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Rousseau MC, Parent ME, Corsenac P, Salmon C, Mésidor M, Fantodji C, Conus F, Richard H, Jantchou P, Benedetti A. Cohort Profile Update: The Québec Birth Cohort on Immunity and Health (CO·MMUNITY). Int J Epidemiol 2024; 53:dyae014. [PMID: 38365966 PMCID: PMC10873493 DOI: 10.1093/ije/dyae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
- Carrefour de l’innovation, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
- Carrefour de l’innovation, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Philippe Corsenac
- Department of Nursing Sciences, Population Health, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
| | - Charlotte Salmon
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - Miceline Mésidor
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
- Carrefour de l’innovation, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Canisius Fantodji
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
| | - Florence Conus
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - Hugues Richard
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - Prévost Jantchou
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire Sainte-Justine, and Université de Montréal, Montréal, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
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Rousseau MC, Conus F, El-Zein M, Benedetti A, Parent ME. Ascertaining asthma status in epidemiologic studies: a comparison between administrative health data and self-report. BMC Med Res Methodol 2023; 23:201. [PMID: 37679673 PMCID: PMC10486089 DOI: 10.1186/s12874-023-02011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Studies have suggested that agreement between administrative health data and self-report for asthma status ranges from fair to good, but few studies benefited from administrative health data over a long period. We aimed to (1) evaluate agreement between asthma status ascertained in administrative health data covering a period of 30 years and from self-report, and (2) identify determinants of agreement between the two sources. METHODS We used administrative health data (1983-2012) from the Quebec Birth Cohort on Immunity and Health, which included 81,496 individuals born in the province of Quebec, Canada, in 1974. Additional information, including self-reported asthma, was collected by telephone interview with 1643 participants in 2012. By design, half of them had childhood asthma based on health services utilization. Results were weighted according to the inverse of the sampling probabilities. Five algorithms were applied to administrative health data (having ≥ 2 physician claims over a 1-, 2-, 3-, 5-, or 30-year interval or ≥ 1 hospitalization), to enable comparisons with previous studies. We estimated the proportion of overall agreement and Kappa, between asthma status derived from algorithms and self-reports. We used logistic regression to identify factors associated with agreement. RESULTS Applying the five algorithms, the prevalence of asthma ranged from 49 to 55% among the 1643 participants. At interview (mean age = 37 years), 49% and 47% of participants respectively reported ever having asthma and asthma diagnosed by a physician. Proportions of agreement between administrative health data and self-report ranged from 88 to 91%, with Kappas ranging from 0.57 (95% CI: 0.52-0.63) to 0.67 (95% CI: 0.62-0.72); the highest values were obtained with the [≥ 2 physician claims over a 30-year interval or ≥ 1 hospitalization] algorithm. Having sought health services for allergic diseases other than asthma was related to lower agreement (Odds ratio = 0.41; 95% CI: 0.25-0.65 comparing ≥ 1 health services to none). CONCLUSIONS These findings indicate good agreement between asthma status defined from administrative health data and self-report. Agreement was higher than previously observed, which may be due to the 30-year lookback window in administrative data. Our findings support using both administrative health data and self-report in population-based epidemiological studies.
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Affiliation(s)
- Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
- School of Public Health, Université de Montréal, Montréal, QC, Canada.
