Evidence map›Paper›PMID 42304464›Full record

ArticleBMC global and public health2026

Routine immunization uptake and timeliness in young children exposed to multidrug-resistant tuberculosis: A secondary analysis of the Tuberculosis Child Multidrug-Resistant Preventive Therapy multi-site randomised controlled trial.

Faeezah Patel, Susan Purchase, Mrinmayee Dhar, Elizea Horne, Janet Grab, Hamisha Soma-Kasiram, Nadia Sabet, Neil Martinson, Suzanne Staples, Joanna Brigden and 6 more

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Article in BMC global and public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

16 authors.

Faeezah PatelWits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. fpatel@wrhi.ac.za.
Susan PurchaseDesmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Mrinmayee DharWits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Elizea HorneWits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Janet GrabWits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Hamisha Soma-KasiramWits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Nadia SabetPerinatal Human Immunodeficiency Virus Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Neil MartinsonPerinatal Human Immunodeficiency Virus Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Suzanne StaplesTuberculosis & Human Immunodeficiency Virus Investigative Network, Durban, South Africa.
Joanna BrigdenMedical Research Council Clinical Trials, Unit at University College London, London, UK.
Thomas WilkinsonHealth Economics Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Hendrik Simon SchaafDesmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
James SeddonDesmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Lee FairlieWits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Anneke HesselingDesmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Trinh DuongMedical Research Council Clinical Trials, Unit at University College London, London, UK.

Funding

JGHT MR/M007340/1U.K. Medical Research Council MC_UU_00004/04UNITAID 2019-36-SUN-MDR
6 · The paper itself

Abstract

backgroundThe Expanded Programme on Immunization (EPI) reduces vaccine preventable disease-related childhood morbidity and mortality. Vaccine coverage and timeliness are crucial to maximise protection in children < 5 years old. This is especially important for children living in households affected by human immunodeficiency virus (HIV) and tuberculosis.

methodsTuberculosis Child Multidrug-Resistant Preventive Therapy (TB-CHAMP), a randomised controlled trial of multidrug-resistant tuberculosis (MDR-TB) prevention, enrolled participants at five sites across South Africa between 26 Sep 2017 and 21 Jan 2023. In this secondary exploratory analysis, we analysed the coverage and timeliness of EPI vaccinations due by 12 months of age and associations between delayed/non-vaccinations and pre-defined factors relating to child participant, adult MDR-TB index patient, and household. Early, on-time, and delayed vaccinations were defined as > 5 days before, within 28 days of, and > 28 days after the projected dates, respectively. Modified Poisson regression was used to assess factors associated with delayed/non-vaccination and vaccination completeness. The COVID-19 period was defined as the 6 months after the start of South African lockdown.

resultsOf 922 enrolled children, 814 children < 5 years with complete immunisation records were included. There was equal sex distribution, median age was 2.5 years (IQR 1.2-3.8), 35% were HIV-exposed, and 1% living with HIV. EPI coverage was over 80% across all vaccine types, excluding measles, with a trend towards an increase in delayed doses and non-vaccination as children aged. Two-dose measles vaccination coverage was 70.6% with 11.3% not having any measles vaccination. We found associations between delayed/non-vaccination with the primary caregiver being the MDR-TB index patient, lower household socioeconomic status and the site where children enrolled. We did not observe increased delays and non-vaccination during the COVID-19 period.

conclusionsEPI coverage in this vulnerable population was reasonable, except for measles, which was low. There was a trend towards increasing delays and non-vaccination with age. Targeting vaccination interventions at households affected by TB and poorer households emphasising caregiver education on routine vaccination especially as children age is important.

trial registrationSouth African National Clinical Trials Register (SANCTR) (RefDOH270117530) and UK's Clinical Study Registry (Ref ISRCTN92634082, https://doi.org/10.1186/ISRCTN92634082.

Indexed as

Expanded programme on immunizationImmunizationMeaslesMultidrug-resistant tuberculosisStockoutVaccines

Identifiers

PMID42304464
PMCPMC13274037

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.