Effectiveness of the First Dose of BCG against Tuberculosis among HIV-Infected, Predominantly Immunodeficient Children
Identifieur interne : 003215 ( Ncbi/Merge ); précédent : 003214; suivant : 003216Effectiveness of the First Dose of BCG against Tuberculosis among HIV-Infected, Predominantly Immunodeficient Children
Auteurs : Joaquim C. V. D. Van-Dunem [Angola] ; Laura C. Rodrigues [Royaume-Uni] ; Luiz Claudio Arraes Alencar [Brésil] ; Maria De Fátima Pessoa Militão-Albuquerque [Brésil] ; Ricardo Arraes De Alencar Ximenes [Brésil]Source :
- BioMed Research International [ 2314-6133 ] ; 2015.
Abstract
The objective of this study was to estimate the protective effect of Bacille Calmette-Guérin (BCG) vaccine against tuberculosis among (predominantly immunodeficient) HIV-infected children in Angola. A hospital-based case-control study was conducted with 230 cases, children coinfected with tuberculosis, and 672 controls, HIV-infected children from the same hospital, aged 18 months to 13 years. The presence of a vaccination scar was taken as a proxy marker for BCG vaccination. The crude effectiveness was 8% (95% CI: −26 to 32) and the adjusted effectiveness was 30% (95% CI: −75 to 72). The present study suggests that BCG does not have a protective effect against tuberculosis among immunodeficient HIV-infected children. Since BCG is no longer given to HIV-infected children, the study may not be replicated. Accepting that these findings should be considered with caution, they are nonetheless likely to be the last estimate of BCG efficacy in a sufficiently powered study.
Url:
DOI: 10.1155/2015/275029
PubMed: 26221585
PubMed Central: 4499653
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A hospital-based case-control study was conducted with 230 cases, children coinfected with tuberculosis, and 672 controls, HIV-infected children from the same hospital, aged 18 months to 13 years. The presence of a vaccination scar was taken as a proxy marker for BCG vaccination. The crude effectiveness was 8% (95% CI: −26 to 32) and the adjusted effectiveness was 30% (95% CI: −75 to 72). The present study suggests that BCG does not have a protective effect against tuberculosis among immunodeficient HIV-infected children. Since BCG is no longer given to HIV-infected children, the study may not be replicated. Accepting that these findings should be considered with caution, they are nonetheless likely to be the last estimate of BCG efficacy in a sufficiently powered study.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Fine, P E M" uniqKey="Fine P">P. E. M. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Biomed Res Int</journal-id><journal-id journal-id-type="iso-abbrev">Biomed Res Int</journal-id><journal-id journal-id-type="publisher-id">BMRI</journal-id><journal-title-group><journal-title>BioMed Research International</journal-title></journal-title-group><issn pub-type="ppub">2314-6133</issn><issn pub-type="epub">2314-6141</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26221585</article-id><article-id pub-id-type="pmc">4499653</article-id><article-id pub-id-type="doi">10.1155/2015/275029</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical Study</subject></subj-group></article-categories><title-group><article-title>Effectiveness of the First Dose of BCG against Tuberculosis among HIV-Infected, Predominantly Immunodeficient Children</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Van-Dunem</surname><given-names>Joaquim C. V. D.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rodrigues</surname><given-names>Laura C.</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Alencar</surname><given-names>Luiz Claudio Arraes</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Militão-Albuquerque</surname><given-names>Maria de Fátima Pessoa</given-names></name><xref ref-type="aff" rid="I4"><sup>4</sup></xref><xref ref-type="aff" rid="I5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ximenes</surname><given-names>Ricardo Arraes de Alencar</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref><xref ref-type="aff" rid="I6"><sup>6</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Departamento de Pediatria, Universidade Agostinho Neto, Avenida Amilcar Cabral, s/n, Maianga, Luanda, Angola</aff><aff id="I2"><sup>2</sup>Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK</aff><aff id="I3"><sup>3</sup>Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Avenida Professor Moraes Rêgo, s/n, Bloco A do Hospital das Clínicas, Cidade Universitária, 50670-420 Recife, PE, Brazil</aff><aff id="I4"><sup>4</sup>Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Avenida Professor Moraes Rêgo, s/n, Bloco A do Hospital