{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T05:36:38Z","timestamp":1790487398745,"version":"4.1.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,2,3]],"date-time":"2019-02-03T00:00:00Z","timestamp":1549152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100003556","name":"Ministry of Foreign Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003556","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"name":"OPTIMUNISE","award":["Health-F3-2011-261375"],"award-info":[{"award-number":["Health-F3-2011-261375"]}]},{"DOI":"10.13039\/501100001732","name":"Danish National Research Foundation","doi-asserted-by":"publisher","award":["DNRF108"],"award-info":[{"award-number":["DNRF108"]}],"id":[{"id":"10.13039\/501100001732","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Hypothesis<\/jats:title>\n                    <jats:p>Maternal priming might enhance the beneficial nonspecific effects (NSEs) of live measles vaccination (MV). Children with a bacillus Calmette-Gu\u00e9rin (BCG) vaccine scar have a lower mortality rate than those without a scar that is not explained by protection against tuberculosis. We examined the hypothesis that BCG scarring would have a stronger effect on a child if the mother also had a BCG scar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a randomized controlled trial (RCT) of early MV in children aged 4.5 months, the BCG-scar status of the children and their mother were registered at enrollment at 4.5 months of age. The children were followed up until they were 36 months of age. Using a Cox proportional hazards model, we compared mortality rate ratios according to maternal and child BCG-scar status after adjusting for where the BCG vaccine was given (the national hospital or elsewhere). We censored for other interventions that have immunomodulating effects on child survival, including neonatal vitamin A supplementation and early MV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2213 children had not received neonatal vitamin A supplementation and early MV; 83% of these children and 44% of the mothers had a BCG scar. Children whose mother had a BCG scar were not more likely to have a BCG scar than those whose mother did not have a BCG scar (risk ratio, 1.01 [95% confidence interval (CI), 0.98\u20131.05]). Among the children, having a BCG scar was associated with a 41% (95% CI, 5%\u201364%) lower mortality between the ages of 4.5 and 36 months. The reduction in mortality was 66% (95% CI, 33%\u201383%) if the mother also had a BCG scar but only 8% (95% CI, \u221283% to 53%) if the mother had no BCG scar (test of interaction, P = .04).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Maternal BCG priming might be important for the effect of BCG vaccination on child survival. Ensuring better BCG vaccine scarring among mothers and children could have a considerable effect on child mortality levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jpids\/piy142","type":"journal-article","created":{"date-parts":[[2019,1,16]],"date-time":"2019-01-16T15:14:22Z","timestamp":1547651662000},"page":"166-172","source":"Crossref","is-referenced-by-count":77,"title":["Maternal Priming: Bacillus Calmette-Gu\u00e9rin (BCG) Vaccine Scarring in Mothers Enhances the Survival of Their Child With a BCG Vaccine Scar"],"prefix":"10.1093","volume":"9","author":[{"given":"Mike L T","family":"Berendsen","sequence":"first","affiliation":[{"name":"Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Bjerreg\u00e5rd","family":"\u00d8land","sequence":"first","affiliation":[{"name":"Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau"},{"name":"Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauli","family":"Bles","sequence":"first","affiliation":[{"name":"Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aksel Karl Georg","family":"Jensen","sequence":"first","affiliation":[{"name":"Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej, Copenhagen, Denmark"},{"name":"Section of Biostatistics, University of Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poul-Erik","family":"Kofoed","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Kolding Hospital, Sygehusvej, Kolding, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilton","family":"Whittle","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L Charlotte J","family":"de Bree","sequence":"first","affiliation":[{"name":"Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej, Copenhagen, Denmark"},{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai G","family":"Netea","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesario","family":"Martins","sequence":"first","affiliation":[{"name":"Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine S","family":"Benn","sequence":"first","affiliation":[{"name":"Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej, Copenhagen, Denmark"},{"name":"OPEN, Institute of Clinical Research, University of Southern Denmark\/Odense University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Aaby","sequence":"first","affiliation":[{"name":"Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau"},{"name":"Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,2,3]]},"reference":[{"key":"2020043013160836400_CIT0001","doi-asserted-by":"crossref","first-page":"c6495","DOI":"10.1136\/bmj.c6495","article-title":"Non-specific effects of standard measles vaccine at 4.5 and 9 months of age on childhood mortality: randomised controlled trial","volume":"341","author":"Aaby","year":"2010","journal-title":"BMJ"},{"key":"2020043013160836400_CIT0002","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1093\/cid\/cix525","article-title":"Early BCG-Denmark and neonatal mortality among infants weighing &lt;2500 g: a randomized controlled trial","volume":"65","author":"Biering-S\u00f8rensen","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2020043013160836400_CIT0003","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1093\/cid\/civ617","article-title":"The effect of oral polio vaccine at birth on infant mortality: a randomized trial","volume":"61","author":"Lund","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2020043013160836400_CIT0004","doi-asserted-by":"crossref","first-page":"17537","DOI":"10.1073\/pnas.1202870109","article-title":"Bacille Calmette-Guerin induces NOD2-dependent nonspecific protection from reinfection via epigenetic reprogramming of monocytes","volume":"109","author":"Kleinnijenhuis","year":"2012","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2020043013160836400_CIT0005","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.it.2013.04.004","article-title":"A small jab\u2014a big effect: nonspecific immunomodulation by vaccines","volume":"34","author":"Benn","year":"2013","journal-title":"Trends Immunol"},{"key":"2020043013160836400_CIT0006","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1093\/cid\/ciu354","article-title":"Measles vaccination in the presence or absence of maternal measles antibody: impact on child survival","volume":"59","author":"Aaby","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2020043013160836400_CIT0007","article-title":"BCG vaccination at birth and rate of hospitalization for infection until 15 months of age in Denmark. A randomized clinical multicenter trial","author":"Stensballe","year":"2018","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2020043013160836400_CIT0008","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1038\/pr.2016.142","article-title":"Nonspecific effect of BCG vaccination at birth on early childhood infections: a randomized, clinical multicenter trial","volume":"80","author":"Kj\u00e6rgaard","year":"2016","journal-title":"Pediatr Res"},{"key":"2020043013160836400_CIT0009","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1093\/cid\/civ452","article-title":"Development of BCG scar and subsequent morbidity and mortality in rural Guinea-Bissau","volume":"61","author":"Storgaard","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2020043013160836400_CIT0010","doi-asserted-by":"crossref","first-page":"2782","DOI":"10.1016\/S0264-410X(03)00181-6","article-title":"BCG scar and positive tuberculin reaction associated with reduced child mortality in West Africa. A non-specific beneficial effect of BCG?","volume":"21","author":"Garly","year":"2003","journal-title":"Vaccine"},{"key":"2020043013160836400_CIT0011","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1097\/01.ede.0000231546.14749.ab","article-title":"Tuberculin reaction, BCG scar, and lower female mortality","volume":"17","author":"Roth","year":"2006","journal-title":"Epidemiology"},{"key":"2020043013160836400_CIT0012","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/ije\/dyh392","article-title":"BCG vaccination scar associated with better childhood survival in Guinea-Bissau","volume":"34","author":"Roth","year":"2005","journal-title":"Int J Epidemiol"},{"key":"2020043013160836400_CIT0013","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1111\/tmi.12614","article-title":"Tuberculin reaction and BCG scar: association with infant mortality","volume":"20","author":"Timmermann","year":"2015","journal-title":"Trop