Volume 75, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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%).


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization. The Yamoussoukro Declaration on Buruli Ulcer. Accessed March 2006. Available from http://www.who.int/buruli/yamoussoukro_declaration/en/index.html.
  2. Buruli ulcer disease, 2004. Wkly Epidemiol Rec 79 : 194–199. [Google Scholar]
  3. Amofah G, Bonsu F, Tetteh C, Okrah J, Asamoa K, Asiedu K, Addy J, 2002. Buruli ulcer in Ghana: results of a national case search. Emerg Infect Dis 8 : 167–170. [Google Scholar]
  4. Debacker M, Aguiar J, Steunou C, Zinsou C, Meyers WM, Guedenon A, Scott JT, Dramaix M, Portaels F, 2004. Mycobacterium ulcerans disease (Buruli ulcer) in rural hospital, southern Benin, 1997–2001. Emerg Infect Dis 10 : 1391–1398. [Google Scholar]
  5. Marston BJ, Diallo MO, Horsburgh CR Jr, Diomande I, Saki MZ, Kanga JM, Patrice G, Lipman HB, Ostroff SM, Good RC, 1995. Emergence of Buruli ulcer disease in the Daloa region of Côte d’Ivoire. Am J Trop Med Hyg 52 : 219–224. [Google Scholar]
  6. van der Werf TS, van der Graaf WT, Tappero JW, Asiedu K, 1999. Mycobacterium ulcerans infection. Lancet 354 : 10131018. [Google Scholar]
  7. Portaels F, Zinsou C, Aguiar J, Debacker M, Biurrun Bakedano E, Guedenon A, Josse R, Lagarrigue V, Silva M, Steunou C, Meyers WM, 2003. Les atteintes osseuses dans l’ulcère de Buruli: à propos de 73 cas. Bull Seances Acad R Sci Outre Mer 49 : 161–190. [Google Scholar]
  8. BCG vaccination against Mycobacterium ulcerans infection (Buruli ulcer). First results of a trial in Uganda, 1969. Lancet 1 : 111–115. [Google Scholar]
  9. Smith PG, Revill WD, Lukwago E, Rykushin YP, 1977. The protective effect of BCG against Mycobacterium ulcerans disease: a controlled trial in an endemic area of Uganda. Trans R Soc Trop Med Hyg 70 : 449–457. [Google Scholar]
  10. Portaels F, Aguiar J, Debacker M, Steunou C, Zinsou C, Guédénon A, Meyers WM, 2002. Prophylactic effect of Mycobacterium bovis BCG vaccination against osteomyelitis in children with Mycobacterium ulcerans disease (Buruli ulcer). Clin Diagn Lab Immunol 9 : 1389–1391. [Google Scholar]
  11. Portaels F, Aguiar J, Debacker M, Guedenon A, Steunou C, Zinsou C, Meyers WM, 2004. Mycobacterium bovis BCG vaccination as prophylaxis against Mycobacterium ulcerans osteomyelitis in Buruli ulcer disease. Infect Immun 72 : 62–65. [Google Scholar]
  12. Amofah GK, Sagoe-Moses C, Adjei-Acquah C, Frimpong EH, 1993. Epidemiology of Buruli ulcer in Amansie West district, Ghana. Trans R Soc Trop Med Hyg 87 : 644–645. [Google Scholar]
  13. Raghunathan PL, Whitney EA, Asamoa K, Stienstra Y, Taylor TH Jr, Amofah GK, Ofori-Adjei D, Dobos K, Guarner J, Martin S, Pathak S, Klutse E, Etuaful S, van der Graaf WT, van der Werf TS, King CH, Tappero JW, Ashford DA, 2005. Risk factors for Buruli ulcer disease (Mycobacterium ulcerans Infection): results from a case-control study in Ghana. Clin Infect Dis 40 : 1445–1453. [Google Scholar]
  14. Debacker M, Portaels F, Aguiar J, Steunou C, Zinsou C, Meyers WM, Dramaix M, 2006. Risk factors for Buruli ulcer, Benin. Emerg Infect Dis. Available at http://www.cdc.gov/ncidod/EID/vol12no09/05-0598htm.
