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. 2019 Jun;24(6):736-746.
doi: 10.1111/tmi.13232. Epub 2019 Apr 5.

BCG scar, socioeconomic and nutritional status: a study of newborns in urban area of Makassar, Indonesia

Aldian Irma Amaruddin  1   2 , Sitti Wahyuni  1 , Firdaus Hamid  3 , Maisuri T Chalid  4 , Maria Yazdanbakhsh  2 , Erliyani Sartono  2
Affiliations

BCG scar, socioeconomic and nutritional status: a study of newborns in urban area of Makassar, Indonesia

Aldian Irma Amaruddin et al. Trop Med Int Health. 2019 Jun.

Abstract
in English, French

Objective: To investigate factors that determine the response to Bacille Calmette-Guérin (BCG) vaccination in urban environments with respect to socioeconomic status (SES), prenatal exposure to infections or newborn's nutritional status.

Methods: The study was conducted in an urban area, in Makassar, Indonesia. At baseline, 100 mother and newborns pair from high and low SES communities were included. Intestinal protozoa, soil transmitted helminths, total IgE, anti-Hepatitis A Virus IgG and anti-Toxoplasma IgG were measured to determine exposure to infections. Information on gestational age, birth weight/height and delivery status were collected. Weight-for-length z-score, a proxy for newborns adiposity, was calculated. Leptin and adiponectin from cord sera were also measured. At 10 months of age, BCG scar size was measured from 59 infants. Statistical modelling was performed using multiple linear regression.

Results: Both SES and birth nutritional status shape the response towards BCG vaccination at 10 months of age. Infants born to low SES families have smaller BCG scar size compared to infants born from high SES families and total IgE contributed to the reduced scar size. On the other hand, infants born with better nutritional status were found to have bigger BCG scar size but this association was abolished by leptin levels at birth.

Conclusion: This study provides new insights into the importance of SES and leptin levels at birth on the development of BCG scar in 10 months old infants.

Objectif: Investiguer les facteurs qui déterminent la réponse à la vaccination par le BCG en milieu urbain en ce qui concerne le statut socioéconomique (SSE), l'exposition prénatale aux infections ou l’état nutritionnel du nouveau-né. MÉTHODES: L’étude a été menée dans une zone urbaine, à Makassar, en Indonésie. Au départ, 100 paires mère-nouveau-né issues de communautés à statut social élevé et faible ont été incluses. Les protozoaires intestinaux, les helminthes transmis par le sol, les IgE totales, les IgG anti-virus de l'hépatite A et anti- Toxoplasma ont été mesurés pour déterminer l'exposition aux infections. Des informations sur l’âge gestationnel, le poids/taille à la naissance et l’état d'accouchement ont été collectées. Le z-score poids-pour la taille, un indicateur indirect de l'adiposité du nouveau-né a été calculé. La leptine et l'adiponectine provenant de sérum des cordons ont également été mesurées. A l’âge de 10 mois, la taille des cicatrices de BCG a été mesurée chez 59 nourrissons. La modélisation statistique a été réalisée à l'aide d'une régression linéaire multiple. RÉSULTATS: Le statut socioéconomique et l’état nutritionnel à la naissance déterminent la réponse à la vaccination par le BCG à l’âge de 10 mois. La taille des cicatrices de BCG est plus petite chez les nourrissons nés de familles à statut socioéconomique faible comparée à celles chez ceux de familles à statut socioéconomique élevé et les IgE totales ont contribué à la réduction de la taille de ces cicatrices. En revanche, les bébés nés avec un meilleur état nutritionnel avaient une taille de cicatrice du BCG plus grande, mais cette association était supprimée par les niveaux de leptine à la naissance.

Conclusion: Cette étude fournit de nouvelles informations sur l'importance du SSE et des niveaux de leptine à la naissance sur le développement d'une cicatrice du BCG chez des nourrissons âgés de 10 mois.

Keywords: Bacille Calmette-Guérin scar; cicatrice du BCG; leptin; leptine; newborns; nouveau-nés; socioeconomic status; statut socioéconomique.

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Figures

Figure 1
Figure 1
Conceptual framework of the study. The analysis of the association between Bacille Calmette–Guérin (BCG) scar size and SES through two different pathways. The analysis asked whether SES contributes to the outcome of BCG vaccination through (A) prenatal exposure to infection or (B) birth nutritional status pathway, using linear regression adjusted with gestational age and child gender for both pathways. *total IgE and anti‐Hepatitis A IgG were measured as proxy of current or previous exposure to infections. **weight‐for‐length z‐score was measured as a proxy of nutritional status at birth. #A/#B Other factors that were not assessed in pathway A or B.
Figure 2
Figure 2
The Bacille Calmette–Guérin scar size in low and high socioeconomic status infants measured at 10 months of age. Data presented as Mean ± SD. * indicates P < 0.05 (adjusted for gestational age, sex and weight‐for‐length z‐score).
Figure 3
Figure 3
Effects of socioeconomic status on Bacille Calmette–Guérin scar size at 10 months. Model 1: crude (adjusted for gestational age, sex and birth weight‐for‐length z‐score); Model 2: Model 1 + cord total IgE. Data presented as beta estimate with 95% confidence interval. [Colour figure can be viewed at http://www.wileyonlinelibrary.com/]
Figure 4
Figure 4
Pathway analysis of nutritional status at birth and Bacille Calmette–Guérin scar size at 10 months. Model 1: Crude (adjusted for gestational age, sex and SES). Model 2: Model 1 + Leptin. Model 3: Model 1 + Adiponectin. Data presented as beta estimate with 95% confidence interval. [Colour figure can be viewed at http://www.wileyonlinelibrary.com/]
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