| | - Florence Conus
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- Direction des enquêtes de santé, Direction principale des statistiques sociales et de santé, Institut de la statistique du Québec, Montréal, QC, Canada
| | - Mariam El-Zein
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- School of Public Health, Université de Montréal, Montréal, QC, Canada
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BCG Vaccination in Early Childhood and Risk of Atopic Disease: A Systematic Review and Meta-Analysis. Can Respir J 2021; 2021:5434315. [PMID: 34868440 PMCID: PMC8635936 DOI: 10.1155/2021/5434315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 01/15/2023] Open
Abstract
Background Several large-scale studies suggest that Bacille Calmette–Guerin (BCG) vaccination in early childhood may reduce the risk of atopic diseases, but the findings remain controversial. Here, we aimed to investigate the potential correlation between early childhood BCG vaccination and the risk of developing atopic diseases. Methods Eligible studies published on PubMed, EMBASE, and Cochrane CENTRAL were systematically sourced from 1950 to July 2021. Studies with over 100 participants and focusing on the association between BCG vaccine and atopic diseases including eczema, asthma, and rhinitis were included. Preliminary assessment of methods, interventions, outcomes, and study quality was performed by two independent investigators. Odds ratio (OR) with 95% confidence interval (CI) was calculated. Random effects of the meta-analysis were performed to define pooled estimates of the effects. Results Twenty studies with a total of 222,928 participants were selected. The quantitative analysis revealed that administering BCG vaccine in early childhood reduced the risk of developing asthma significantly (OR 0.77, 95% CI 0.63 to 0.93), indicating a protective efficacy of 23% against asthma development among vaccinated children. However, early administration of BCG vaccine did not significantly reduce the risk of developing eczema (OR 0.94, 95% CI 0.76 to 1.16) and rhinitis (OR 0.99, 95% CI 0.81 to 1.21). Further analysis revealed that the effect of BCG vaccination on asthma prevalence was significant especially in developed countries (OR 0.73, 95% CI 0.58 to 0.92). Conclusion BCG vaccination in early childhood is associated with reduced risk of atopic disease, especially in developed countries.
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BCG for the prevention and treatment of allergic asthma. Vaccine 2021; 39:7341-7352. [PMID: 34417052 DOI: 10.1016/j.vaccine.2021.07.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 12/30/2022]
Abstract
Allergic diseases, in particular atopic asthma, have been on the rise in most industrialized countries for several decades now. Allergic asthma is characterized by airway narrowing, bronchial hyperresponsiveness, excessive airway mucus production, eosinophil influx in the lungs and an imbalance of the Th1/Th2 responses, including elevated IgE levels. Most available interventions provide only short-term relief from disease symptoms and do not alter the underlying immune imbalance. A number of studies, mostly in mouse models, have shown that Mycobacterium bovis bacillus Calmette-Guérin (BCG) treatment is capable of preventing or reducing an established allergen-driven inflammatory response, by redirecting pathogenic Th2 towards protective Th1 and/or regulatory T cell responses. Dendritic cells stimulated by BCG appear to be a crucial first step in the immunomodulatory effects of BCG. While the protective and therapeutic effects of BCG against allergy and asthma are well documented in animal models, they are less clear in humans, both in observational studies and in randomized controlled trials. The purpose of this article is to provide an up-to-date overview of the available evidence on the anti-allergy, in particular anti-asthma effects of BCG in mice, rats and humans.
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Abdelaziz MH, Ji X, Wan J, Abouelnazar FA, Abdelwahab SF, Xu H. Mycobacterium-Induced Th1, Helminths-Induced Th2 Cells and the Potential Vaccine Candidates for Allergic Asthma: Imitation of Natural Infection. Front Immunol 2021; 12:696734. [PMID: 34413850 PMCID: PMC8369065 DOI: 10.3389/fimmu.2021.696734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023] Open
Abstract
Bronchial asthma is one of the most chronic pulmonary diseases and major public health problems. In general, asthma prevails in developed countries than developing countries, and its prevalence is increasing in the latter. For instance, the hygiene hypothesis demonstrated that this phenomenon resulted from higher household hygienic standards that decreased the chances of infections, which would subsequently increase the occurrence of allergy. In this review, we attempted to integrate our knowledge with the hygiene hypothesis into beneficial preventive approaches for allergic asthma. Therefore, we highlighted the studies that investigated the correlation between allergic asthma and the two different types of infections that induce the two major antagonizing arms of T cells. This elucidation reflects the association between various types of natural infections and the immune system, which is predicted to support the main objective of the current research on investigating of the benefits of natural infections, regardless their immune pathways for the prevention of allergic asthma. We demonstrated that natural infection with Mycobacterium tuberculosis (Mtb) prevents the development of allergic asthma, thus Bacille Calmette-Guérin (BCG) vaccine is suggested at early age to mediate the same prevention particularly with increasing its efficiency through genetic engineering-based modifications. Likewise, natural helminth infections might inhabit the allergic asthma development. Therefore, helminth-derived proteins at early age are good candidates for designing vaccines for allergic asthma and it requires further investigation. Finally, we recommend imitation of natural infections as a general strategy for preventing allergic asthma that increased dramatically over the past decades.
