@article{PAR00025510,
  title = {{I}nfant {BCG} vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course : a systematic review and individual participant data meta-analysis},
  author = {{M}artinez, {L}. and {C}ords, {O}. and {L}iu, {Q}. and {A}cuna-{V}illaorduna, {C}. and {B}onnet, {M}aryline and {F}ox, {G}. {J}. and {C}arvalho, {A}. {C}. {C}. and {C}han, {P}. {C}. and {C}roda, {J}. and {H}ill, {P}. {C}. and {L}opez-{V}arela, {E}. and {D}onkor, {S}. and {F}ielding, {K}. and {G}raham, {S}. {M}. and {E}spinal, {M}. {A}. and {K}ampmann, {B}. and {R}eingold, {A}. and {H}uerga, {H}. and {V}illalba, {J}. {A}. and {G}randjean, {L}. and {S}otgiu, {G}. and {E}gere, {U}. and {S}ingh, {S}. and {Z}hu, {L}. {M}. and {L}ienhardt, {C}hristian and {D}enholm, {J}. {T}. and {S}eddon, {J}. {A}. and {W}halen, {C}. {C}. and {G}arcia-{B}asteiro, {A}. {L}. and {T}riasih, {R}. and {C}hen, {C}. and {S}ingh, {J}. and {H}uang, {L}. {M}. and {S}harma, {S}. and {H}announ, {D}. and {D}el {C}orral, {H}. and {M}andalakas, {A}. {M}. and {M}alone, {L}. {L}. and {L}ing, {D}. {L}. and {K}ritski, {A}. and {S}tein, {C}. {M}. and {V}ashishtha, {R}. and {B}oulahbal, {F}. and {F}ang, {C}. {T}. and {B}oom, {W}. {H}. and {N}etto, {E}. {M}. and {L}emos, {A}. {C}. and {H}esseling, {A}. {C}. and {K}ay, {A}. and {J}ones-{L}opez, {E}. {C}. and {H}orsburgh, {C}. {R}. and {L}ange, {C}. and {A}ndrews, {J}. {R}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {BCG} vaccines are given to more than 100 million children every year, but there is considerable debate regarding the effectiveness of {BCG} vaccination in preventing tuberculosis and death, particularly among older children and adults. {W}e therefore aimed to investigate the age-specific impact of infant {BCG} vaccination on tuberculosis (pulmonary and extrapulmonary) development and mortality. {M}ethods {I}n this systematic review and individual participant data meta-analysis, we searched {MEDLINE}, {W}eb of {S}cience, {BIOSIS}, and {E}mbase without language restrictions for case-contact cohort studies of tuberculosis contacts published between {J}an 1, 1998, and {A}pril 7, 2018. {S}earch terms included "mycobacterium tuberculosis", "{TB}", "tuberculosis", and "contact". {W}e excluded cohort studies that did not provide information on {BCG} vaccination or were done in countries that did not recommend {BCG} vaccination at birth. {I}ndividual-level participant data for a prespecified list of variables, including the characteristics of the exposed participant (contact), the index case, and the environment, were requested from authors of all eligible studies. {O}ur primary outcome was a composite of prevalent (diagnosed at or within 90 days of baseline) and incident (diagnosed more than 90 days after baseline) tuberculosis in contacts exposed to tuberculosis. {S}econdary outcomes were pulmonary tuberculosis, extrapulmonary tuberculosis, and mortality. {W}e derived adjusted odds ratios (a{OR}s) using mixed-effects, binary, multivariable logistic regression analyses with study-level random effects, adjusting for the variable of interest, baseline age, sex, previous tuberculosis, and whether data were collected prospectively or retrospectively. {W}e stratified our results by contact age and {M}ycobacterium tuberculosis infection status. {T}his study is registered with {PROSPERO}, {CRD}42020180512. {F}indings {W}e identified 14 927 original records from our database searches. {W}e included participant-level data from 26 cohort studies done in 17 countries in our meta-analysis. {A}mong 68 552 participants, 1782 (2.6%) developed tuberculosis (1309 [2.6%] of 49 686 {BCG}-vaccinated participants vs 473 [2.5%] of 18 866 unvaccinated participants). {T}he overall effectiveness of {BCG} vaccination against all tuberculosis was 18% (a{OR} 0.82, 95% {CI} 0.74-0.91). {W}hen stratified by age, {BCG} vaccination only significantly protected against all tuberculosis in children younger than 5 years (a{OR} 0.63, 95% {CI} 0.49-0.81). {A}mong contacts with a positive tuberculin skin test or {IFN}y release assay, {BCG} vaccination significantly protected against tuberculosis among all participants (a{OR} 0.81, 95% {CI} 0.69-0.96), participants younger than 5 years (0.68, 0.47-0.97), and participants aged 5-9 years (0.62, 0.38-0.99). {T}here was no protective effect among those with negative tests, unless they were younger than 5 years (0.54, 0.32-0.90). 14 cohorts reported on whether tuberculosis was pulmonary or extrapulmonary (n=57421). {BCG} vaccination significantly protected against pulmonary tuberculosis among all participants (916 [2. 2%] in 41119 vaccinated participants vs 334 [2.1%] in 16 161 unvaccinated participants; a{OR} 0.81, 0.70-0.94) but not against extra pulmonary tuberculosis (106 [0.3%] in 40 318 vaccinated participants vs 38 [0 2%]in 15 865 unvaccinated participants; 0.96, 0 - 65-1.41). {I}n the four studies with mortality data, {BCG} vaccination was significantly protective against death (0.25, 0.13-0-49). {I}nterpretation {O}ur results suggest that {BCG} vaccination at birth is effective at preventing tuberculosis in young children but is ineffective in adolescents and adults. {I}mmunoprotection therefore needs to be boosted in older populations.},
  keywords = {{MONDE}},
  booktitle = {},
  journal = {{L}ancet {G}lobal {H}ealth},
  volume = {10},
  numero = {9},
  pages = {{E}1307--{E}1316},
  ISSN = {2214-109{X}},
  year = {2022},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00025510},
}