Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g4643 (Published 05 August 2014)Cite this as: BMJ 2014;349:g4643

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   A Roy, senior scientist1, 
3. M Eisenhut, consultant paediatrician2, 
4. R J Harris, statistician1, 
5. L C Rodrigues, professor of epidemiology3, 
6. S Sridhar, research associate4, 
7. S Habermann, junior doctor2, 
8. L Snell, junior doctor2, 
9. P Mangtani, senior lecturer3, 
10. I Adetifa, paediatrician and medical epidemiologist5, 
11. A Lalvani, professor of infectious disease4, 
12. I Abubakar, professor of infectious disease epidemiology16

Author affiliations

1. Correspondence to: I Abubakar i.abubakar@ucl.ac.uk

• Accepted 11 July 2014

Abstract

Objectives To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children.

Design Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts.

Setting Community congregate settings and households.

Inclusion criteria Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays.

Data extraction Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis.

Results The primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77).

Conclusions BCG protects against M tuberculosis infection as well as progression from infection to disease.

Trial registration PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/).

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The quality of reporting of randomised controlled trials in asthma: a systematic review.

Prim Care Respir J. 2013 Dec;22(4):417-24. doi: 10.4104/pcrj.2013.00089.

Ntala C1, Birmpili P, Worth A, Anderson NH, Sheikh A.

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Abstract

BACKGROUND:

There are concerns about the reporting quality of asthma trials.

AIMS:

To describe the reporting of contemporary asthma trials and to identify factors associated with better reporting quality.

METHODS:

Two reviewers independently searched MEDLINE for randomised controlled trials (RCTs) of asthma published between January 2010 and July 2012 in leading generalist and specialist journals. We calculated the proportion of trials that adequately reported each Consolidated Standards of Reporting Trials (CONSORT) checklist item and an overall quality score for each trial. Factors associated with better reporting quality were investigated.

RESULTS:

Thirty-five RCTs satisfied our eligibility criteria. Four trials adequately reported -50% of the items, 15 adequately reported 50-60% of items, and 16 adequately reported >60% of items. Seventeen of the 38 CONSORT items were consistently well reported in more than two-thirds of the articles. In contrast, nine items were poorly reported in more than half the trials - namely, identification as a randomised trial in the title (40.0%), an adequate structured summary/abstract (48.6%), details of eligibility criteria (34.3%), recruitment (48.6%), randomisation procedures (22.9%), intervention (38.5%), harms (34.3%), the funding source (45.7%), and access to the full trial protocol (17.1%). Studies led by teams in high-income country settings were associated with better quality of reporting (relative risk=1.33, 95% CI 1.09 to 1.64).

CONCLUSIONS:

The quality of reporting in contemporary asthma literature remains suboptimal. We have identified important areas in which reporting quality needs to be improved.

Comment in

• Poor reporting may infer poor science: lessons learned from asthma trials. [Prim Care Respir J. 2013]

PMID:

 

24248328

 

[PubMed - indexed for MEDLINE] 

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The impact of azithromycin therapy on the airway microbiota in asthma

Thorax 2014;69:673-674 doi:10.1136/thoraxjnl-2013-204517

• Research letter

1. Mariel Slater1, 
2. Damian W Rivett2, 
3. Lisa Williams3, 
4. Matthew Martin3, 
5. Tim Harrison3,
6. Ian Sayers1, 
7. Kenneth D Bruce4, 
8. Dominick Shaw3

+Author Affiliations

1. ¹Department of Therapeutics and Molecular Medicine, University of Nottingham, Nottingham, UK
2. ²Department of Ecology and Evolution, Imperial College, London, UK
3. ³Department of Respiratory Medicine, University of Nottingham, Nottingham, UK
4. ⁴Institute of Pharmaceutical Science, Kings College London, London, UK

1. Correspondence toDr Kenneth Bruce, King's College London, Molecular Microbiology Research Laboratory, Institute of Pharmaceutical Science, 150 Stamford Street, London SE1 9NH, UK;kenneth.bruce@kcl.ac.uk

• Received 15 September 2013
• Revised 5 November 2013
• Accepted 6 November 2013
• Published Online First 28 November 2013

Introduction

There is interest in the use of macrolide antibiotics in asthma. Macrolides have been shown to improve airway hyper-responsiveness (AHR) and measures of airway inflammation.1 The degree of AHR may relate to the microbiota present in the airways,2 with a recent study reporting that patients with asthma with a significant improvement in AHR following treatment with clarithromycin had a higher bacterial diversity prior to treatment.3 To our knowledge, the impact on the asthmatic airway microbiota of an antibiotic has not been reported and we therefore set out to establish if macrolide therapy was associated with a change in airway microbiota in asthma.

Methods

Five adult patients with moderate/severe asthma (British Thoracic Society step 4–5) (see online supplementary table S1) and no evidence of respiratory infection or bronchiectasis underwent bronchoscopy before and after 6 weeks of daily 250 mg azithromycin therapy. Patients had consented to the study (REC 11/EM/0062). Saline washings of the right upper lobe were obtained following standard procedure, DNA was isolated from the samples (see online supplementary …

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