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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2007 Mar 1;98(2):116–120. doi: 10.1007/BF03404321

Mycobacterium tuberculosis Infection in First Nations Preschool Children in Alberta

Implications for BCG (bacille Calmette-Guérin) Vaccine Withdrawal

Sandy Jacobs 18, Andrea Warman 18, Natalie Roehrig 18, Wadieh Yacoub 18, Chandrani Wijayasinghe 18, Ruth Richardson 18, Elaine Benjamin 28, Huey Chong 38, Jure Manfreda 48, Richard Long 28,38,
PMCID: PMC6975600  PMID: 17441534

Abstract

Background

On April 1, 2004, BCG (bacille Calmette-Guérin), a tuberculosis (TB) control vaccine, was discontinued in all but four high-risk communities in Alberta. To confirm the safety of vaccine withdrawal, and for future planning, the annual risk of infection (ARI) was determined in preschool First Nations children.

Methods

First Nations children born into reserve communities in Alberta between April 1, 1998 and March 31, 2004, and still living on reserve in 2004–2005, were identified. Health centre TB histories were validated by cross-referencing the birth cohort with the provincial TB Registry. Children that were not BCG vaccinated and not known to be tuberculin skin test (TST) positive underwent a TST. Birth cohort children were grouped as follows: (i) BCG vaccinated; (ii) BCG non-vaccinated, no TST; (iii) BCG non-vaccinated, TST; (iv) BCG vaccination status unknown. The ARI was calculated and the age and community characteristics of the groups were compared.

Results

There were 8,447 children in the 6-year birth cohort, 4,699 (55.6%) vaccinated, 2,696 (31.9%) non-vaccinated, and 1,052 (12.5%) whose vaccination status was unknown. Of the non-vaccinated children, 1,921 (71.3%) were tested and only 2 were TST positive. No other TST positive, BCG non-vaccinated children were identified in the TB Registry cross-match. The prevalence of infection in 2004–2005 was 0.1% and the ARI was 0.03%. The community risk of TB exposure was comparable in tuberculin-tested and non-tested BCG non-vaccinated children.

Conclusion

In low BCG-uptake First Nations communities in Alberta, the ARI is low and it is safe to withdraw BCG.

MeSH terms: BCG vaccine, mycobacterium infections

Footnotes

This study was presented in poster format to the International Union Against Tuberculosis and Lung Disease North American Regional meeting in Vancouver, February 24–26, 2005. p ]Supported by: First Nations and Inuit Health Branch, Alberta Region, and Alberta Health and Wellness.

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