卡介苗-谷氨酰胺疫苗预防儿童结核分枝杆菌感染的效果：一项最新的系统评价和荟萃分析

IF 4.3 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Infectious Diseases Pub Date : 2025-04-16 DOI:10.1016/j.ijid.2025.107909

Shunli Cai , Qingyi Luo , Guozhong Zhou , Xin Guo , Yan Dong , Hongbo Chen , Shiqi Luo , Jian He , Yuan Xia , Hanse Li , Yingchen Zhou , Chao Song

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引用次数: 0

摘要

目的提高对卡介苗预防儿童结核（TB）感染效果的认识。方法检索spubmed、Web of Science、Cochrane和Embase自成立至2025年1月12日的文献。如果研究的重点是暴露于肺结核的19岁以下儿童，使用干扰素- γ释放法（IGRA）进行感染评估，并报告卡介苗组和非卡介苗组的IGRA阳性结果，则纳入研究。采用随机效应荟萃分析得出汇总估计值，通过I²统计量评估异质性。结果32项研究共纳入8242名受试者。卡介苗对感染的总体保护效力为18%，相对危险度[RR]为0.82（95%可信区间[CI]: 0.73-0.91], I²= 60%）。亚组分析显示，低结核病发病率地区的疗效较高，为29% (RR = 0.71 [95% CI: 0.62-0.82], I²= 41%)，而高结核病发病率地区的疗效不显著（RR = 0.95 [95% CI: 0.84-1.09], I²= 55%）。结论卡介苗接种对结核病感染具有保护作用，特别是在结核病低发病率地区。它在结核病高发地区的有效性仍然不确定，强调需要进一步研究以优化这些地区的疫苗接种策略。

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Effect of Bacillus Calmette-Guérin vaccination against Mycobacterium tuberculosis infection in children: an updated systematic review and meta-analysis

Objectives

To update the understanding of the effectiveness of the Bacillus Calmette-Guérin (BCG) vaccine in preventing tuberculosis (TB) infection in children.

Methods

PubMed, Web of Science, Cochrane, and Embase were searched from their inception to January 12, 2025. Studies were included if they focused on children under 19 years exposed to pulmonary TB, used interferon-gamma release assays (IGRA) for infection assessment, and reported IGRA-positive outcomes for both BCG and non-BCG groups. Pooled estimates were derived using random-effects meta-analysis, with heterogeneity assessed by the I² statistic.

Results

Total 8242 participants were enrolled in 32 studies. The overall protective effectiveness of BCG against infection was 18%, with a relative risk [RR] of 0.82 (95% confidence interval [CI]: 0.73-0.91], I² = 60%). Subgroup analysis revealed a higher effectiveness of 29% (RR = 0.71 [95% CI: 0.62-0.82], I² = 41%) in low-TB incidence areas, while effectiveness was not significant (RR = 0.95 [95% CI: 0.84-1.09], I² = 55%) in high-TB incidence areas.

Conclusions

BCG vaccination shows protective effectiveness against TB infection, particularly in low-TB incidence areas. Its effectiveness in high-TB incidence areas remains uncertain, underscoring the need for further research to optimize vaccination strategies in these settings.

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来源期刊

International Journal of Infectious Diseases 医学-传染病学

CiteScore

18.90

自引率

2.40%

发文量

1020

审稿时长

30 days

期刊介绍： International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.