Fu, H., Lin, H.H., Hallett, T.B. and Arinaminpathy, N., 2018. Modelling the effect of discontinuing universal Bacillus Calmette-Guérin vaccination in an intermediate tuberculosis burden setting. Vaccine, 36(39), pp.5902-5909.
Discontinuing the BCG vaccine could increase the tuberculosis (TB) burden, requiring careful consideration against the costs and adverse effects of the vaccination program.In regions with high vaccine efficacy (VE), stopping BCG could negatively impact health more than it would reduce side effects, due to the increased TB burden.Improving early TB detection and starting treatment promptly might be more effective than BCG vaccination in controlling TB.The immunity provided by BCG may wane over time, making the elderly less protected or not protected at all, even if they were vaccinated at birth.Even in scenarios where BCG offers strong protection for up to 40 years, older adults are least affected by the cessation of the BCG vaccination program.Instead of completely stopping the BCG vaccination, implementing selective vaccination could be a more viable alternative.
d'Elbée, M., Harker, M., Mafirakureva, N., Nanfuka, M., Nguyet, M.H.T.N., Taguebue, J.V., Moh, R., Khosa, C., Mustapha, A., Mwanga-Amumpere, J. and Borand, L., 2024. Cost-effectiveness and budget impact of decentralising childhood tuberculosis diagnosis in six high tuberculosis incidence countries: a mathematical modelling study. EClinicalMedicine, 70, p.102528.
Diagnosing tuberculosis (TB) in children is challenging due to difficulties in collecting sputum samples and the paucibacillary nature of pulmonary TB in children.Alternative specimen collection methods like induced sputum and gastric aspirate require specialized equipment and trained personnel, which are often unavailable at primary health centers (PHC) and sometimes even at district hospitals (DH).As a result, many children with symptoms suggestive of TB do not receive appropriate diagnostic tests, even at the DH level.Stool samples can be collected more easily in young children across various settings and can be used to identify Mycobacterium tuberculosis using Xpert MTB/RIF testing.Nasopharyngeal aspirates (NPA) are easier to collect than gastric aspirate or induced sputum and, when combined with stool samples, offer similar sensitivity to Xpert MTB/RIF testing on gastric aspirates or induced sputum.Decentralization of pediatric TB services to the DH level could be cost-effective in Cambodia and Côte d’Ivoire, but decentralization to the PHC level is unlikely to be cost-effective in any country.Targeted decentralization to areas with high TB prevalence would likely be cost-effective in all countries.Implementing decentralization, particularly focused on PHCs, would require significant financial investment in the early phases.The PHC-focused strategy is more costly and less effective than the DH-focused strategy due to the need for diagnostic equipment across more facilities and the higher TB diagnosis rates at the DH level.Higher TB diagnosis rates at DHs may be due to care-givers bringing more severely ill children there first or because children are referred from PHCs with more advanced disease.All children at DHs had chest X-rays (CXR) performed, while at PHCs, only children with persisting symptoms after 7 days were referred for CXR, contributing to higher TB detection in the DH-focused strategy. =-=
Lin, H.H., Dowdy, D., Dye, C., Murray, M. and Cohen, T., 2012. The impact of new tuberculosis diagnostics on transmission: why context matters. Bulletin of the World Health Organization, 90, pp.739-747.
- Faster Decline in Tuberculosis Burden: The use of a new diagnostic tool is expected to reduce the burden of pulmonary tuberculosis more rapidly compared to continued reliance on smear microscopy.
- Influence of Contextual Factors: The impact of the new diagnostic tool on tuberculosis epidemiology is significantly influenced by contextual factors that are unrelated to the tool's performance.
- Greatest Impact in Certain Settings: The epidemiological impact of the new tool is most significant in areas where access to tuberculosis care is good but where existing diagnostic strategies have low sensitivity, such as limited access to chest X-rays for smear-negative cases.
- Lesser Impact in Equipped Laboratories: The new diagnostic tool may have a lesser impact at the population level if implemented in reference laboratories that are poorly accessible but already have sensitive diagnostic tools like culture.
- Increased Patient Trust: A new diagnostic test could boost patients' confidence in the healthcare system and encourage physicians to consider tuberculosis diagnosis more readily, reducing delays for both patients and the health system.
- Reduced Diagnostic Default: A new test with a quick turnaround time would lessen the need for multiple visits to the healthcare system, thereby decreasing the likelihood of patients defaulting on diagnosis.