• Sarah Jackson, Zubair Kabir, and Catherine Comiskey.
• School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland. Electronic address: jacksos2@tcd.ie.
• Lancet. 2022 Nov 1; 400 Suppl 1: S53S53.

BackgroundUniversal Bacillus Calmette-Guérin vaccine (BCG) vaccination was discontinued in Ireland in April 2015 due to a lack of vaccine supply. We analysed notifications from the Irish National Tuberculosis Surveillance System from 2011 to 2021 to examine the direct impact of vaccination cessation on active tuberculosis cases among young children.MethodsWe did a cross-sectional study to compare tuberculosis age-specific incidence rates (ASIRs) among children aged 0-4 years born during a period of BCG vaccination (January 2007 to March 2015) with those born after BCG vaccination cessation (April 2015 to December 2021). We calculated ASIRs using census population denominators and did a temporal trend analysis of ASIRs using negative binomial regression. Data were anonymised before use in this study so no ethical approval or patient consent was required.FindingsNo significant temporal trend was detected in ASIR by notification year during 2011-21 (incidence rate ratio [IRR] 0·98; 95% CI 0·85-1·1). However, the temporal trend for cases born during universal vaccination was significantly declining (IRR 0·72 [95% CI 0·56-0·93]) whereas cases born after vaccination ceased had a non-significant increase (1·4 [0·99-1·96]). No meningitis cases were reported during universal vaccination compared with one (5%) of 19 cases reported after vaccination ceased. The proportion of cases reported as vaccinated decreased from 58% (11 of 19) during universal vaccination to 21% (four of 19) after vaccination ceased. Six (32%) of 19 cases born after vaccination ceased would have been eligible to receive BCG under a selective programme. No significant difference in the proportion of cases associated with outbreaks was detected across the two periods. Regional ASIRs increased in two eastern regions after vaccination ceased, whereas they declined in the remaining six regions.InterpretationUniversal BCG cessation has not directly impacted on new tuberculosis cases among children aged 0-4 years. However, timely surveillance is needed to monitor the impact of vaccination cessation. A selective BCG programme might have prevented cases diagnosed in certain risk groups.FundingHealth Service Executive, Ireland.Copyright © 2022 Elsevier Ltd. All rights reserved.

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