BCG Revaccination Does Not Protect Against Leprosy in the Brazilian Amazon A Cluster Randomised Trial 英文参考文献.docVIP

BCGRevaccinationDoesNotProtectAgainstLeprosyin theBrazilianAmazon:AClusterRandomisedTrial Se′rgioS.Cunha1*,NealAlexander2,MauricioL.Barreto1,EmiliaS.Pereira3,Ine?sDourado1,Mariade Fa′timaMaroja3,YuryIchihara4,SilvanaBrito1,SusanPereira1,LauraC.Rodrigues2 1Instituto de Sau′de Coletiva, Universidade Federal da Bahia, State of Bahia, Brazil, 2London School of Hygiene and Tropical Medicine, United Kingdom, 3Fundac?a?o AlfredodaMatta,Manaus,StateofAmazonas,Brazil,4Fundac?a?o NacionaldeSau′de,StateofBahia,Brazil Abstract Background:AlthoughBCGhasbeenfoundtoimpartprotectionagainstleprosyinmanypopulations,theutilityofrepeat or booster BCG vaccinations is stillunclear. When a policyof giving asecond BCGdose to school children in Brazil was introduced,atrialwasconductedtoassessitsimpactagainsttuberculosis,andaleprosycomponentwasthenundertaken inparallel.Objective:toestimatetheprotectionagainstleprosyimpartedbyaseconddoseofBCGgiventoschoolchildren. MethodsandFindings:Thisisaclusterrandomisedcommunitytrial,with6yearsand8monthsoffollow-up.Studysite: Cityof Manaus,Amazonregion, aleprosy-endemic areain Brazil.Participants: 99,770 schoolchildren withneonatal BCG (aged 7–14years at baseline), of whom 42,662 were in the intervention arm (revaccination). Intervention: BCG given by intradermal injection. Main outcome: Leprosy (all clinical forms). Results: The incidence rate ratio of leprosy in the intervention over the control arm within the follow-up, in schoolchildren with neonatal BCG, controlled for potential confoundersandadjustedforclustering,was0.99(95%confidenceinterval:0.68to1.45). Conclusions/Significance:TherewasnoevidenceofprotectionconferredbytheseconddoseofBCGvaccinationinschool childrenagainstleprosyduringthetrialfollow-up.Theseresultspointtoaneedtoconsidertheeffectivenessofthecurrent policyofBCGvaccinationofcontactsofleprosycasesinBrazilianAmazonregion. Citation:CunhaSS,AlexanderN,BarretoML,PereiraES,DouradoI,etal.(2008)BCGRevaccinationDoesNotProtectAgainstLepr