15 August 2016

BCG vaccination could improve survival of HIV exposed babies

In 2015, it was estimated that nearly 10 out of every 100 Ugandan children born alive do not live beyond their fifth birthday and in total, 39,000 new-borns die every year.

It is against this background that Dr Victoria Nankabirwa, a senior lecturer in the Department of Epidemiology and Biostatistics, School of Public Health and also a senior researcher at the University of Bergen with other researchers decided to conduct a study on other health benefits of the BCG vaccine (vaccine given to new born babies in the first few hours of their life to boost their immunity against tuberculosis).

Speaking at the Launch of the study in Kampala last week, Dr Nankabirwa, the principal investigator of this study explained that illnesses such as pneumonia, diarrhoea and malaria can be prevented by BCG vaccination. “Unfortunately, there is little research describing this type of protection and this study intends to fill this gap.”

Target group
She adds that conventionally, the BCG vaccine has been given to children at birth. “But after a successful cohort study in Mbale District on 819 babies, we have reason to believe that if we give another dose of the vaccine to children when they are a bit older, the effect of the vaccine will be enhanced. So we are looking at the second dose being administered at 14 weeks.”
Now in a bigger clinical trial which began last month and will continue for four years, the researchers are looking at 2,200 babies born by HIV positive mothers.

“They will be recruited from three health centres of Kawala Health Centre III, Kitebi Health Centre III and Mukono Health Centre IV. These children will be recruited in a period of three years and we will follow them for a period of one year because we believe that the benefits of the vaccine can be prolonged and seen even when the child is older than one year,” Dr Nankabirwa explains.

She adds: “The reason we focused on HIV exposed babies is because we think the benefits of the vaccine will be evident in these kinds of children.

“There has been an increase in the number of HIV-exposed babies as a result of the extensive rollout of antiretroviral treatment of pregnant HIV-positive women to prevent mother-to-child transmission of HIV coupled with stagnating or increasing adult HIV prevalence. Unfortunately, these babies are more likely to suffer from serious illnesses, be resistant to treatment and to die in comparison to children in the general population,” Dr Nankabirwa explains adding,
“It is possible that a well-timed BCG vaccine could have non-specific beneficial effects and protect these babies from being severely ill from common childhood illness such as pneumonia.

“However, the most appropriate timing for the BCG vaccine among these babies that could maximise these non-specific effects is not known. By comparing different vaccine timings, our trial may identify the best timing and protect these babies from severe illnesses.”

Importance of the study
While speaking at the same function, Prof Halvor Sommerfelt, director, CISMAC at the University of Bergen said this study will help inform the right timing for the vaccine to help prevent not only TB but other common diseases that are known to lead to child mortality.

“The study will answer a very important question of whether there could be a need to increase the BCG vaccine. It will also inform the government on how best to protect children with the use of BCG and come up with ways of increasing the number of times it is given.”

Additionally, Dr Nankabirwa says, “We hope our study will provide crucial information on the most appropriate timing for the BCG vaccine that maximises any non-specific beneficial effects of the vaccine, such as a reduced occurrence of severe illness from malaria, pneumonia and diarrhea.”

She adds, “This information, could in-turn, inform policy regarding the best timing of BCG vaccination for HIV-exposed infants. Moreover, the study has a proactive dissemination plan for key stakeholders that will facilitate rapid uptake of the findings both nationally and internationally.”

While launching the study, Dr Joyce Moriku Kaducu, the minister of state for Primary Healthcare said if successful, the project will help improve the lives of children in Uganda.

“As government, we welcome such projects because the BCG study will inform child health policies in Uganda and it is in line with Sustainable Development Goal three.”



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