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CSU 33/2008: BCG AND LEPROSY PROTECTION

Monday, 4th of August 2008 Print
CSU 33/2008: BCG AND LEPROSY PROTECTION

Work from Malawi and elsewhere has pointed to a protective effect against leprosy of BCG vaccination. In this study from Brazil, summarized below, the authors conclude that contact BCG vaccination of leprosy patients is justified in areas still endemic for leprosy. Good reading. BD 'Effectiveness of BCG vaccination among leprosy contacts: a cohort study' Trans Roy Soc Trop Med Hyg, 2008, Pages 631-638 N.C. Düppre, L.A.B. Camacho, S.S. da Cunha, C.J. Struchiner, A.M. Sales, J.A.C. Nery, E.N. Sarno Summary The study assessed the effectiveness of BCG vaccination against leprosy among the contacts of 1161 leprosy patients at the FIOCRUZ Leprosy Outpatient Clinic, RJ, Brazil, from June 1987 to December 2006. Following National Leprosy Program guidelines, the clinic has administered one-to-two doses to all healthy contacts since 1991. Among the 5680 contacts, 304 (5.4%) already had leprosy. Of the 5376 eligible healthy contacts, 3536 were vaccinated, 30 of whom were excluded due to previous or current tuberculosis, or HIV. In 18 years of follow up, 122 (2.15%) incident cases were diagnosed (58 vaccinated and 64 not), 28 occurring in the first year of follow up (21 vaccinated, 16 with no scar). The protection conferred by BCG was 56% and was not substantially affected by previous BCG vaccination (50% with a scar and 59% without). The risk of tuberculoid leprosy during the initial months was high among those vaccinated with no scar. However, it had substantially declined by the first year and in the following years, when the protection rate in this group reached 80%. Since Brazil is endemic for leprosy and the detection rate is not declining satisfactorily, vaccinating all contacts could be an effective means of substantially reducing the incidence of leprosy.
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