das Clínicas, Cidade Universitária, 50670-420 Recife, PE, Brazil</aff><aff id="I5"><sup>5</sup>Departamento de Saúde Coletiva, CPqAM, FIOCRUZ, Avenida Professor Moraes Rêgo, s/n, Campus da UFPE, Cidade Universitária, 50670-420 Recife, PE, Brazil</aff><aff id="I6"><sup>6</sup>Programa de Mestrado e Doutorado em Ciências da Saúde, UPE, Rua Arnóbio Marques, No. 310, Santo Amaro, 50100-130 Recife, PE, Brazil</aff><author-notes><corresp id="cor1">*Ricardo Arraes de Alencar Ximenes: <email>raaximenes@uol.com.br</email></corresp><fn fn-type="other"><p>Academic Editor: Pere Domingo</p></fn></author-notes><pub-date pub-type="ppub"><year>2015</year></pub-date><pub-date pub-type="epub"><day>29</day><month>6</month><year>2015</year></pub-date><volume>2015</volume><elocation-id>275029</elocation-id><history><date date-type="received"><day>25</day><month>2</month><year>2015</year></date><date date-type="accepted"><day>19</day><month>5</month><year>2015</year></date></history><permissions><copyright-statement>Copyright © 2015 Joaquim C. V. D. Van-Dunem et al.</copyright-statement><copyright-year>2015</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>The objective of this study was to estimate the protective effect of Bacille Calmette-Guérin (BCG) vaccine against tuberculosis among (predominantly immunodeficient) HIV-infected children in Angola. A hospital-based case-control study was conducted with 230 cases, children coinfected with tuberculosis, and 672 controls, HIV-infected children from the same hospital, aged 18 months to 13 years. The presence of a vaccination scar was taken as a proxy marker for BCG vaccination. The crude effectiveness was 8% (95% CI: −26 to 32) and the adjusted effectiveness was 30% (95% CI: −75 to 72). The present study suggests that BCG does not have a protective effect against tuberculosis among immunodeficient HIV-infected children. Since BCG is no longer given to HIV-infected children, the study may not be replicated. Accepting that these findings should be considered with caution, they are nonetheless likely to be the last estimate of BCG efficacy in a sufficiently powered study.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Selection of the study population. <sup><italic>∗</italic></sup>Staff responsible for the X-ray reading discovered the diagnostic hypothesis before delivering the report.</p></caption><graphic xlink:href="BMRI2015-275029.001"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Comparison of the main characteristics of cases (TB/HIV-infected children) and controls (HIV-infected children). Hospital Pediátrico David Bernardino (HPDB, Angola): January 2005–December 2006. </p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Cases<break></break><italic>n</italic></th><th align="center" rowspan="1" colspan="1">%</th><th align="center" rowspan="1" colspan="1">Controls<break></break><italic>N</italic></th><th align="center" rowspan="1" colspan="1">%</th><th align="center" rowspan="1" colspan="1">Odds ratio</th><th align="center" rowspan="1" colspan="1">95% CI</th><th align="center" rowspan="1" colspan="1"><italic>p</italic> value</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age group (months)</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> ≤36</td><td align="center" rowspan="1" colspan="1">35</td><td align="center" rowspan="1" colspan="1">15.2</td><td align="center" rowspan="1" colspan="1">248</td><td align="center" rowspan="1" colspan="1">36.9</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> 37–60</td><td align="center" rowspan="1" colspan="1">95</td><td align="center" rowspan="1" colspan="1">41.3</td><td align="center" rowspan="1" colspan="1">272</td><td align="center" rowspan="1" colspan="1">40.4</td><td align="center" rowspan="1" colspan="1">2.48 </td><td align="center" rowspan="1" colspan="1">1.62–3.78</td><td align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> ≥61</td><td align="center" rowspan="1" colspan="1">100</td><td align="center" rowspan="1" colspan="1">43.5</td><td align="center" rowspan="1" colspan="1">152</td><td align="center" rowspan="1" colspan="1">22.6</td><td align="center" rowspan="1" colspan="1">4.66</td><td align="center" rowspan="1" colspan="1">3.02–7.20</td><td align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">230</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1">672</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Sex</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Female</td><td align="center" rowspan="1" colspan="1">109</td><td align="center" rowspan="1" colspan="1">47.4</td><td align="center" rowspan="1" colspan="1">353</td><td align="center" rowspan="1" colspan="1">52.5</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Male</td><td