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Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015.

ABSTRACT: BackgroundIn 2005 in England, universal Bacillus Calmette-Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates.AimEstimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England.MethodsWe conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both the universal and targeted vaccination between 1 January 2000 and 31 December 2010. We then estimated incidence rates over a 5-year follow-up period and used regression modelling to estimate the impact of the change in policy on TB.ResultsIn the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR):?0.74;?95%?credible interval (CrI):?0.61?to?0.88 and neonatal IRR:?0.62;?95%CrI:?0.44?to?0.88). We found some evidence that the change in policy was associated with an increase in incidence rates in the UK born school-age population (IRR:?1.08;?95%CrI:?0.97?to?1.19) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR:?0.96;?95%CrI:?0.82?to?1.14). Overall, we found that the change in policy was associated with directly preventing 385 (95%CrI:?-105?to?881) cases.ConclusionsWithdrawing universal vaccination at school age and targeting vaccination towards high-risk neonates was associated with reduced incidence of TB. This was largely driven by reductions in the non-UK born with cases increasing in the UK born.

SUBMITTER: Abbott S

PROVIDER: S-EPMC6905296 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015.

Abbott Sam S Christensen Hannah H Welton Nicky J NJ Brooks-Pollock Ellen E

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 20191201 49

BackgroundIn 2005 in England, universal Bacillus Calmette-Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates.AimEstimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England.MethodsWe conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both th ...[more]

PMID: 31822330

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Project description:OBJECTIVES:To estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000-2015 as part of a wider investigation into reasons for late diagnosis of HIV. DESIGN:Retrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care. SETTING:404 general practices in England. PARTICIPANTS:5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation. OUTCOMES:Annual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000-2015. RESULTS:HIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16-44 years compared with older adults. Rates per 100 000 in women aged 16-44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16-44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK. CONCLUSIONS:HIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men. IMPLICATIONS AND FURTHER RESEARCH NEEDED:Opportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.

Project description:A critical review of the last 25 years of dioxin policy in the Elbe river catchment is presented along seven main theses of the River Basin Community (RBC)-Elbe background document "Pollutants" for the Management Plan 2016-2021. In this period, polychlorinated dibenzodioxins/-furans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (dl-PCBs) will play a major role: (i) as new priority substances for which environmental quality standards (EQSs) need to be derived (Directive 2013/39/EC); (ii) in the search for innovative solutions in sediment remediation (i.e., respecting the influence of mechanical processes; Flood Risk Directive 2007/60/EC); and (iii) as indicators at the land-sea interface (Marine Strategy Framework Directive 2008/56/EC). In the Elbe river catchment, aspects of policy and science are closely connected, which became particularly obvious in a classic example of dioxin hot spot contamination, the case of the Spittelwasser creek. Here, the "source-first principle" of the first cycle of the European Water Framework Directive (WFD) had to be confirmed in a controversy on the dioxin hot spots with Saxony-Anhalt's Agency for Contaminated Sites (LAF). At the Spittelwasser site, the move from "inside the creek" to "along the river banks" goes parallel to a general paradigm shift in retrospective risk assessment frameworks and remediation techniques for organic chemicals (Ortega-Calvo et al. 2015). With respect to dioxin, large-scale stabilization applying activated carbon additions is particularly promising. Another important aspect is the assessment of the ecotoxicology of dioxins and dl- PCBs in context of sediment mobility and flood risk assessment, which has been studied in the project framework FloodSearch. Currently, the quality goals of the WFD to reach a "good chemical status" are not met in many catchment areas because substances such as mercury do and others probably will (PCDD/Fs and dl-PCB) exceed biota-EQS values catchment area-wide. So far, relating biota-EQS values to sediment-EQSs is not possible. To overcome these limitations, the DioRAMA project was initiated, which has led to improved approaches for the assessment of dioxin-contaminated sediment using in vitro bioassays and to a robust dataset on the interrelation between dioxins and dioxin-like compounds in sediments and biota.

Project description:BACKGROUND: National malaria control programmes must deal with the complex process of changing national malaria treatment guidelines, often without guidance on the process of change. Selecting a replacement drug is only one issue in this process. There is a paucity of literature describing successful malaria treatment policy changes to help guide control programs through this process. OBJECTIVES: To understand the wider context in which national malaria treatment guidelines were formulated in a specific country (Peru). METHODS: Using qualitative methods (individual and focus group interviews, stakeholder analysis and a review of documents), a retrospective analysis of the process of change in Peru's anti-malarial treatment policy from the early 1990's to 2003 was completed. RESULTS: The decision to change Peru's policies resulted from increasing levels of anti-malarial drug resistance, as well as complaints from providers that the drugs were no longer working. The context of the change occurred in a time in which Peru was changing national governments, which created extreme challenges in moving the change process forward. Peru utilized a number of key strategies successfully to ensure that policy change would occur. This included a) having the process directed by a group who shared a common interest in malaria and who had long-established social and professional networks among themselves, b) engaging in collaborative teamwork among nationals and between nationals and international collaborators, c) respect for and inclusion of district-level staff in all phases of the process, d) reliance on high levels of technical and scientific knowledge, e) use of standardized protocols to collect data, and f) transparency. CONCLUSION: Although not perfectly or fully implemented by 2003, the change in malaria treatment policy in Peru occurred very quickly, as compared to other countries. They identified a problem, collected the data necessary to justify the change, utilized political will to their favor, approved the policy, and moved to improve malaria control in their country. As such, they offer an excellent example for other countries as they contemplate or embark on policy changes.

Dataset Information

Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015.

Publications

Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015.

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