Could changes in national tuberculosis vaccination policies be ill-informed ?

D.J. Gerberry; F.A. Milner

Mathematical Modelling of Natural Phenomena (2012)

  • Volume: 7, Issue: 3, page 78-98
  • ISSN: 0973-5348

Abstract

top
National policies regarding the BCG vaccine for tuberculosis vary greatly throughout the international community and several countries are currently considering discontinuing universal vaccination. Detractors of BCG point to its uncertain effectiveness and its interference with the detection and treatment of latent tuberculosis infection (LTBI). In order to quantify the trade-off between vaccination and treatment of LTBI, a mathematical model was designed and calibrated to data from Brazil, Ghana, Germany, India, Mexico, Romania, the United Kingdom and the United States. Country-specific thresholds for when LTBI treatment outperforms mass vaccination were found and the consequences of policy changes were estimated. Our results suggest that vaccination outperforms LTBI treatment in all settings but with greatly reduced efficiency in low incidence countries. While national policy statements emphasize BCG’s interference with LTBI detection, we find that reinfection should be more determinant of a country’s proper policy choice.

How to cite

top

Gerberry, D.J., and Milner, F.A.. "Could changes in national tuberculosis vaccination policies be ill-informed ?." Mathematical Modelling of Natural Phenomena 7.3 (2012): 78-98. <http://eudml.org/doc/222418>.

@article{Gerberry2012,
abstract = {National policies regarding the BCG vaccine for tuberculosis vary greatly throughout the international community and several countries are currently considering discontinuing universal vaccination. Detractors of BCG point to its uncertain effectiveness and its interference with the detection and treatment of latent tuberculosis infection (LTBI). In order to quantify the trade-off between vaccination and treatment of LTBI, a mathematical model was designed and calibrated to data from Brazil, Ghana, Germany, India, Mexico, Romania, the United Kingdom and the United States. Country-specific thresholds for when LTBI treatment outperforms mass vaccination were found and the consequences of policy changes were estimated. Our results suggest that vaccination outperforms LTBI treatment in all settings but with greatly reduced efficiency in low incidence countries. While national policy statements emphasize BCG’s interference with LTBI detection, we find that reinfection should be more determinant of a country’s proper policy choice. },
author = {Gerberry, D.J., Milner, F.A.},
journal = {Mathematical Modelling of Natural Phenomena},
keywords = {tuberculosis; BCG; vaccination; mathematical modeling; threshold analysis; latent tuberculosis detection; latent tuberculosis treatment},
language = {eng},
month = {6},
number = {3},
pages = {78-98},
publisher = {EDP Sciences},
title = {Could changes in national tuberculosis vaccination policies be ill-informed ?},
url = {http://eudml.org/doc/222418},
volume = {7},
year = {2012},
}

TY - JOUR
AU - Gerberry, D.J.
AU - Milner, F.A.
TI - Could changes in national tuberculosis vaccination policies be ill-informed ?
JO - Mathematical Modelling of Natural Phenomena
DA - 2012/6//
PB - EDP Sciences
VL - 7
IS - 3
SP - 78
EP - 98
AB - National policies regarding the BCG vaccine for tuberculosis vary greatly throughout the international community and several countries are currently considering discontinuing universal vaccination. Detractors of BCG point to its uncertain effectiveness and its interference with the detection and treatment of latent tuberculosis infection (LTBI). In order to quantify the trade-off between vaccination and treatment of LTBI, a mathematical model was designed and calibrated to data from Brazil, Ghana, Germany, India, Mexico, Romania, the United Kingdom and the United States. Country-specific thresholds for when LTBI treatment outperforms mass vaccination were found and the consequences of policy changes were estimated. Our results suggest that vaccination outperforms LTBI treatment in all settings but with greatly reduced efficiency in low incidence countries. While national policy statements emphasize BCG’s interference with LTBI detection, we find that reinfection should be more determinant of a country’s proper policy choice.
LA - eng
KW - tuberculosis; BCG; vaccination; mathematical modeling; threshold analysis; latent tuberculosis detection; latent tuberculosis treatment
UR - http://eudml.org/doc/222418
ER -