align="center" rowspan="1" colspan="1">121</td><td align="center" rowspan="1" colspan="1">52.6</td><td align="center" rowspan="1" colspan="1">319</td><td align="center" rowspan="1" colspan="1">47.5</td><td align="center" rowspan="1" colspan="1">1.22</td><td align="center" rowspan="1" colspan="1">0.90–1.67</td><td align="center" rowspan="1" colspan="1"> 0.18</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">230</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1">672</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Orphaned</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">133</td><td align="center" rowspan="1" colspan="1">59.1</td><td align="center" rowspan="1" colspan="1">543</td><td align="center" rowspan="1" colspan="1">83.1</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1"> 92</td><td align="center" rowspan="1" colspan="1">40.9</td><td align="center" rowspan="1" colspan="1">110</td><td align="center" rowspan="1" colspan="1">16.9</td><td align="center" rowspan="1" colspan="1">3.42</td><td align="center" rowspan="1" colspan="1">2.44–4.78</td><td align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">225</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1">653</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Sibling died of AIDS</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">163</td><td align="center" rowspan="1" colspan="1">91.6</td><td align="center" rowspan="1" colspan="1">409</td><td align="center" rowspan="1" colspan="1">97.8</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1"> 16</td><td align="center" rowspan="1" colspan="1">8.4</td><td align="center" rowspan="1" colspan="1"> 9</td><td align="center" rowspan="1" colspan="1">2.2</td><td align="center" rowspan="1" colspan="1">4.18</td><td align="center" rowspan="1" colspan="1">1.79–9.75</td><td align="center" rowspan="1" colspan="1"> 0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">178</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1">418</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Admission point</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Outpatient clinic</td><td align="center" rowspan="1" colspan="1"> 74</td><td align="center" rowspan="1" colspan="1">32.2</td><td align="center" rowspan="1" colspan="1">450</td><td align="center" rowspan="1" colspan="1">67.0</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Hospital</td><td align="center" rowspan="1" colspan="1">156</td><td align="center" rowspan="1" colspan="1">67.8</td><td align="center" rowspan="1" colspan="1">222</td><td align="center" rowspan="1" colspan="1">33.0</td><td align="center" rowspan="1" colspan="1">4.27 </td><td align="center" rowspan="1" colspan="1">3.07–5.96</td><td align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">230</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1">672</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Antiretroviral treatment</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> No </td><td align="center" rowspan="1" colspan="1"> 54</td><td align="center" rowspan="1" colspan="1">33.3</td><td align="center" rowspan="1" colspan="1">76</td><td align="center" rowspan="1" colspan="1">39.0</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">108</td><td align="center" rowspan="1" colspan="1">66.7</td><td align="center" rowspan="1" colspan="1">119</td><td align="center" rowspan="1" colspan="1">61.0</td><td align="center" rowspan="1" colspan="1">1.28 </td><td align="center" rowspan="1" colspan="1">0.83–1.97</td><td align="center" rowspan="1" colspan="1"> 0.27</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">162</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1">195</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Mode of HIV transmission</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Vertical</td><td align="center" rowspan="1" colspan="1">215</td><td align="center" rowspan="1" colspan="1">95.5</td><td align="center" rowspan="1" colspan="1">619</td><td align="center" rowspan="1" colspan="1">94.4</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Others</td><td align="center" rowspan="1" colspan="1"> 10</td><td align="center" rowspan="1" colspan="1">4.5</td><td align="center" rowspan="1" colspan="1"> 37</td><td align="center" rowspan="1" colspan="1">5.6</td><td align="center" rowspan="1" colspan="1">0.78 </td><td align="center" rowspan="1" colspan="1">0.38–1.59</td><td align="center" rowspan="1" colspan="1"> 0.49</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">225</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1">656</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Immunodeficiency</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Absent</td><td