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Affiliation(s)
- Mohamed Hamed Abdelaziz
- International Genomics Research Center (IGRC), Institute of Immunology, Jiangsu University, Zhenjiang, China
- Department of Microbiology and Immunology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Xiaoyun Ji
- International Genomics Research Center (IGRC), Institute of Immunology, Jiangsu University, Zhenjiang, China
| | - Jie Wan
- International Genomics Research Center (IGRC), Institute of Immunology, Jiangsu University, Zhenjiang, China
- Department of Neuroimmunology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Fatma A. Abouelnazar
- Department of Clinical Laboratory Diagnostics, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Sayed F. Abdelwahab
- Division of Pharmaceutical Microbiology, Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
- *Correspondence: Huaxi Xu, ; orcid.org/0000-0002-2568-7393; Sayed F. Abdelwahab, ; ; orcid.org/0000-0002-9636-7485
| | - Huaxi Xu
- International Genomics Research Center (IGRC), Institute of Immunology, Jiangsu University, Zhenjiang, China
- *Correspondence: Huaxi Xu, ; orcid.org/0000-0002-2568-7393; Sayed F. Abdelwahab, ; ; orcid.org/0000-0002-9636-7485
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Yitbarek K, Abraham G, Girma T, Tilahun T, Woldie M. The effect of Bacillus Calmette-Guérin (BCG) vaccination in preventing severe infectious respiratory diseases other than TB: Implications for the COVID-19 pandemic. Vaccine 2020; 38:6374-6380. [PMID: 32798142 PMCID: PMC7416741 DOI: 10.1016/j.vaccine.2020.08.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
Abstract
The rapid spread of the Coronavirus pandemic and its significant health and social impact urges the search for effective and readily available solutions to mitigate the damages. Thus, evaluating the effectiveness of existing vaccines like Bacillus Calmette–Guérin (BCG) has attracted attention. The aim of this review was evidence synthesis on the effect of BCG vaccine in preventing severe infectious respiratory disease including COVD-19, but not tuberculosis. We considered studies conducted on human participants of any study design from any country setting that were published in Enlgish. We did a systematic literature search in MEDLINE, Scopus and Google scholar databases and a free search on Google. The identified studies were appraised and relevant data were extracted using Joanna Briggs Institute tools. The extracted findings were synthesized with tables and narrative summary. Nine studies met the inclusion criteria. The findings indicated that BCG vaccine has a strong protective effect against both upper and lower acute respiratory tract infections. For instance in countries with universal BCG vaccination policy, the incidence of COVID-19 was lower compared to the counterparts. Addtionally, BCG vaccine was found to protect against infections like lethal influenza A virus, pandemic influenza (H1N1), and other acute respiratory tract infections. BCG improved the human body’s immune response involving antigen-specific T cells and memory cells. It also induced adaptive functional reprogramming of mononuclear phagocytes that induce protective effects against different respiratory infections other than tuberculosis. In countries with universal BCG vaccination, the incidence and death from acute respiratory viral infection including COVID – 19 is significantly low. However, there is an urgent need for further evidence from well-designed studies to understand the possible role of BCG vaccination over time and across age groups, its possible benefits in special populations such as health workers and cost-savings related to a policy of universal BCG vaccination.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Gelila Abraham
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia; Ethiopian Evidence Based Health Care Centre, Health, Behaviour, and Society Department, Public Health Faculty, Jimma Institute of Health Sciences, Jimma University, Ethiopia
| | - Tsinuel Girma
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Tizta Tilahun
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia; Department of Reproductive Health and Population Studies, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia; Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
