PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 10 January 2015)

Research Article
Effectiveness of Routine BCG Vaccination on Buruli Ulcer Disease: A Case-Control Study in the Democratic Republic of Congo, Ghana and Togo
Richard Odame Phillips, Delphin Mavinga Phanzu, Marcus Beissner, Kossi Badziklou, Elysée Kalundieko Luzolo, Fred Stephen Sarfo, Wemboo Afiwa Halatoko, Yaw Amoako, Michael Frimpong, Abass Mohammed Kabiru, Ebekalisai Piten, Issaka Maman, Bawimodom Bidjada,
[ … ], Karl-Heinz Herbinger mail, [ view all ]
Published: January 08, 2015
DOI: 10.1371/journal.pntd.0003457
Abstract
Background
The only available vaccine that could be potentially beneficial against mycobacterial diseases contains live attenuated bovine tuberculosis bacillus (Mycobacterium bovis) also called Bacillus Calmette-Guérin (BCG). Even though the BCG vaccine is still widely used, results on its effectiveness in preventing mycobacterial diseases are partially contradictory, especially regarding Buruli Ulcer Disease (BUD). The aim of this case-control study is to evaluate the possible protective effect of BCG vaccination on BUD.
Methodology
The present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors.
Principal Findings
After stratification by the three countries, two sexes and four age groups, no significant correlation was found between the presence of BCG scar and BUD status of individuals. Multivariate analysis has shown that the independent variables country (p = 0.31), sex (p = 0.24), age (p = 0.96), and presence of a BCG scar (p = 0.07) did not significantly influence the development of BUD category I or category II/III. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or time to healing of lesions.
Conclusions
In our study, we did not observe significant evidence of a protective effect of routine BCG vaccination on the risk of developing either BUD or severe forms of BUD. Since accurate data on BCG strains used in these three countries were not available, no final conclusion can be drawn on the effectiveness of BCG strain in protecting against BUD. As has been suggested for tuberculosis and leprosy, well-designed prospective studies on different existing BCG vaccine strains are needed also for BUD.
Author Summary
After tuberculosis and leprosy, Buruli Ulcer Disease (BUD) is the third most common human mycobacterial disease. The only available vaccine that could be potentially beneficial against these diseases is BCG. Even though BCG vaccine is widely used, the results on its effectiveness are partially contradictory, probably since different BCG strains are used. The aim of this study was to evaluate the possible protective effect of BCG vaccines on BUD. The present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors. Considering the three countries, sex, and age, the analysis confirmed that the BCG vaccination did not significantly decrease the risk for developing BUD or for developing severe forms of BUD. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or to time to healing of lesions. In our study, we could not find any evidence of a protective effect of routine BCG vaccination on BUD.

Strengthening Research Capacity—TDR’s Evolving Experience in Low- and Middle-Income Countries
Olumide A. T. Ogundahunsi mail, Mahnaz Vahedi, Edward M. Kamau, Garry Aslanyan, Robert F. Terry, Fabio Zicker, Pascal Launois
Published: January 08, 2015
DOI: 10.1371/journal.pntd.0003380
Introduction
In the 1970s, very few international programmes provided support to strengthen tropical disease research capacity and most research for the diseases prevalent in low- and middle-income countries (LMICs) was done by scientists and institutions in advanced industrialised countries. Soon after inception in 1974, TDR established a research capacity strengthening (RCS) programme with a goal to train individuals and strengthen research capacity in disease-endemic countries so that they can find and implement appropriate solutions to their health problems [1], [2]. At that time, very little research addressed the burden of these diseases. For most of its existence, up to a third of TDR’s total resources were earmarked for strengthening research capacity in LMICs. In the past 20 years, other charities, foundations, health research councils, and development agencies have begun their own capacity strengthening programmes, so today, the concept is well accepted, although the means to achieve the end vary [3]–[5]. This paper presents a broad description from the TDR secretariat’s perspective on evolving approaches used to promote research capacity strengthening in LMICs. The paper is part of a special series commemorating TDR’s 40-year anniversary.

TDR has an intertwined approach: training support for individuals and collaborative research programmes for institutions [1], [2]. Research training requires adequate research facilities, which may need strengthening. Similarly, strengthening an institution so that it can fully participate in a research partnership often calls for supporting training facilities and staff. The specific needs and priorities that are funded by TDR have been identified by a capacity building steering committee and approved by the TDR Scientific and Technical Advisory Committee (STAC), which comprises 15 to 18 experts in a wide range of scientific disciplines who peer review the programme’s scientific and technical activities.

TDR’s placement within the United Nations system provides close collaboration with country offices of not only the World Health Organization but also of other co-sponsoring agencies UNICEF and UNDP, and with the World Bank. As a consequence, those who are supported by TDR often work closely with disease control programmes as well as other international organizations.

Regular reviews of TDR’s research capacity strengthening programmes have helped reorient the strategy as needed, shifting focus from institutional strengthening in the 1980s to human resources strengthening in the 1990s [1], as well as identifying the need to move to a more demand-driven model of national health research systems [4]. Over the years, TDR has continued to support multidisciplinary research, particularly to bring social science research and biomedical research together through different mechanisms [6], and has reinforced this effort through training in implementation research [7] and operations research [8]…

.

A Changing Model for Developing Health Products for Poverty-Related Infectious Diseases
Piero L. Olliaro, Annette C. Kuesel, John C. Reeder Historical Profiles and Perspectives | published 08 Jan 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003379

Applied Research for Better Disease Prevention and Control
Johannes Sommerfeld, Andrew Ramsay, Franco Pagnoni, Robert F. Terry, Jamie A. Guth, John C. Reeder Historical Profiles and Perspectives | published 08 Jan 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003378

What Have We Learned from 40 Years of Supporting Research and Capacity Building?
John C. Reeder, Jamie A. Guth Historical Profiles and Perspectives | published 08 Jan 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003355

Shaping the Research Agenda
Edith Certain, Robert F. Terry, Fabio Zicker Historical Profiles and Perspectives | published 08 Jan 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003350