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Walker et al rightly conclude that BCG vaccination does have a
significant protective effect against tuberculous meningitis(TBM).(1)
However it might be worth pointing out that the analysis does not include
a few recent studies, which lead to the same conclusion based on robust
data.(2, 4, 5) This is presumably because the literature search by the
authors was carried out in January 2005.
A recent hospital based case control study showed that an absent BCG
scar was a significant independent predictor for the occurrence of TBM
(adjusted OR 1.98; 95%CI 1.09-3.57).(2) The meta-analysis mentioned by the
authors is from 1993.(3) A more recent meta-analysis took an interesting
slant on the issue and came to the conclusion that 1 case of TBM will be
prevented for every 3435 vaccinations.(4) While this is certainly an
impressive figure, region specific analysis shows that the maximum benefit
is for South East Asia (46%) where the risk of the tuberculosis is
highest.(4) Even among TBM cases, vaccinated children appear to have a
Although these data do not change the conclusions reached by the
authors, they are sufficiently impressive to add more strength to the
analysis. Evidence based paediatrics, even with all the resources at our
disposal, is an ever-changing field. The evidence and the conclusions
drawn are subject to change during the significant lag phase between
submission of articles and actual publication.
1. Walker V, Selby G, Wacogne I. Does neonatal BCG vaccination
protect against tuberculous meningitis? Arch Dis Child 2006; 91(9):789-
2. Kumar P, Kumar R, Srivastava KL, Kumar M. Protective role of BCG
vaccination against tuberculous meningitis in Indian children: a
reappraisal. Natl Med J India 2005;18(1):7-11.
3. Rodrigues LC. Diwan VK, Wheeler JG. Protective effect of BCG
against tuberculous meningitis and miliary tuberculosis: a meta-analysis.
Int J Epidemiol 1993;22:1154–8.
4. Trunz BB, Fine P, Dye C. Effect of BCG vaccination on childhood
tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis
and assessment of cost-effectiveness. Lancet 2006;367(9517):1173-80.
5. Kumar R, Dwivedi A, Kumar P, Kohli N. Tuberculous meningitis in
BCG vaccinated and unvaccinated children. J Neurol Neurosurg Psychiatry