TY - JOUR
T1 - Mortality Risk Among Frail Neonates and Maternal BCG Vaccine Scar Status
T2 - Observational study from Guinea-Bissau
AU - Schaltz-Buchholzer, Frederik
AU - Aaby, Peter
AU - Silva, Isaquel
AU - Monteiro, Ivan
AU - Kollmann, Tobias R
AU - Amenyogbe, Nelly
AU - Bjerregaard-Andersen, Morten
AU - Benn, Christine Stabell
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America and HIV Medicine Association.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - BACKGROUND: Maternal priming with the Bacille Calmette-Guérin (BCG) vaccine has been associated with reduced offspring mortality rates. We investigated this association in a cohort of frail neonates.METHODS: We performed an observational study within a randomized BCG trial conducted at the neonatal intensive care unit (NICU) in Guinea-Bissau from 2015 to 2017. At NICU admission and after informed consent, the maternal scar status was evaluated by visual inspection before neonates were randomized 1:1 to receive BCG + oral polio vaccine immediately or at hospital discharge. Stratified by maternal scar status, we assessed overall in-hospital and postdischarge mortality rates through 42 days of age in Cox proportional hazards models providing adjusted mortality rate ratios (aMRRs).RESULTS: Overall, 62% of mothers (903 of 1451) had a BCG vaccine scar. During NICU admission, the mortality risk was 1.7% (15 of 903) for neonates born to mothers with a scar versus 3.3% (18 of 548) for those born to mothers with no scar; the aMRR for maternal scar versus no scar was 0.53 (95% CI, .26-1.05), 0.39 (95% CI, .13-1.05) for unvaccinated and 0.70 (95% CI, .26-1.87) for vaccinated neonates.CONCLUSIONS: This small study indicates that maternal BCG vaccine might be associated with reduced all-cause NICU mortality rate. If confirmed elsewhere, this finding would have substantial ramifications for global health.
AB - BACKGROUND: Maternal priming with the Bacille Calmette-Guérin (BCG) vaccine has been associated with reduced offspring mortality rates. We investigated this association in a cohort of frail neonates.METHODS: We performed an observational study within a randomized BCG trial conducted at the neonatal intensive care unit (NICU) in Guinea-Bissau from 2015 to 2017. At NICU admission and after informed consent, the maternal scar status was evaluated by visual inspection before neonates were randomized 1:1 to receive BCG + oral polio vaccine immediately or at hospital discharge. Stratified by maternal scar status, we assessed overall in-hospital and postdischarge mortality rates through 42 days of age in Cox proportional hazards models providing adjusted mortality rate ratios (aMRRs).RESULTS: Overall, 62% of mothers (903 of 1451) had a BCG vaccine scar. During NICU admission, the mortality risk was 1.7% (15 of 903) for neonates born to mothers with a scar versus 3.3% (18 of 548) for those born to mothers with no scar; the aMRR for maternal scar versus no scar was 0.53 (95% CI, .26-1.05), 0.39 (95% CI, .13-1.05) for unvaccinated and 0.70 (95% CI, .26-1.87) for vaccinated neonates.CONCLUSIONS: This small study indicates that maternal BCG vaccine might be associated with reduced all-cause NICU mortality rate. If confirmed elsewhere, this finding would have substantial ramifications for global health.
KW - Bacille Calmette-Guerin (BCG) vaccine
KW - NICU mortality
KW - maternal BCG priming
KW - maternal BCG scar
KW - nonspecific effects of vaccines
KW - perinatal mortality
KW - vertical priming
U2 - 10.1093/infdis/jiac140
DO - 10.1093/infdis/jiac140
M3 - Journal article
C2 - 35417538
SN - 0022-1899
VL - 227
SP - 1237
EP - 1244
JO - The Journal of Infectious Diseases
JF - The Journal of Infectious Diseases
IS - 11
ER -