Peer-reviewed article
BCG vaccination and household TB exposure in childhood tuberculosis: a community-based case-control study in rural Bangladesh.
Rahman T, Kundu S, Hossain A ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how well BCG vaccination protects children against tuberculosis in rural Bangladesh, using a case-control design with 207 children with TB and 207 matched controls without TB. BCG vaccination reduced the odds of developing TB by 57%, while older children (11-14 years), boys, and those with recent household TB exposure had higher risk. The findings suggest that strengthening BCG vaccination coverage and monitoring household TB exposure are important for reducing childhood TB in resource-limited settings.
Key points
- BCG vaccination reduced the odds of childhood TB by 57% (aOR 0.43, 95% CI = 0.20-0.93)
- Adolescents aged 11-14 years had 2.53 times higher odds of TB than children aged 2-5 years
- Male sex was associated with 1.79 times higher odds of TB
- Family history of TB within the last 6 months increased odds by 1.92 times
- A predictive model achieved 71.6% classification accuracy with sensitivity of 68.5% and specificity of 73.9%
Limitations
This is a case-control study conducted in one district of rural Bangladesh among a specific population (tea-garden workers), so findings may not generalise to other settings or populations. The study cannot determine causation or long-term effectiveness of BCG vaccination, only associations at a point in time.
Abstract
Background BCG vaccination and household exposure to tuberculosis (TB) are central to childhood TB control, yet their delivery and effectiveness vary considerably across communities. Evidence from community-based studies in high-transmission, resource-limited settings remains sparse, particularly among marginalised populations such as tea-garden worker communities. This study evaluates their protective effect against childhood TB in rural Bangladesh to address this gap. Methods We conducted a community-based case-control study in Moulavibazar District, enrolling children aged 2-14 years from January 8 to April 30, 2023. Cases had newly diagnosed, confirmed TB; controls were community-matched by neighborhood children without respiratory symptoms. We used multivariable logistic regression to calculate adjusted odds ratios (aORs). The Hosmer-Lemeshow goodness-of-fit test was used to assess model calibration. For the Random Forest model, variable importance was assessed using mean decrease in accuracy (MDA) with permutation-based testing. Results The dataset comprised 207 cases and 207 controls, with a mean age of 10.09 ± 3.69 years among cases and 9.38 ± 3.37 years among controls. The multivariable analysis identified adolescent age (11-14 years vs. 2-5 years: aOR 2.53, 95% CI = 1.33-4.80), male sex (aOR 1.79, 95% CI = 1.19-2.71), and a family history of TB within the last 6 months (aOR 1.92, 95% CI = 1.22-3.03) as having an association with TB. BCG vaccination demonstrated a significant protective association, reducing the odds of TB by 57% (aOR 0.43, 95% CI = 0.20-0.93). A random forest model confirmed these as the most important predictors, achieving a classification accuracy of 71.6% (AUC = 0.74, sensitivity = 68.5%, specificity = 73.9%). Conclusion In rural Bangladesh, childhood TB is associated with adolescent age, male sex, and household exposure. Intensifying universal BCG vaccination and prioritizing household TB exposure assessment, especially for adolescent boys, are critical to reducing the disease burden. Clinical trial number Not applicable.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- BCG vaccination
- Population
- Children aged 2-14 years in rural Moulavibazar District, Bangladesh
Key finding
BCG vaccination reduced odds of TB by 57% (aOR 0.43, 95% CI = 0.20-0.93)
T et al. · Europe PMC · 27 Jul 2026