{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:02:49Z","timestamp":1787313769582,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004046","name":"Karen Elise Jensens Fond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004046","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001732","name":"Danmarks Grundforskningsfond","doi-asserted-by":"publisher","award":["DNRF108"],"award-info":[{"award-number":["DNRF108"]}],"id":[{"id":"10.13039\/501100001732","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. Intern. Med."],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Bacillus Calmette\u2013Gu\u00e9rin (BCG) vaccine against tuberculosis (TB) is recommended at birth in TB\u2010endemic areas. Currently, BCG vaccination programmes use \u201cBCG vaccination coverage by 12\u00a0months of age\u201d as the performance indicator. Previous studies suggest that BCG\u2010vaccinated children, who develop a scar, have better overall survival compared with BCG\u2010vaccinated children, who do not develop a scar. We summarized the available studies of BCG scarring and child survival. A structured literature search for studies with original data and analysis of BCG scarring and mortality were performed. Combined analyses on the effect of BCG scarring on overall mortality. We identified six studies covering seven cohorts, all from Guinea\u2010Bissau, West Africa, with evaluation of BCG scarring amongst BCG\u2010vaccinated children and follow\u2010up for mortality. Determinants of BCG scarring were BCG strain, intradermal injection route, size of injection wheal, and co\u2010administered vaccines and micronutrients. In a combined analysis, having a BCG scar vs. no BCG scar was associated with a mortality rate ratio (MRR) of 0.61 (95% CI: 0.51\u20130.74). The proportion with a BCG scar varied from 52 to 93%; the estimated effect of a BCG scar was not associated with the scar prevalence. The effect was strongest in the first (MRR\u00a0=\u00a00.48 (0.37\u20130.62)) and second (MRR\u00a0=\u00a00.63 (0.44\u20130.92)) year of life, and in children BCG\u2010vaccinated in the neonatal period (MRR\u00a0=\u00a00.45 (0.36\u20130.55)). The effect was not explained by protection against TB. Confounding and genetic factors are unlikely to explain the strong association between BCG scarring and subsequent survival. Including \u201cBCG scar prevalence\u201d as a BCG vaccination programme performance indicator should be considered. The effect of revaccinating scar\u2010negative children should be studied.<\/jats:p>","DOI":"10.1111\/joim.13084","type":"journal-article","created":{"date-parts":[[2020,4,17]],"date-time":"2020-04-17T02:15:34Z","timestamp":1587089734000},"page":"614-624","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["BCG scarring and improved child survival: a combined analysis of studies of BCG scarring"],"prefix":"10.1111","volume":"288","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6102-3810","authenticated-orcid":false,"given":"C. S.","family":"Benn","sequence":"first","affiliation":[{"name":"From the Bandim Health Project Indepth Network Bissau Guinea\u2010Bissau"},{"name":"Research Centre for Vitamins and Vaccines (CVIVA) Statens Serum Institute Copenhagen S Denmark"},{"name":"OPEN Institute of Clinical Research University of Southern Denmark\/Odense University Hospital Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Roth","sequence":"additional","affiliation":[{"name":"Public Health Agency of Sweden Solna Sweden"},{"name":"Institution for Translational Medicine Lund University Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.\u2010L.","family":"Garly","sequence":"additional","affiliation":[{"name":"From the Bandim Health Project Indepth Network Bissau Guinea\u2010Bissau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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Vaccination Pr\u00e9ventive de la Tuberculose de l'homme et des animaux par le B C G Rapports et Documents Provenant Des Divers Pays (la France except\u00e9e) transmis \u00e0 l'Institut Pasteur en 1932","author":"Naeslund C","year":"1932"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7274.1435"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0264-410X(01)00339-5"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0264-410X(03)00181-6"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyh392"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ede.0000231546.14749.ab"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ452"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12614"},{"key":"e_1_2_11_11_1","article-title":"Maternal priming: BCG\u2010scarring in the mother enhances the survival of children with a 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