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Salmon C, Conus F, Parent MÉ, Benedetti A, Rousseau MC. Association between Bacillus Calmette-Guérin vaccination and lymphoma: a population-based birth cohort study. J Intern Med 2019; 286:583-595. [PMID: 31361936 DOI: 10.1111/joim.12965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most risk factors for lymphoma identified so far relate to immunosuppression, but its aetiology remains unclear. OBJECTIVES We investigated whether Bacillus Calmette-Guérin (BCG) vaccination is associated with lymphoma, overall and separately for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). METHODS A cohort of 400 611 subjects born in the province of Québec, Canada, between 1970 and 1974 was used. Information on BCG vaccination was extracted from the Quebec BCG Vaccination Registry. Lymphomas cases were individuals who had ≥2 health encounters, medical visits or hospitalizations, for lymphoma within 2 months or who were identified through the Quebec Tumor Registry. Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence interval (CI), adjusting for potential confounders. RESULTS A total of 178 335 (46.0%) subjects were BCG-vaccinated, and 1478 (0.38%) cases of lymphomas were ascertained. Amongst them, 922 were identified as NHL and 421 as HL. After adjustment, no association was observed between BCG vaccination and either lymphoma (any type) (HR = 1.03, 95% CI: 0.96-1.11) or NHL (HR = 0.99, 95% CI: 0.86-1.13). For HL, nonproportional hazards were observed. Before the age of 18, the risk of HL was elevated amongst vaccinated individuals (HR = 2.26, 95% CI: 1.39-3.69). However after 18 years of age, no association was found (HR = 0.93, 95% CI: 0.75-1.15). CONCLUSION Bacillus Calmette-Guérin vaccination may increase the risk of HL before 18 years of age, but residual confounding cannot entirely be excluded. Given the benefits of BCG vaccination, these results need to be reproduced in other populations before firm conclusions can be drawn.
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Affiliation(s)
- C Salmon
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Université du Québec, Laval, QC, Canada
| | - F Conus
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Université du Québec, Laval, QC, Canada
| | - M-É Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Université du Québec, Laval, QC, Canada
| | - A Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - M-C Rousseau
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Université du Québec, Laval, QC, Canada
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Rousseau MC, El-Zein M, Conus F, Parent ME, Benedetti A. Cohort Profile: The Québec Birth Cohort on Immunity and Health (QBCIH). Int J Epidemiol 2019; 47:1040-1041h. [PMID: 29447365 DOI: 10.1093/ije/dyy011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Université du Québec, Laval, QC, Canada
| | - Mariam El-Zein
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Université du Québec, Laval, QC, Canada
| | - Florence Conus
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Université du Québec, Laval, QC, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Université du Québec, Laval, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada and.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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Daley MF, Shoup JA, Newcomer SR, Jackson ML, Groom HC, Jacobsen SJ, McLean HQ, Klein NP, Weintraub ES, McNeil MM, Glanz JM. Assessing Potential Confounding and Misclassification Bias When Studying the Safety of the Childhood Immunization Schedule. Acad Pediatr 2018; 18:754-762. [PMID: 29604461 PMCID: PMC6445249 DOI: 10.1016/j.acap.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/13/2018] [Accepted: 03/17/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Some parents are concerned the childhood immunization schedule could increase risk for allergic disorders, including asthma. To inform future safety studies of this speculated association, a parent survey was conducted to examine the risk of misclassification of vaccination status in electronic health record data, and to assess the potential for confounding if asthma risk factors varied by vaccination status. METHODS A survey was conducted among parents of children 19 to 35 months old at 6 medical organizations within the Vaccine Safety Datalink. Parents of children in 4 vaccination groups were surveyed: 1) no vaccines by 12 months of age and a diagnosis of parental vaccine refusal; 2) consistent vaccine limiting (≤2 vaccines per visit); 3) not consistently vaccine limiting but otherwise undervaccinated with a vaccine refusal diagnosis; and 4) fully vaccinated with no delays and no vaccine refusal. Parents were surveyed about their child's vaccination status and whether asthma risk factors existed. RESULTS Among a survey sample of 2043 parents, 1209 responded (59.2%). For receiving no vaccines, the observed agreement between parent report and electronic health record data was 94.0% (κ = 0.79); for receiving all vaccines with no delays, the observed agreement was 87.3% (κ = 0.73). Although most asthma risk factors (allergic rhinitis, eczema, food allergies, family asthma history) reported by parents did not differ significantly between children in the vaccination groups studied, several factors (aeroallergen sensitivity, breastfeeding) differed significantly between groups. CONCLUSIONS Measurement and control of disease risk factors should be carefully considered in observational studies of the safety of the immunization schedule.
