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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

Patel F, Purchase S, Dhar M, Horne E, Grab J, Soma-Kasiram H, Sabet N, Martinson N et al.

BMC global and public health, 2026

922 participants

Abstract

Background: The 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.

Methods: Tuberculosis 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.

Results: Of 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…

How strong is the evidence?

Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 922 participants or records.

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