align="center" rowspan="1" colspan="1"> 7</td><td align="center" rowspan="1" colspan="1"> 3.0</td><td align="center" rowspan="1" colspan="1">392</td><td align="center" rowspan="1" colspan="1">58.6</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Present</td><td align="center" rowspan="1" colspan="1">222</td><td align="center" rowspan="1" colspan="1">97.0</td><td align="center" rowspan="1" colspan="1">277</td><td align="center" rowspan="1" colspan="1">41.4</td><td align="center" rowspan="1" colspan="1">44.88</td><td align="center" rowspan="1" colspan="1">6.73–20.82</td><td align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">229</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1">669</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Clinical category of HIV (CDC)<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Categories N and A</td><td align="center" rowspan="1" colspan="1"> 55</td><td align="center" rowspan="1" colspan="1">24.0</td><td align="center" rowspan="1" colspan="1">457</td><td align="center" rowspan="1" colspan="1">68.1</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Categories B and C</td><td align="center" rowspan="1" colspan="1">174</td><td align="center" rowspan="1" colspan="1">76.0</td><td align="center" rowspan="1" colspan="1">214</td><td align="center" rowspan="1" colspan="1">31.9</td><td align="center" rowspan="1" colspan="1">6.76</td><td align="center" rowspan="1" colspan="1">4.79–9.53</td><td align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">229</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1">671</td><td align="center" rowspan="1" colspan="1">100.0</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn><p><sup><italic>∗</italic></sup>Reference [<xref rid="B24" ref-type="bibr">20</xref>].</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Odds ratios and effectiveness of the association between BCG vaccination and TB according to different diagnostic categories. Hospital Pediátrico David Bernardino (HPDB, Angola): January 2005–December 2006.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" colspan="1">Variable</th><th align="center" colspan="2" rowspan="1">Tuberculosis<break></break>(all diagnostic categories)</th><th align="center" colspan="2" rowspan="1">Control</th><th align="center" rowspan="2" colspan="1">OR<break></break> (95% CI)</th><th align="center" rowspan="2" colspan="1"><italic>p</italic> value</th><th align="center" rowspan="2" colspan="1">(1-OR) (%)<break></break> (95% CI)</th></tr><tr><th align="center" rowspan="1" colspan="1"><italic>N</italic></th><th align="center" rowspan="1" colspan="1">%</th><th align="center" rowspan="1" colspan="1"><italic>N</italic></th><th align="center" rowspan="1" colspan="1">%</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">BCG vaccination</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> No </td><td align="center" rowspan="1" colspan="1">86</td><td align="center" rowspan="1" colspan="1">37.4</td><td align="center" rowspan="1" colspan="1">239</td><td align="center" rowspan="1" colspan="1">35.6</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes </td><td align="center" rowspan="1" colspan="1">144</td><td align="center" rowspan="1" colspan="1">62.6</td><td align="center" rowspan="1" colspan="1">433</td><td align="center" rowspan="1" colspan="1">64.4</td><td align="center" rowspan="1" colspan="1">0.92<break></break>(0.68–1.26)</td><td align="center" rowspan="1" colspan="1">0.62</td><td align="center" rowspan="1" colspan="1">8<break></break>(−26–32)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total </td><td align="center" rowspan="1" colspan="1">230</td><td align="center" rowspan="1" colspan="1">25.5</td><td align="center" rowspan="1" colspan="1">672</td><td align="center" rowspan="1" colspan="1">74.5</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="center" colspan="8" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="2" colspan="1">Variable</td><td align="left" colspan="2" rowspan="1">Tuberculosis<break></break> (confirmed diagnosis)</td><td align="center" colspan="2" rowspan="1">Control</td><td align="center" rowspan="2" colspan="1">OR<break></break> (95% CI)</td><td align="center" rowspan="2" colspan="1"><italic>p</italic> value</td><td align="center" rowspan="2" colspan="1">(1-OR) (%)<break></break> (95% CI)</td></tr><tr><td align="center" rowspan="1" colspan="1"><italic>N</italic></td><td align="center" rowspan="1" colspan="1">%</td><td align="center" rowspan="1" colspan="1"><italic>N</italic></td><td align="center" rowspan="1" colspan="1">%</td></tr><tr><td