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Nevertheless, several countries have ceased universal BCG vaccination over the past 40\u00a0years, with scarce comparative epidemiological analyses regarding childhood TB after the policy change. We analysed data on childhood TB in countries that ceased universal BCG vaccination. Data sources included national\/international databases, published papers, annual TB reports, and public health authority websites. Childhood TB notification rate increased in one of seven countries with available data. Pulmonary TB and TB lymphadenitis were the main causes of increasing childhood cases, while changes in severe forms of TB cases were minor. Maintaining high vaccine coverage for the target group was a common challenge after shifting selective vaccination. In some countries showing no increase in childhood TB after a BCG policy change, the majority of childhood TB cases were patients from abroad or those with overseas parents; these countries had changed immigration policies during the same period. Heterogeneity in childhood TB epidemiology was observed after ceasing universal BCG vaccination; several factors might obscure the influence of vaccination policy change. Lessons learned from these countries may aid in the development of better BCG vaccination strategies.<\/jats:p>","DOI":"10.1038\/s41598-021-95294-y","type":"journal-article","created":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T10:02:50Z","timestamp":1628157770000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Epidemiology of childhood tuberculosis after ceasing universal Bacillus Calmette\u2013Gu\u00e9rin vaccination"],"prefix":"10.1038","volume":"11","author":[{"given":"Sayori","family":"Kobayashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Yoshiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Uchimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Hamaguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiya","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,5]]},"reference":[{"key":"95294_CR1","unstructured":"Global Tuberculosis Report 2019. 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European Centre for Disease Prevention and Control https:\/\/www.ecdc.europa.eu\/en\/tuberculosis\/surveillance\/atlas (2019)."},{"key":"95294_CR5","unstructured":"Population ages 0\u201314, total dataset. The World Bank https:\/\/data.worldbank.org\/indicator\/SP.POP.0014.TO (2019)."},{"key":"95294_CR6","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/0962-8479(92)90149-E","volume":"73","author":"V Romanus","year":"1992","unstructured":"Romanus, V., Svensson, A. & Hallander, H. O. The impact of changing BCG coverage on tuberculosis incidence in Swedish-born children between 1969 and 1989. Tuber. Lung Dis. 73, 150\u2013161 (1992).","journal-title":"Tuber. Lung Dis."},{"key":"95294_CR7","unstructured":"Tuberculosis notifications in Australia annual reports. 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Tubercle. 64, 101\u2013110 (1983).","journal-title":"Tubercle."},{"key":"95294_CR11","unstructured":"Combating tuberculosis in Slovakia is a battle not yet won. WHO Regional Office for Europe. https:\/\/www.euro.who.int\/en\/countries\/slovakia\/news\/news\/2014\/04\/combating-tuberculosis-in-slovakia-is-a-battle-not-yet-won (2014)."},{"key":"95294_CR12","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1097\/INF.0000000000002200","volume":"38","author":"T Mohiyuddin","year":"2019","unstructured":"Mohiyuddin, T., Seddon, J., Thomas, H. L. & Lalor, M. K. The changing landscape of childhood tuberculosis in the United Kingdom: A retrospective cohort (2000\u20132015). Pediatr. Infect. Dis. J. 38, 470\u2013475 (2019).","journal-title":"Pediatr. Infect. Dis. J."},{"key":"95294_CR13","first-page":"34","volume":"63","author":"V Romanus","year":"1988","unstructured":"Romanus, V. Swedish experiences 12 years after the cessation of general BCG vaccination of newborns in 1975. Bull. Int. 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The 2006 French Immigration and Integration Law: Europeanisation or Nicolas Sarkozy\u2019s presidential keystone? ESCR Centre on Migration, Policy and Society Working Paper No. 45 https:\/\/www.compas.ox.ac.uk\/wp-content\/uploads\/WP-2007-045-Meng-Hsuan-Baygert_French_Immigration_Law.pdf (2007)."},{"key":"95294_CR35","unstructured":"Kofman, E., Rogoz, M. & L\u00e9vy, F. Family migration policies in France. International Centre for Migration Policy Development: NODE Policy Report. http:\/\/research.icmpd.org\/fileadmin\/Research-Website\/Project_material\/NODE\/FR_Policy_Report_formatted7May.pdf (2010)."},{"key":"95294_CR36","doi-asserted-by":"crossref","unstructured":"Organisation for Economic Cooperation and Development (OECD). A portrait of family migration in OECD countries in International Migration Outlook 2017 107\u2013166. 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