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Bacillus of Calmette and Guérin (BCG) and the risk of leprosy in Ciudad del Este, Paraguay, 2016-2017
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Nancy Carolina Cuevas, Victor M. Cardenas
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Epidemiol Health. 2021;43:e2021060. Published online September 8, 2021
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DOI: https://doi.org/10.4178/epih.e2021060
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Abstract
OBJECTIVES
Paraguay has experienced a 35% reduction in the detected incidence of leprosy during the last ten years, as the vaccination coverage against tuberculosis (Bacillus of Calmette and Guérin [BCG] vaccine) reached ≥95% among infants. The objective of this case-control study was to evaluate the protective effect of BCG on the risk of leprosy.
METHODS We used a population-based case-control study of 20 leprosy confirmed cases reported among residents of Ciudad del Este, Paraguay, diagnosed in 2016-2017. Three controls were selected from a random sample of households from the city. We assessed vaccine effectiveness using 1- odds ratio [OR], and confounding for age, gender, education, occupation, and marital status using stratified and exact logistic regression, and explored if there was effect modification calculating the synergy factor (SF) and relative excess risk due to interaction (RERI).
RESULTS After controlling for age, gender, education, occupation and marital status, the OR of BCG scar on the risk of leprosy was 0.10 (95% confidence interval [CI], 0.02 to 0.45), for an estimate of vaccine effectiveness of 89.5% reduced risk of leprosy (95% CI, 55.2 to 98.1). There was evidence of heterogeneity by which the effectiveness of BCG seemed stronger among younger persons (Breslow-Day and Z-test of the SF had a p<0.05), and both the RERI and SF indicated a less then multiplicative and additive interaction of BCG and younger age.
CONCLUSIONS BCG vaccination was associated with a decreased risk of leprosy in the study population, particularly in persons born after 1980.
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Summary
Key Message
Paraguay had the second highest reported incidence in the Americas, but no previous study had investigated the topic of BCG for leprosy in Paraguay. We confirmed that BCG protected from leprosy, hence it may have contributed to the observed decline of leprosy.
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Citations
Citations to this article as recorded by  - An update of the diagnosis, treatment, and prevention of leprosy: A narrative review
Chien-Yuan Huang, Shih-Bin Su, Kow-Tong Chen
Medicine.2024; 103(34): e39006. CrossRef - Comparison of Antiphenolic Glycolipid-1 Antibody Levels in Seropositive Contacts of Leprosy after 2 Years of Single-dose Rifampicin as Postexposure Prophylaxis
Odelia Jovita Jusuf Fantoni, Rusmawardiana, Yulia Farida Yahya, Erial Bahar, Theresia Lumban Toruan, Muhammad Izazi Hari Purwoko
The International Journal of Mycobacteriology.2023; 12(4): 399. CrossRef - BCG and SARS-CoV-2—What Have We Learned?
Jakub Kulesza, Ewelina Kulesza, Piotr Koziński, Wojciech Karpik, Marlena Broncel, Marek Fol
Vaccines.2022; 10(10): 1641. CrossRef
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