A supplementation and early MV; 83% of these children and 44% of the mothers had a BCG scar. Children whose mother had a BCG scar were not more likely to have a BCG scar than those whose mother did not have a BCG scar (risk ratio, 1.01 [95% confidence interval (CI), 0.98–1.05]). Among the children, having a BCG scar was associated with a 41% (95% CI, 5%–64%) lower mortality between the ages of 4.5 and 36 months. The reduction in mortality was 66% (95% CI, 33%–83%) if the mother also had a BCG scar but only 8% (95% CI, −83% to 53%) if the mother had no BCG scar (test of interaction, P = .04).ConclusionsMaternal BCG priming might be important for the effect of BCG vaccination on child survival. Ensuring better BCG vaccine scarring among mothers and children could have a considerable effect on child mortality levels.

AB - Background and HypothesisMaternal priming might enhance the beneficial nonspecific effects (NSEs) of live measles vaccination (MV). Children with a bacillus Calmette-Guérin (BCG) vaccine scar have a lower mortality rate than those without a scar that is not explained by protection against tuberculosis. We examined the hypothesis that BCG scarring would have a stronger effect on a child if the mother also had a BCG scar.MethodsIn a randomized controlled trial (RCT) of early MV in children aged 4.5 months, the BCG-scar status of the children and their mother were registered at enrollment at 4.5 months of age. The children were followed up until they were 36 months of age. Using a Cox proportional hazards model, we compared mortality rate ratios according to maternal and child BCG-scar status after adjusting for where the BCG vaccine was given (the national hospital or elsewhere). We censored for other interventions that have immunomodulating effects on child survival, including neonatal vitamin A supplementation and early MV.ResultsA total of 2213 children had not received neonatal vitamin A supplementation and early MV; 83% of these children and 44% of the mothers had a BCG scar. Children whose mother had a BCG scar were not more likely to have a BCG scar than those whose mother did not have a BCG scar (risk ratio, 1.01 [95% confidence interval (CI), 0.98–1.05]). Among the children, having a BCG scar was associated with a 41% (95% CI, 5%–64%) lower mortality between the ages of 4.5 and 36 months. The reduction in mortality was 66% (95% CI, 33%–83%) if the mother also had a BCG scar but only 8% (95% CI, −83% to 53%) if the mother had no BCG scar (test of interaction, P = .04).ConclusionsMaternal BCG priming might be important for the effect of BCG vaccination on child survival. Ensuring better BCG vaccine scarring among mothers and children could have a considerable effect on child mortality levels.

U2 - 10.1093/jpids/piy142

DO - 10.1093/jpids/piy142

M3 - Journal article

JO - Pediatric Infectious Diseases Society. Journal

JF - Pediatric Infectious Diseases Society. Journal

SN - 2048-7193

ER -