A case-control study to evaluate the effectiveness of mass neonatal BCG vaccination among Canadian Indians

Abstract

This paper reports a case-control study to assess the protective effect of BCG (bacille Calmette-Guérin) vaccination among Indian infants in Manitoba, Canada. A record of past BCG vaccination was found in 49 per cent of the tuberculosis cases, compared to 77 per cent of the controls, yielding a relative risk of 0.30. Stratified analysis, controlling for age, increased the relative risk to 0.39 (95% confidence interval 0.22 - 0.69). The preventive fraction was 44 per cent. Non-differential misclassification of exposure status could have occurred; if this was adjusted for, the relative risk would be reduced. If only bacteriologically confirmed cases were analyzed, the age-adjusted relative risk was 0.27. The protective effect of BCG vaccination in the newborn among Manitoba Indians is therefore at least 60 per cent. The implications for health policy in this population are further discussed.