align="center" colspan="8" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">BCG vaccination</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> No </td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">35.7</td><td align="center" rowspan="1" colspan="1">239</td><td align="center" rowspan="1" colspan="1">35.6</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes </td><td align="center" rowspan="1" colspan="1">36</td><td align="center" rowspan="1" colspan="1">64.3</td><td align="center" rowspan="1" colspan="1">433</td><td align="center" rowspan="1" colspan="1">64.4</td><td align="center" rowspan="1" colspan="1">0.99<break></break>(0.54–1.82)</td><td align="center" rowspan="1" colspan="1">0.90</td><td align="center" rowspan="1" colspan="1">1<break></break>(−82%–46%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total </td><td align="center" rowspan="1" colspan="1">56</td><td align="center" rowspan="1" colspan="1">7.7</td><td align="center" rowspan="1" colspan="1">672</td><td align="center" rowspan="1" colspan="1">92.3</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="center" colspan="8" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="2" colspan="1">Variable</td><td align="left" colspan="2" rowspan="1">Tuberculosis<break></break> (probable diagnosis)</td><td align="center" colspan="2" rowspan="1">Control</td><td align="center" rowspan="2" colspan="1">OR<break></break> (95% CI)</td><td align="center" rowspan="2" colspan="1"><italic>p</italic> value</td><td align="center" rowspan="2" colspan="1">(1-OR) (%)<break></break> (95% CI)</td></tr><tr><td align="center" rowspan="1" colspan="1"><italic>N</italic></td><td align="center" rowspan="1" colspan="1">%</td><td align="center" rowspan="1" colspan="1"><italic>N</italic></td><td align="center" rowspan="1" colspan="1">%</td></tr><tr><td align="center" colspan="8" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">BCG vaccination</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> No </td><td align="center" rowspan="1" colspan="1">66</td><td align="center" rowspan="1" colspan="1">37.9</td><td align="center" rowspan="1" colspan="1">239</td><td align="center" rowspan="1" colspan="1">35.6</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes </td><td align="center" rowspan="1" colspan="1">108</td><td align="center" rowspan="1" colspan="1">62.1</td><td align="center" rowspan="1" colspan="1">433</td><td align="center" rowspan="1" colspan="1">64.4</td><td align="center" rowspan="1" colspan="1">0.90<break></break>(0.63–1.29)</td><td align="center" rowspan="1" colspan="1">0.62</td><td align="center" rowspan="1" colspan="1">10<break></break>(−29–37)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total </td><td align="center" rowspan="1" colspan="1">174</td><td align="center" rowspan="1" colspan="1">20.6</td><td align="center" rowspan="1" colspan="1">672</td><td align="center" rowspan="1" colspan="1">79.4</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn><p>BCG: Bacille Calmette-Guérin; TB: tuberculosis; OR: odds ratio; CI: confidence interval; (1-OR) (%): BCG effectiveness. </p></fn></table-wrap-foot></table-wrap><table-wrap id="tab3" orientation="portrait" position="float"><label>Table 3</label><caption><p>Odds ratios of the association between BCG vaccination and TB adjusted for biological, family structure, healthcare, and socioeconomic variables and clinical conditions. Hospital Pediátrico David Bernardino (HPDB, Angola): January 2005–December 2006.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variables</th><th align="center" rowspan="1" colspan="1">OR<sub>adjusted</sub></th><th align="center" rowspan="1" colspan="1">95% CI</th><th align="center" rowspan="1" colspan="1"><italic>p</italic> value</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">BCG (adjusted for biological variables)<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">0.88</td><td align="center" rowspan="1" colspan="1">0.64 to 1.21</td><td align="center" rowspan="1" colspan="1">0.42</td></tr><tr><td align="left" rowspan="1" colspan="1">BCG (adjusted for family structure variables)<sup><italic>∗∗</italic></sup></td><td align="center" rowspan="1" colspan="1">0.85</td><td align="center" rowspan="1" colspan="1">0.57 to 1.26</td><td align="center" rowspan="1" colspan="1">0.41</td></tr><tr><td align="left" rowspan="1" colspan="1">BCG (adjusted for healthcare variables)<sup><italic>∗∗∗</italic></sup></td><td align="center" rowspan="1" colspan="1">0.79</td><td align="center" rowspan="1" colspan="1">0.40 to 1.56</td><td align="center" rowspan="1" colspan="1">0.50</td></tr><tr><td align="left" rowspan="1" colspan="1">BCG (adjusted for socioeconomic