  15. Johnson RC, Makoutode M, Sopoh GE, Elsen P, Gbovi J, Pouteau LH, Meyers WM, Boko M, Portaels F, 2005. Buruli ulcer distribution in Benin. Emerg Infect Dis 11 : 500–501. [Google Scholar]
  16. Stoffel V, Barthelme B, Chague F, 2005. Tropical ecopathology: up hill and down dale Buruli ulcer. Sante Publique 17 : 191–197. [Google Scholar]
  17. UNAIDS, 2004. UNAIDS/WHO Epidemiological Fact Sheet. Benin. 2004 Update. Geneva: UNAIDS/WHO.
  18. World Health Organization, 2001. Buruli ulcer. Diagnosis of Mycobacterium ulcerans Disease. A Manual for Health Care Providers. Portaels F, Johnson P, Meyers WM, editors. Geneva: World Health Organization.
  19. Machin D, Campbell M, Fayers P, Pinol A, 1997. Sample Size Tables for Clinical Studies. Second edition. Oxford, United Kingdom: Blackwell Science Ltd.
  20. Smith PG, 1988. Epidemiological methods to evaluate vaccine efficacy. Br Med Bull 44 : 679–690. [Google Scholar]
  21. Institut National de la Statistique et l’Analyse Economique (INSAE) et ORC Macro, 2002. Enquête Démographique et de Santé au Bénin 2001. Calverton, MD: Institut National de la Statistique et l’Analyse Economique (INSAE) et ORC Macro.
  22. Comstock GW, 1994. Evaluating vaccination effectiveness and vaccine efficacy by means of case-control studies. Epidemiol Rev 16 : 77–89. [Google Scholar]
  23. Aujoulat I, Johnson C, Zinsou C, Guedenon A, Portaels F, 2003. Psychosocial aspects of health seeking behaviours of patients with Buruli ulcer in southern Benin. Trop Med Int Health 8 : 750–759. [Google Scholar]
  24. Asiedu K, Etuaful S, 1998. Socioeconomic implications of Buruli ulcer in Ghana: a three-year review. Am J Trop Med Hyg 59 : 1015–1022. [Google Scholar]
  25. Rodrigues LC, Smith PG, 1999. Use of the case-control approach in vaccine evaluation: efficacy and adverse effects. Epidemiol Rev 21 : 56–72. [Google Scholar]
  26. Pereira SM, Dourado I, Barreto ML, Cunha SS, Ichiara MY, Hijjar MA, Goes JC, Rodrigues LC, 2001. Sensitivity and specificity of BCG scar reading in Brazil. Int J Tuberc Lung Dis 5 : 1067–1070. [Google Scholar]
  27. Floyd S, Ponnighaus JM, Bliss L, Warndorff DK, Kasunga A, Mogha P, Fine PE, 2000. BCG scars in northern Malawi: sensitivity and repeatability of scar reading, and factors affecting scar size. Int J Tuberc Lung Dis 4 : 1133–1142. [Google Scholar]
  28. Karonga Prevention Trial Group, 1996. Randomised controlled trial of single BCG, repeated BCG, or combined BCG and killed Mycobacterium leprae vaccine for prevention of leprosy and tuberculosis in Malawi. Lancet 348 : 17–24. [Google Scholar]
  29. Rodrigues LC, Pereira SM, Cunha SS, Genser B, Ichihara MY, de Brito SC, Hijjar MA, Dourado I, Cruz AA, Sant’Anna C, Bierrenbach AL, Barreto ML, 2005. Effect of BCG revaccination on incidence of tuberculosis in school-aged children in Brazil: the BCG-REVAC cluster-randomised trial. Lancet 366 : 1290–1295. [Google Scholar]
  30. Sterne JA, Rodrigues LC, Guedes IN, 1998. Does the efficacy of BCG decline with time since vaccination? Int J Tuberc Lung Dis 2 : 200–207. [Google Scholar]
  31. Smith PG, 1982. Retrospective assessment of the effectiveness of BCG vaccination against tuberculosis using the case-control method. Tubercle 63 : 23–35. [Google Scholar]

Data & Media loading...

  • Received : 31 Mar 2006
  • Accepted : 01 Jun 2006

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error