PLoS Neglected Tropical Diseases (Jan 2015)

Effectiveness of routine BCG vaccination on buruli ulcer disease: a case-control study in the Democratic Republic of Congo, Ghana and Togo.

  • Richard Odame Phillips,
  • Delphin Mavinga Phanzu,
  • Marcus Beissner,
  • Kossi Badziklou,
  • Elysée Kalundieko Luzolo,
  • Fred Stephen Sarfo,
  • Wemboo Afiwa Halatoko,
  • Yaw Amoako,
  • Michael Frimpong,
  • Abass Mohammed Kabiru,
  • Ebekalisai Piten,
  • Issaka Maman,
  • Bawimodom Bidjada,
  • Adjaho Koba,
  • Koffi Somenou Awoussi,
  • Basile Kobara,
  • Jörg Nitschke,
  • Franz Xaver Wiedemann,
  • Abiba Banla Kere,
  • Ohene Adjei,
  • Thomas Löscher,
  • Bernhard Fleischer,
  • Gisela Bretzel,
  • Karl-Heinz Herbinger

DOI
https://doi.org/10.1371/journal.pntd.0003457
Journal volume & issue
Vol. 9, no. 1
p. e3457

Abstract

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The only available vaccine that could be potentially beneficial against mycobacterial diseases contains live attenuated bovine tuberculosis bacillus (Mycobacterium bovis) also called Bacillus Calmette-Guérin (BCG). Even though the BCG vaccine is still widely used, results on its effectiveness in preventing mycobacterial diseases are partially contradictory, especially regarding Buruli Ulcer Disease (BUD). The aim of this case-control study is to evaluate the possible protective effect of BCG vaccination on BUD.The present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors.After stratification by the three countries, two sexes and four age groups, no significant correlation was found between the presence of BCG scar and BUD status of individuals. Multivariate analysis has shown that the independent variables country (p = 0.31), sex (p = 0.24), age (p = 0.96), and presence of a BCG scar (p = 0.07) did not significantly influence the development of BUD category I or category II/III. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or time to healing of lesions.In our study, we did not observe significant evidence of a protective effect of routine BCG vaccination on the risk of developing either BUD or severe forms of BUD. Since accurate data on BCG strains used in these three countries were not available, no final conclusion can be drawn on the effectiveness of BCG strain in protecting against BUD. As has been suggested for tuberculosis and leprosy, well-designed prospective studies on different existing BCG vaccine strains are needed also for BUD.