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BCG VACCINE EFFECTIVENESS AGAINST BURULI ULCER: A CASE-CONTROL STUDY IN BENIN

FABIENNE NACKERS^*, MICHÈLE DRAMAIX, ROCH CHRISTIAN JOHNSON, CLAUDE ZINSOU, ANNIE ROBERT, ELISA DE BIURRUN BAKEDANO, JUDITH R. GLYNN, FRANÇOISE PORTAELS, AND RENÉ TONGLET

BCG remains the only possible prophylactic intervention against Buruli ulcer (BU). Estimating its public health impact on BU control is an important issue. We conducted a case-control study to investigate the vaccine effectiveness of routine BCG vaccine against BU in southern Benin. From August 2002 to August 2003, BCG vaccination status was obtained for 279 clinically diagnosed BU cases and 988 age- and sex-matched neighborhood controls. BCG coverage, which was estimated by the presence of a scar or a vaccination record, was 64.5% in cases and 67.2% in controls. There was no evidence of a protective effect of routine BCG vaccination against BU in southern Benin (vaccine effectiveness adjusted for socioeconomic status = 12%, 95% confidence interval = –24% to 37%).

Received March 31, 2006. Accepted for publication June 1, 2006.

Acknowledgments: This article is dedicated to the memory of Professor René Tonglet, who passed away June 5, 2005. We sincerely thank the field investigators, the staff of the Programme National de Lutte contre de l’Ulcère de Buruli, CDT/UB, and CSNG for their help and hospitality, especially Soeur Julia Aguiar. We are grateful to all patients and villagers for participating in this study.

Financial support: This work was supported by the Damien Foundation (Brussels, Belgium), the Belgian Fonds de la Recherche Scientifique Médicale (grant no. 3.4501.03), and the Université Catholique de Louvain Fonds Spéciaux de Recherche (grant No 2002, 20c5). Fabienne Nackers analyzed the data while obtaining an MSc degree in Epidemiology at the London School of Hygiene and Tropical Medicine. She was supported by a British Medical Research Council Advanced Course Masters studentship and a grant from the Belgian Medical Foundation Mathilde Horlait-Dapsens. Roch Christian Johnson, Claude Zinsou, and Elisa de Biurrun Bakedano were supported by a grant from the Directorate-General for Development Cooperation (Brussels, Belgium; Project: Buruli Ulcer in Benin). Judith Glynn is supported by the United Kingdom Department of Health (Public Health Career Scientist Award).

^* Address correspondence to Fabienne Nackers, Ecole de Santé Publique, Université Catholique de Louvain, Clos Chapelle-aux-Champs 30/EPID3058, 1200 Woluwé-Saint-Lambert, Belgium. E-mail: Fabienne.Nackers{at}epid.ucl.ac.be

Authors’ addresses: Fabienne Nackers, Annie Robert, and René Tonglet, Ecole de Santé Publique, Université Catholique de Louvain, Clos Chapelle-aux-Champs 30/EPID3058, 1200 Woluwé-Saint-Lambert, Belgium, Telephone: 32-2-764-3320, Fax: 32-2-764-3328, E-mails: Fabienne.Nackers{at}epid.ucl.ac.be and Annie.Robert{at}epid.ucl.ac.be. Michèle Dramaix, Ecole de Santé Publique, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium, Telephone: 32-2-555-4051, Fax: 32-2-555-4049, E-mail: miwilmet{at}ulb.ac.be. Roch Christian Johnson, Programme National de Lutte contre l’Ulcère de Buruli au Bénin, Ministère de la Santé Publique, 06 BP 2572, Cotonou, Benin, Telephone: 229-331-827, Fax: 229-337-057, E-mail: rochjohnson{at}yahoo.fr. Claude Zinsou, Centre Sanitaire et Nutritionnel de Gbemoten, Zagnanado, Benin, Fax: 229-520-293. Elisa de Biurrun Bakedano, Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, C/Sinesio Delgado 4, Pabellón 13, 28029 Madrid, Spain, Telephone: 91-8-222-940, Fax: 91-3-877-756, E-mail: ebiurrun{at}isciii.es. Judith R. Glynn, Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, Telephone: 44-20-792-72423, Fax: 44-20-7636-8739, E-mail: Judith.Glynn{at}lshtm.ac.uk. Françoise Portaels, Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium, Telephone: 32-3-247-6317, Fax: 32-3-247-6333, E-mail: portaels{at}itg.be.

Deceased.

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