Routine vaccination for tuberculosis ends in UK
http://www.100md.com
《英国医生杂志》
The UK government is to end routine vaccination against tuberculosis for schoolchildren and plans to switch instead to targeted jabs for those most at risk. From September, the BCG vaccination will be reserved for babies born in areas of high risk and children whose families originate from countries with high rates of tuberculosis, the chief medical officer for England, Liam Donaldson, announced last week.
Professor Donaldson said that, in recent years, various expert committees had looked at making such a switch but that ministers wanted to be certain that children would not be put at risk. 揟his was first talked about in the 1980s,?Professor Donaldson said. 揃ut we have been cautious that we have all the necessary evidence to do it.?
Tuberculosis once accounted for one in eight deaths in the United Kingdom, spreading through bacteria in contaminated droplets coughed or sneezed into the air. But improvements in housing, nutrition, and treatments largely eradicated the disease in Britain by the 1980s. In the past 20 years, it has made something of a comeback, especially among immigrant groups and the homeless. About 7000 people a year are now diagnosed with the infection—an increase of 25% in the last decade.
Despite this, evidence indicates that mass immunisation of children aged 10 to 14 confers little benefit. Under the current programme, school pupils first undergo a Heaf test to measure whether they have been exposed to Mycobacterium tuberculosis, the bacterium that causes the infection. If the results are negative, they receive the BCG injection. It is estimated that about 70% of children aged 10 to 14 are currently vaccinated.
Although the decision officially marks the end of the national BCG programme, many health authorities abandoned routine vaccinations more than 10 years ago to focus on high risk groups. The programme was introduced when tuberculosis infection rates were highest in young adults moving out of school and into the workplace, spreading the disease even further. Today, the UK is the only country in Europe that still vaccinates young teenagers. Countries like Ireland, Switzerland, and Italy already immunise babies; others, such as France and Greece, target 6 year olds.
The new policy means that the vaccine will be given to babies born or living in areas where the incidence of tuberculosis is at least 40 per 100 000 people. Children whose parents or grandparents have lived in a country with a tuberculosis prevalence rate of at least 40 per 100 000 will also be offered the jab, as will unprotected immigrants.
揧oung children are now the higher risk group,?said Professor Donaldson. 揟hose under 12 months who are exposed to infection have a 43% chance of progressing to full blown . Children aged one to five have a 24% risk.?
The new policy also involves abandoning the Heaf test in favour of the more effective Mantoux test. Both work by exposing the skin to a protein and measuring the extent of inflammation, but the Mantoux test is judged to be the most reliable. 揑t抯 the gold standard,?said Donaldson. 揥e抮e the only country in the world still using the Heaf test.?(Pat Hagan)
Professor Donaldson said that, in recent years, various expert committees had looked at making such a switch but that ministers wanted to be certain that children would not be put at risk. 揟his was first talked about in the 1980s,?Professor Donaldson said. 揃ut we have been cautious that we have all the necessary evidence to do it.?
Tuberculosis once accounted for one in eight deaths in the United Kingdom, spreading through bacteria in contaminated droplets coughed or sneezed into the air. But improvements in housing, nutrition, and treatments largely eradicated the disease in Britain by the 1980s. In the past 20 years, it has made something of a comeback, especially among immigrant groups and the homeless. About 7000 people a year are now diagnosed with the infection—an increase of 25% in the last decade.
Despite this, evidence indicates that mass immunisation of children aged 10 to 14 confers little benefit. Under the current programme, school pupils first undergo a Heaf test to measure whether they have been exposed to Mycobacterium tuberculosis, the bacterium that causes the infection. If the results are negative, they receive the BCG injection. It is estimated that about 70% of children aged 10 to 14 are currently vaccinated.
Although the decision officially marks the end of the national BCG programme, many health authorities abandoned routine vaccinations more than 10 years ago to focus on high risk groups. The programme was introduced when tuberculosis infection rates were highest in young adults moving out of school and into the workplace, spreading the disease even further. Today, the UK is the only country in Europe that still vaccinates young teenagers. Countries like Ireland, Switzerland, and Italy already immunise babies; others, such as France and Greece, target 6 year olds.
The new policy means that the vaccine will be given to babies born or living in areas where the incidence of tuberculosis is at least 40 per 100 000 people. Children whose parents or grandparents have lived in a country with a tuberculosis prevalence rate of at least 40 per 100 000 will also be offered the jab, as will unprotected immigrants.
揧oung children are now the higher risk group,?said Professor Donaldson. 揟hose under 12 months who are exposed to infection have a 43% chance of progressing to full blown . Children aged one to five have a 24% risk.?
The new policy also involves abandoning the Heaf test in favour of the more effective Mantoux test. Both work by exposing the skin to a protein and measuring the extent of inflammation, but the Mantoux test is judged to be the most reliable. 揑t抯 the gold standard,?said Donaldson. 揥e抮e the only country in the world still using the Heaf test.?(Pat Hagan)