References

top
  1. Centers for Disease Control and Prevention. TB Elimination : Treatment of Latent Tuberculosis Infection (LTBI) July 2007. Accessed March 25, 2009 from :  URIhttp://cdc.gov/TB/pubs/tbfactsheets/treatmentLTBI.pdf
  2. World Health Organization. WHO position paper on BCG vaccination. Weekly Epidemiological Record, 79(4) :27–38, January 2004. Accessed on May 5, 2008 from :  URIhttp://www.who.int/wer
  3. Centers for Disease Control and Prevention. The role of BCG vaccine in the prevention and control of tuberculosis in the United States. Morbidity and Mortality Weekly Report : Recommendations and Reports, 45(RR-4), 1996.  
  4. World Health Organization. Global Tuberculosis Database, 2008. Accessed March 12, 2009 from :  URIhttp://www.who.int/tb/country/global_tb_database/en/
  5. World Health Organization, Department of Immunization, Vaccines and Biologicals. WHO vaccine-preventable diseases : monitoring system. 2007 Global Summary, 2007. Accessed on March 12, 2009 from :  URIhttp://whqlibdoc.who.int/hq/2007/who_ivb_2007_eng.pdf
  6. United States Census Bureau, Population Division. International Data Base, Decemeber 15, 2008. Accessed Jan 9, 2009 from  URIhttp://www.census.gov/ipc/www/idb/index.html
  7. E. Ziv, C.L. Daley, and S.M. Blower. Potential public health impact of new tuberculosis vaccines. Emerg. Inf. Dis.10(9) :1529–1535, September 2004.  
  8. Ted Cohen, Caroline Colijn, Bryson Finklea, and Megan Murray. Exogenous re-infection and the dynamics of tuberculosis epidemics : local effects in a network model for transmission. J. R. Soc. Interface, 4 :523–531, 2007.  
  9. P.G. Smith and A.R. Moss. Tuberculosis : Pathogenesis, Protection, and Control, chapter Epidemiology of tuberculosis. ASM Press, 1994.  
  10. D. Smith, E. Wiegeshaus, and V. Balasubramanian. An analysis of some hypothesis related to the Chingelput Bacille Calmette-Guérin trial. Clinical Infectious Diseases, 31 (Suppl 3) :S77–80, 2000.  
  11. M.G.M. Gomes, A.O. Franco, M.C. Gomes, G.F. Medley. The reinfection threshold promotes variability in tuberculosis epidemiology and vaccine efficay. Proc. R. Soc. Lond. B, 271 :617–623, 2004.  
  12. D. Menzies. What does tuberculin reactivity after Bacille Calmette-Guèrin vaccination tell us ?Clinical Infectious Diseases, 31(Suppl 3) :S71–4, 2000.  
  13. R.I. Menzies and B. Vissandjee. Effect of Bacille Calmette-Guérin vaccination on tuberculin reactivity. Am. Rev. Respir. Dis., 145 :621–5, 1992.  
  14. Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. Morbidity and Mortality Weekly Report : Recommendations and Reports, 49(RR-6) :1–54, 2000.  
  15. F. Ma. Cecilia García-Sancho, Lourdes García-García, Ma. Eugenia Jiménez-Corona, Manuel Palacios-Martínez, Leticia D. Ferreyra-Reyes, Sergio Canizales-Quintero, Bulmaro Cano-Arellano, Alfredo Ponce de León, José Sifuentes-Osornio, Peter Small, and Kathryn DeRiemer. Is tuberculin skin testing useful to diagnose latent tuberculosis in BCG-vaccinated children ?International Journal of Epidemiology, 35 :1447–1454, 2006.  
  16. S. Gryzbowski, G.D. Barnett, and K Styblo. Contact case of active pulmonary tuberculosis. International Union against Tuberculosis, 50(1) :90–106, Mar 1975.  
  17. T.J. Joos, W.C. Miller, and D.M. Murdoch. Tuberculin reactivity in bacille Calmette-Guérin vaccinated populations : a compilation of international data. Int J Tuberc Lung Dis, 10(8) :883–91, Aug 2006.  
  18. D.-L. Ling, Y.-P. Liaw, C.-Y. Lee, H.-Y. Lo, H.-L. Yang, and P.-C. Chan. Contact investigation for tuberculosis in taiwan contacts aged under 20 years in 2005. Int J Tuberc Lung Dis, 15(1) :50–5, Jan 2011.  
  19. P. Musoke Mudido, D. Guwatudde, M.K. Nakakeeto, G.B. Bukenya, D. Nsamba, J.L. Johnson, R.D. Mugerwa, J.J. Ellner, and C.C. Whalen. The effect of bacille Calmette-Guérin vaccination at birth of tuberculin skin test reactivity in Ugandan children. Int. J. Tuberc. Lung Dis., 3(10) :891–895, 1999.  
  20. Ibrahim O Al-Orainey. Diagnosis of latent tuberculosis : Can we do better ?Ann Thorac Med, 4(1) :5–9, Jan 2009.  
  21. Ajit Lalvani and Manish Pareek. A 100 year update on diagnosis of tuberculosis infection. British Medical Bulletin93 :69–84, Jan 2010.  
  22. O. Oxlade, K. Schwartzman, and D. Menzies. Interferon-gamma release assays and tb screening in high-income countries : a cost-effectiveness analysis. Int J Tuberc Lung Dis, 11(1) :16–26, Jan 2007.  