variables)<sup><italic>∗∗∗∗</italic></sup></td><td align="center" rowspan="1" colspan="1">0.91</td><td align="center" rowspan="1" colspan="1">0.66 to 1.27</td><td align="center" rowspan="1" colspan="1">0.59</td></tr><tr><td align="left" rowspan="1" colspan="1">BCG (adjusted for clinical condition variables)<sup><italic>∗∗∗∗∗</italic></sup></td><td align="center" rowspan="1" colspan="1">1.14</td><td align="center" rowspan="1" colspan="1">0.78 to 1.65</td><td align="center" rowspan="1" colspan="1">0.49</td></tr></tbody></table><table-wrap-foot><fn><p>BCG: Bacille Calmette-Guérin; TB: tuberculosis; OR: odds ratio; CI: confidence interval; <sup><italic>∗</italic></sup>age; <sup><italic>∗∗</italic></sup>age, orphaned, and sibling died of AIDS; <sup><italic>∗∗∗</italic></sup>age, admission point, adherence to antiretroviral treatment, distance to health center, and regularity of AIDS consultations; <sup><italic>∗∗∗∗</italic></sup>age, employment status, number of people living in household, and housing conditions; <sup><italic>∗∗∗∗∗</italic></sup>age, previous history of pneumonia, clinical category of HIV infection (CDC), and degree of immunodeficiency.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab4" orientation="portrait" position="float"><label>Table 4</label><caption><p>Crude and adjusted effectiveness based on the presence of BCG scar for all children; crude effectiveness based on the vaccination card and BCG scar for those children with a vaccination card. Hospital Pediátrico David Bernardino (HPDB, Angola): January 2005–December 2006.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"> </th><th align="center" colspan="2" rowspan="1">OR<break></break> (95% CI)</th><th align="center" colspan="2" rowspan="1">(1-OR) (%)<break></break> (95% CI) </th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1">Crude</th><th align="center" rowspan="1" colspan="1">Adjusted<sup><italic>∗</italic></sup></th><th align="center" rowspan="1" colspan="1">Crude</th><th align="center" rowspan="1" colspan="1">Adjusted<sup><italic>∗</italic></sup></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">All children based on BCG scar (<italic>n</italic> = 902)</td><td align="center" rowspan="1" colspan="1">0.92<break></break>(0.68–1.26)</td><td align="center" rowspan="1" colspan="1">0.70<break></break>(0.28–1.75)</td><td align="center" rowspan="1" colspan="1">8<break></break>(−26–32)</td><td align="center" rowspan="1" colspan="1">30<break></break>(−75–72)</td></tr><tr><td align="left" rowspan="1" colspan="1">Children with vaccination card (<italic>n</italic> = 541)</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Based on the vaccination card </td><td align="center" rowspan="1" colspan="1">0.71<break></break>(0.44–1.14)</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">29<break></break>(−14–56)</td><td align="center" rowspan="1" colspan="1">—</td></tr><tr><td align="left" rowspan="1" colspan="1"> Based on the BCG scar </td><td align="center" rowspan="1" colspan="1">0.84<break></break>(0.53–1.32)</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">16<break></break>(−32–47)</td><td align="center" rowspan="1" colspan="1">—</td></tr></tbody></table><table-wrap-foot><fn><p><sup><italic>∗</italic></sup>Adjusted for sibling died of AIDS, regularity of AIDS consultations, adherence to antiretroviral treatment, degree of immunodeficiency, and clinical category of HIV infection (CDC); variables that remained statistically significant in the intrablock multivariable analysis. </p></fn><fn><p>BCG: Bacille Calmette-Guérin; CI: confidence interval; OR: odds ratio; (1-OR) (%): effectiveness.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab5" orientation="portrait" position="float"><label>Table 5</label><caption><p>Odds ratios and effectiveness of the association between BCG vaccination and TB (pulmonary and extrapulmonary). Hospital Pediátrico David Bernardino (Angola): January 2005–December 2006.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" colspan="1">Variable</th><th align="center" colspan="2" rowspan="1">Pulmonary tuberculosis</th><th align="center" colspan="2" rowspan="1">Control</th><th align="center" rowspan="2" colspan="1">OR<break></break> (95% CI)</th><th align="center" rowspan="2" colspan="1"><italic>p</italic> value</th><th align="center" rowspan="2" colspan="1">(1-OR) (%)<break></break> (95% CI) </th></tr><tr><th align="center" rowspan="1" colspan="1"><italic>N</italic></th><th align="center" rowspan="1" colspan="1">%</th><th align="center" rowspan="1" colspan="1"><italic>N</italic></th><th align="center" rowspan="1" colspan="1">%</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">BCG vaccine</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes </td><td align="center" rowspan="1" colspan="1">124</td><td align="center" rowspan="1" colspan="1">62.0</td><td align="center" rowspan="1" colspan="1">433</td><td align="center" rowspan="1" colspan="1">64.4</td><td align="center" rowspan="1" colspan="1">0.90<break></break>(0.64–1.26)</td><td align="center" rowspan="1" colspan="1">0.58</td><td align="center" rowspan="1" colspan="1">10<break></break>(−26%–36%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> No </td><td align="center" rowspan="1" colspan="1">76</td><td align="center" rowspan="1" colspan="1">38.0</td><td align="center" rowspan="1" colspan="1">239</td><td align="center" rowspan="1" colspan="1">35.6</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Total </td><td align="center" rowspan="1" colspan="1">200</td><td align="center" rowspan="1" colspan="1">22.9</td><td align="center" rowspan="1" colspan="1">672</td><td align="center" rowspan="1" colspan="1">77.1</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="center" colspan="8" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="2" colspan="1">Variable</td><td align="center" colspan="2" rowspan="1">Extrapulmonary tuberculosis</td><td align="center" colspan="2" rowspan="1">Control</td><td align="center" rowspan="2" colspan="1">OR<break></break> (95% CI)</td><td align="center" rowspan="2" colspan="1"><italic>p</italic> value</td><td align="center" rowspan="2" colspan="1">(1-OR) (%)<break></break> (95% CI)</td></tr><tr><td align="center" rowspan="1" colspan="1"><italic>N</italic></td><td align="center" rowspan="1" colspan="1">%</td><td align="center" rowspan="1" colspan="1"><italic>N</italic></td><td align="center" rowspan="1" colspan="1">%</td></tr><tr><td align="center" colspan="8" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">BCG vaccination</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">66.7</td><td align="center" rowspan="1" colspan="1">433</td><td align="center" rowspan="1" colspan="1">64.4</td><td align="center" rowspan="1" colspan="1">1.10<break></break>(0.48–2.57)</td><td align="center" rowspan="1" colspan="1">0.96</td><td align="center" rowspan="1" colspan="1">−10<break></break>(−157–52)</td></tr><tr><td align="left" rowspan="1" colspan="1"> No </td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">33.3</td><td align="center" rowspan="1" colspan="1">239</td><td align="center" rowspan="1" colspan="1">35.6</td><td align="center" rowspan="1" colspan="1">1.00</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Total </td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">4.3</td><td align="center" rowspan="1" colspan="1">672</td><td align="center" rowspan="1" colspan="1">95.7</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn><p>BCG: Bacille Calmette-Guérin; TB: tuberculosis; OR: odds ratio; CI: confidence interval; (1-OR) (%): effectiveness.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Angola</li><li>Brésil</li><li>Royaume-Uni</li></country><region><li>Pernambuco</li></region></list><tree><country name="Angola"><noRegion><name sortKey="Van Dunem, Joaquim C V D" sort="Van Dunem, Joaquim C V D" uniqKey="Van Dunem J" first="Joaquim C. V. D." last="Van-Dunem">Joaquim C. V. D. Van-Dunem</name></noRegion></country><country name="Royaume-Uni"><noRegion><name sortKey="Rodrigues, Laura C" sort="Rodrigues, Laura C" uniqKey="Rodrigues L" first="Laura C." last="Rodrigues">Laura C. Rodrigues</name></noRegion></country><country name="Brésil"><region name="Pernambuco"><name sortKey="Alencar, Luiz Claudio Arraes" sort="Alencar, Luiz Claudio Arraes" uniqKey="Alencar L" first="Luiz Claudio Arraes" last="Alencar">Luiz Claudio Arraes Alencar</name></region><name sortKey="Militao Albuquerque, Maria De Fatima Pessoa" sort="Militao Albuquerque, Maria De Fatima Pessoa" uniqKey="Militao Albuquerque M" first="Maria De Fátima Pessoa" last="Militão-Albuquerque">Maria De Fátima Pessoa Militão-Albuquerque</name><name sortKey="Militao Albuquerque, Maria De Fatima Pessoa" sort="Militao Albuquerque, Maria De Fatima Pessoa" uniqKey="Militao Albuquerque M" first="Maria De Fátima Pessoa" last="Militão-Albuquerque">Maria De Fátima Pessoa Militão-Albuquerque</name><name sortKey="Ximenes, Ricardo Arraes De Alencar" sort="Ximenes, Ricardo Arraes De Alencar" uniqKey="Ximenes R" first="Ricardo Arraes De Alencar" last="Ximenes">Ricardo Arraes De Alencar Ximenes</name><name sortKey="Ximenes, Ricardo Arraes De Alencar" sort="Ximenes, Ricardo Arraes De Alencar" uniqKey="Ximenes R" first="Ricardo Arraes De Alencar" last="Ximenes">Ricardo Arraes De Alencar Ximenes</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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