{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:30:44Z","timestamp":1787599844075,"version":"build-2736575974"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2017,6,20]],"date-time":"2017-06-20T00:00:00Z","timestamp":1497916800000},"content-version":"vor","delay-in-days":170,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The live smallpox and Bacillus Calmette-Gu\u00e9rin (BCG) vaccinations have been associated with better adult survival in both Guinea-Bissau and Denmark. In Guinea-Bissau, human immunodeficiency virus (HIV)-1 became an important cause of death after smallpox vaccination was phased out globally in 1980. We hypothesised that smallpox and BCG vaccinations were associated with a lower prevalence of HIV-1 infection, and we tested this hypothesis in both Guinea-Bissau and Denmark.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted 2 studies: (1) a cross-sectional study of HIV infection and vaccination scars in Guinea-Bissau including 1751 individuals and (2) a case-base study with a background population of 46239 individuals in Denmark. In Guinea-Bissau, HIV-1 transmission was almost exclusively sexually transmitted. In Denmark, we excluded intravenous drug users. Data were analyzed using logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Bacillus Calmette-Gu\u00e9rin and\/or smallpox vaccination compared with neither of these vaccines was associated with an adjusted odds ratio (aOR) for HIV-1 of 0.62 (95% confidence interval [CI], 0.36\u20131.07) in Guinea-Bissau and 0.70 (95% CI, 0.43\u20131.15) in Denmark. We combined the results from both settings in a meta-analysis (aOR = 0.66; 95% CI, 0.46\u20130.96). Data from Guinea-Bissau indicated a stronger effect of multiple smallpox vaccination scars (aOR = 0.27; 95% CI, 0.10\u20130.75) as follows: women, aOR = 0.18 (95% CI, 0.05\u20130.64); men, aOR = 0.52 (95% CI, 0.12\u20132.33); sex-differential effect, P = .29.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The studies from Guinea-Bissau and Denmark, 2 very different settings, both suggest that the BCG and smallpox vaccines could be associated with a decreased risk of sexually transmitted HIV-1. It might be informative to pursue this observation and explore possible protective mechanisms as part of the search for an HIV-1 vaccine.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofx130","type":"journal-article","created":{"date-parts":[[2017,6,20]],"date-time":"2017-06-20T15:11:14Z","timestamp":1497971474000},"source":"Crossref","is-referenced-by-count":22,"title":["The Effect of Smallpox and Bacillus Calmette-Gu\u00e9rin Vaccination on the Risk of Human Immunodeficiency Virus-1 Infection in Guinea-Bissau and Denmark"],"prefix":"10.1093","volume":"4","author":[{"given":"Andreas","family":"Rieckmann","sequence":"first","affiliation":[{"name":"Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen,"},{"name":"OPEN, Odense University Hospital\/Institute of Clinical Research, University of Southern Denmark,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Villumsen","sequence":"additional","affiliation":[{"name":"Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen,"},{"name":"Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospital,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mette Lundsby","family":"Jensen","sequence":"additional","affiliation":[{"name":"Holb\u00e6k Hospital, Region Zealand, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Ravn","sequence":"additional","affiliation":[{"name":"Coraxo Consulting, Virum, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zacarias J","family":"da Silva","sequence":"additional","affiliation":[{"name":"National Institute of Public Health (INASA), Bissau, Guinea-Bissau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Signe","family":"S\u00f8rup","sequence":"additional","affiliation":[{"name":"Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer Lyn","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospital,"},{"name":"Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amab\u00e9lia","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine Stabell","family":"Benn","sequence":"additional","affiliation":[{"name":"Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen,"},{"name":"OPEN, Odense University Hospital\/Institute of Clinical Research, University of Southern Denmark,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam E","family":"Roth","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Lund University, Malm\u00f6, Sweden;and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Aaby","sequence":"additional","affiliation":[{"name":"Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,6,20]]},"reference":[{"key":"2020081005180214900_CIT0001","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/0196-6553(82)90003-7","article-title":"The global eradication of smallpox","volume":"10","author":"Strassburg","year":"1982","journal-title":"Am J Infect Control"},{"key":"2020081005180214900_CIT0002","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":"2020081005180214900_CIT0003","doi-asserted-by":"crossref","first-page":"aaf1098","DOI":"10.1126\/science.aaf1098","article-title":"Trained immunity: a program of innate immune memory in health and disease","volume":"352","author":"Netea","year":"2016","journal-title":"Science"},{"key":"2020081005180214900_CIT0004","doi-asserted-by":"crossref","first-page":"5718","DOI":"10.1016\/j.vaccine.2006.04.045","article-title":"Vaccinia scars associated with better survival for adults. 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