  23. S. Verver, R.M. Warren, N. Beyers, M. Richardson, G.D. van der Spuy, M.W. Borgdorff, D.A. Enarson, M.A. Behr, and P.D. Helden. Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. Am. J. Respir. Crit. Care. Med., 171(12) :1324–5, June 2005.  
  24. Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 2007. Atlanta, GA, September 2008.  
  25. D.J. Gerberry. Trade-off between bcg vaccination and the ability to detect and treat latent tuberculosis. Journal of Theoretical Biology, 261(4) :548–60, 2009.  
  26. G.W. Comstock, V.T. Livesay, and S.F. Woolpert. The prognosis of a positive tuberculin reaction in childhood and adolescence. American Journal of Epidemiology, 99(2) :131–8, Feb 1974.  
  27. Thomas R. Frieden, Timothy R. Sterling, Sonal S. Munsiff, Catherine J. Watt, and Christopher Dye. Tuberculosis. Lancet, 362 :887–899, 2003.  
  28. Douglas Young and Christopher Dye. The development and impact of tuberculosis vaccines. Cell, 124(4) :683–687, 2006.  
  29. S.M. Blower, A.R. McLean, T.C. Porco, P.M. Small, P.C. Hopewell, M.A. Sanchez, and A.R. Moss. The intrinsic transmission dynamics of tuberculosis epidemics. Nature Medicine, 1(8) :815–821, August 1995.  
  30. T.C. Porco and S.M. Blower. Quantifying the intrinsic transmission dynamics of tuberculosis epidemics. Theoretical Population Biology, 54 :117–132, 1998.  
  31. Mayo Foundation for Medical Education and Research. Tuberculosis, Jan 28, 2009. Accessed May 21, 2009 from :  URIhttp://www.mayoclinic.com/health/tuberculosis/DS00372/
  32. N.E. Aronson, M. Santosham, G.W. Comstock, R.S. Howard, L.H. Moulton, E.R. Rhoades, and L.H. Harrison. Long-term efficacy of BCG vaccine in American Indians and Alaska Natives : A 60-year follow-up study. JAMA, 291(17) :2086–2091, 2004.  
  33. J.A.C. Sterne, L.C. Rodrigues, and I.N. Guedes. Does the efficacy of BCG decline with time since vaccination ?Int. J. Tuberc. Lung Dis., 2(3) :200–207, 1998.  
  34. Christopher Dye, Geoffrey P. Garnett, Karen Sleeman, and Brian G. Williams. Prospects for worldwide tuberculosis control under the WHO DOTS strategy. The Lancet, 352 :1886–1891, 1998.  
  35. Christopher Dye, Suzanne Scheele, Paul Dolin, Vikram Pathania, and Mario C. Raviglione. Global burden of tuberculosis : Estimated incidence, prevalence, and mortality by country. JAMA, 282 :677–686, 1999.  
  36. World Health Organization. Tuberculosis factsheet No. 104, March 2007. Accessed May 10, 2009 from :  URIhttp://www.who.int/mediacentre/factsheets/fs104/en/index.html
  37. Diane E. Bennett, Jeanne M. Courval, Ida Onorato, Tracy Agerton, Judy D. Gibson, Lauren Lambert, Geraldine M. McQuillan, Brenda Lewis, Thomas R. Navin, and Kenneth G. Castro. Prevalence of tuberculosis infection in the United States population. Am. J. Respir. Crit. Care Med., 177 :348–355, 2008.  
  38. Timothy R. Sterling, James Bethel, Stefan Goldberg, Paul Weinfurter, Lourdes Yun, C. Robert Horsburgh, and the Tuberculosis Epidemiologic Studies Consortium. The scope and and impact of treatment of latent tuberculosis infection in the United States and Canada. Am. J. Respir. Crit. Care Med., 173 :927–931, 2006.  
  39. Anneke C Hesseling, Ben J Marais, Robert P Gie, H Simon Schaaf, Paul E M Fine, Peter Godfrey-Faussett, and Nulda Beyers. The risk of disseminated Bacille Calmette-Guerin (BCG) disease in HIV-infected children. Vaccine, 25(1) :14–8, Jan 2007.  
  40. World Health Organization. Revised BCG vaccination guidelines for children with HIV infection. pages 1–4, Apr 2007.  
  41. G. Elzinga, M.C. Raviglione, and D. Maher. Scale up : meeting targets in global tuberculosis control. Lancet, 363 :814–819, 2004.  

NotesEmbed ?

top

You must be logged in to post comments.

To embed these notes on your page include the following JavaScript code on your page where you want the notes to appear.

Only the controls for the widget will be shown in your chosen language. Notes will be shown in their authored language.

Tells the widget how many notes to show per page. You can cycle through additional notes using the next and previous controls.

    
                

                
Note: Best practice suggests putting the JavaScript code just before the closing </body> tag.