The role of the Childhood TB Subgroup in vaccine research Gunnar Bjune TB in the 21st Century Consortium.
Post on 22-Dec-2015
214 Views
Preview:
Transcript
The role of the Childhood TB Subgroup in vaccine research
Gunnar BjuneTB in the 21st Century
Consortium
Not to loose what we have (BCG)
Reduces child mortalityPrime the immune response for strong Th1 reactivity
Protects against allergyModulates the immune response to ags towards Th1 pattern, not Th2
The gateway to EPIQuality of MC servicesAdministered at birth (institutional
delivery, registration, vaccination card)
BCG coverage
Institutional delivery Quality, referral
services/transport Side effects and other SEFIs Control, management,
registration/reporting Evaluation
BCG and immune deficiencies
HIVMothers’ HIV status MeaslesLack of maternal antibodies Malnutrition/immaturity Low birth weigth babies
Watch introduction of ”emerging successful Mtb strains”
Relative strain prevalence in <15 yrs versus >40 yrs TB pats
TB diagnosis in children, gastric lavage
Efficacy of BCG vaccination Case-control studies with strain typing TB meningitis and BCG status
New anti-TB vaccines
”BCG boosting vaccines” Mtb specific antigens + new
adjuvance Live vectors with rec. Mtb antigens Vaccines to prevent reactivation of
latent TB (therapeutic/post-exposure) ”2nd generation” anti-TB vaccines
(resistance/escape)
Diverse TB epidemiology and diverse vaccine needs
A: Stable, mainly reactivation of latent TB, low HIV prevalence (small overlap)
B: Increase, recent infections, low HIV (more overlap)
C: Increase, recent infections, high HIV (full overlap)
Overlap.. (age/socioec./gender…)
Norway
Russia
Tanzania
HIV TB
A: Stable, mainly reactivation of latent TB, low HIV prevalence (small overlap)
High cost-effectiveness of coordinated preventive programs
Childhood cases few and mainly among household contacts
Full coverage of newborns with BCG Post-exposure vaccine preferably as
a BCG boostering strategy (previous BCG coverage?)
Overlap.. (stage of the epidemics)
Early Late
% sp+ TBCosts HS Cost
Transmission
Cost/effective
The cost of human immunodeficiency virus co-infection to health services in Sudan. Asma Elsony et al. 2004
4% of TB pts HIV+ Total cost of management of HIV+ pts
was 6% of all costs for TB management. Marginal cost attributable to HIV-
positivity was 0.9% of the total cost. Still total cost significantly higher for
HIV+/ HIV- TB ptss ($ 105.1 vs $ 73.9, p=0.003).
Cost… continued
No sign. difference in costs between HIV+ / HIV- TB pats for: diagnostic tests, drugs and management of adverse reactions
Slightly more side effects of treatment among HIV+ / HIV – TB pats (14% vs 9.6%).
Cost difference due to more hospitalization (mortality and morbidity) of HIV+ / HIV- TB pts ($190.8 vs $141)
B: Increase, recent infections, low HIV (more overlap)
High cost-effectiveness of coordinated preventive programs
More childhood cases, but HIV neg. (TBmeningitis in < 5yrs old)
Full coverage of newborn BCG ”2nd generation” anti-TB vaccines
(prevalence of emerging successful strains?)
C: Increase, recent infections, high HIV (full overlap)
Cost-effectiveness of coordinated preventive programs low
Childhood cases many, community contacts (more HIV pos.)
BCG to newborns with caution ”2nd generation” anti-TB vaccines,
no live vector
TB meningitis (BCG failure?)
Efficiently prevented by BCG No effect of environmental
mycobacteria < 1 y of age Diagnostic performance, recording,
reporting? Strain epidemiology?
Emerging successful strains
Rate in TB pats < 15yrs / <40 yrs RFLP + spoligotyping + ? Culture (gastric lavage)? BCG coverage registration / reporting Other selective factors?
(drugs, BCG, HIV, urbanization, MOT..)
What to do??? Meet EPI Support full coverage of BCG to newborns (quality of
services, evaluation, documentation) Meet NTP TB meningitis, strains from pts < 15 yrs (quality of
services, evaluation, documentation) BCG status of TB pts (by scar) recording Meet NHAP HIV+ among TB pts; TB among HIV+s (overlap) Meet the vaccine carpenters and funders and tell them
what you need (post-exposure and second generation ignored)
The End???? or the beginning?
top related