Med Int Health"},{"key":"2020043013160836400_CIT0014","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1111\/all.12216","article-title":"Vitamin A supplementation and BCG vaccination at birth may affect atopy in childhood: long-term follow-up of a randomized controlled trial","volume":"68","author":"Kiraly","year":"2013","journal-title":"Allergy"},{"key":"2020043013160836400_CIT0015","doi-asserted-by":"crossref","first-page":"3991","DOI":"10.1016\/j.vaccine.2004.10.022","article-title":"Vaccination technique, PPD reaction and BCG scarring in a cohort of children born in Guinea-Bissau 2000\u20132002","volume":"23","author":"Roth","year":"2005","journal-title":"Vaccine"},{"key":"2020043013160836400_CIT0016","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1016\/j.vaccine.2016.11.006","article-title":"Campaigns with oral polio vaccine may lower mortality and create unexpected results","volume":"35","author":"Benn","year":"2017","journal-title":"Vaccine"},{"key":"2020043013160836400_CIT0017","doi-asserted-by":"crossref","first-page":"13","DOI":"10.3389\/fpubh.2018.00013","article-title":"National immunization campaigns with oral polio vaccine reduce all-cause mortality: a natural experiment within seven randomized trials","volume":"6","author":"Andersen","year":"2018","journal-title":"Front Public Health"},{"key":"2020043013160836400_CIT0018","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1097\/00002030-199905280-00020","article-title":"HIV-negative infants born to HIV-1 but not HIV-2-positive mothers fail to develop a bacillus Calmette-Guerin scar","volume":"13","author":"Ota","year":"1999","journal-title":"AIDS"},{"key":"2020043013160836400_CIT0019","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1097\/QAD.0b013e328300a33d","article-title":"Changes in prevalence and incidence of HIV-1, HIV-2 and dual infections in urban areas of Bissau, Guinea-Bissau: is HIV-2 disappearing?","volume":"22","author":"da Silva","year":"2008","journal-title":"AIDS"},{"key":"2020043013160836400_CIT0020","volume-title":"Systematic review of the non-specific effects of BCG, DTP and measles containing vaccines","author":"Higgins"},{"key":"2020043013160836400_CIT0021","doi-asserted-by":"crossref","first-page":"919","DOI":"10.4049\/jimmunol.168.2.919","article-title":"Neonatal immunisation with Mycobacterium bovis bacillus Calmette-Gu\u00e9rin promotes immune responses to unrelated vaccine antigens","volume":"168","author":"Ota","year":"2002","journal-title":"J Immunol"},{"key":"2020043013160836400_CIT0022","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.vaccine.2016.11.079","article-title":"Maternal BCG scar is associated with increased infant proinflammatory immune responses","volume":"35","author":"Mawa","year":"2017","journal-title":"Vaccine"},{"key":"2020043013160836400_CIT0023","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.ebiom.2016.07.016","article-title":"Revaccination with live attenuated vaccines confer additional beneficial nonspecific effects on overall survival: a review","volume":"10","author":"Benn","year":"2016","journal-title":"EBioMedicine"},{"key":"2020043013160836400_CIT0024","doi-asserted-by":"crossref","first-page":"3794","DOI":"10.1111\/mec.14088","article-title":"The within-host dynamics of infection in trans-generationally primed flour beetles","volume":"26","author":"Tate","year":"2017","journal-title":"Mol Ecol"},{"key":"2020043013160836400_CIT0025","doi-asserted-by":"crossref","first-page":"c671","DOI":"10.1136\/bmj.c671","article-title":"Effect of revaccination with BCG in early childhood on mortality: randomised trial in Guinea-Bissau","volume":"340","author":"Roth","year":"2010","journal-title":"BMJ"}],"container-title":["Journal of the Pediatric Infectious Diseases Society"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jpids\/article-pdf\/9\/2\/166\/33149416\/piy142.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jpids\/article-pdf\/9\/2\/166\/33149416\/piy142.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,14]],"date-time":"2024-07-14T00:23:26Z","timestamp":1720916606000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpids\/article\/9\/2\/166\/5306131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,3]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,2,3]]},"published-print":{"date-parts":[[2020,4,30]]}},"URL":"https:\/\/doi.org\/10.1093\/jpids\/piy142","relation":{},"ISSN":["2048-7207"],"issn-type":[{"value":"2048-7207","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,6]]},"published":{"date-parts":[[2019,2,3]]}}}