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Affiliation(s)
- Matthew F. Daley
- Department of Pediatrics, University of Colorado School of Medicine Aurora, Colo; Institute for Health Research, Kaiser Permanente Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado
| | | | | | | | | | | | | | - Eric S. Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention Atlanta, Ga
| | - Michael M. McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention Atlanta, Ga
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado
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Rousseau MC, Conus F, Kâ K, El-Zein M, Parent MÉ, Menzies D. Bacillus Calmette-Guérin (BCG) vaccination patterns in the province of Québec, Canada, 1956-1974. Vaccine 2017; 35:4777-4784. [PMID: 28705514 DOI: 10.1016/j.vaccine.2017.06.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND In the province of Québec, Canada, the Bacillus Calmette-Guérin (BCG) vaccine was offered to newborns and school-age children from the 1950s to mid-1970s in an organized tuberculosis prevention program. OBJECTIVE We aimed to describe the annual rates of skin test administration, proportion of skin tests that were positive, and rates of BCG vaccination from 1956 to 1974 according to age, sex, and administrative region. METHODS For rates, numerators were extracted from the Québec BCG Vaccination Registry whereas population denominators were obtained from the Canadian Census and governmental publications. Time trends were assessed with linear regression. RESULTS A total of 2,755,336 skin tests and 2,531,366 BCG vaccinations were administered. Yearly rates of skin tests, routinely administered before vaccination among all except newborns, were highest among children aged 5-9 (9.3 per 100) and 10-14years (7.9 per 100). The proportion of positive skin tests varied greatly by age, ranging from 10.2% among children <1year to 67.2% among adults ≥20years. The vast majority of individuals who had a negative skin test were subsequently vaccinated, whereas those with a positive result were not, as per recommended guidelines. The average annual vaccination rate was highest among children aged <1year (43.8 per 100) and 5-9year-olds (6.9 per 100). There were salient differences in immunization rates, including positive skin tests and vaccinations, across administrative regions but no difference by sex. CONCLUSION This is the first comprehensive description of the tuberculosis prevention program in Québec which offered free, non-mandatory BCG vaccination. Our results confirm that the targeted groups, newborns and school-age children, were preferentially reached. Socioeconomic, demographic, and organizational factors may explain regional differences in immunization rates. Beyond presenting a historical context for this vaccination campaign, our findings are relevant to contemporary uses of the Québec BCG Vaccination Registry in epidemiological research.
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Affiliation(s)
- Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique (INRS)-Institut Armand-Frappier, 531 boul. des Prairies, Laval, QC H7V 1B7, Canada.
| | - Florence Conus
- Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique (INRS)-Institut Armand-Frappier, 531 boul. des Prairies, Laval, QC H7V 1B7, Canada.
| | - Khady Kâ
- Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique (INRS)-Institut Armand-Frappier, 531 boul. des Prairies, Laval, QC H7V 1B7, Canada.
| | - Mariam El-Zein
- Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique (INRS)-Institut Armand-Frappier, 531 boul. des Prairies, Laval, QC H7V 1B7, Canada.
| | - Marie-Élise Parent
- Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique (INRS)-Institut Armand-Frappier, 531 boul. des Prairies, Laval, QC H7V 1B7, Canada.
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, 5252 de Maisonneuve Blvd West, Montréal, QC H4A 3S5, Canada.
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