BCG vaccination

The author expounds the fairly obscure history of BCG vaccination. Summarises the efficiency of accomplished vaccinations of different geographical areas. He accounts the diversity of results by the distinction of technical and methodical conditions and disparity in virulence of BCG strains. Overviews the Inland and European routine and the risk of possible complications. The favourable position of domestic childhood tuberculosis is due to the effective preventive arrangements. Considering the international and national epidemiology of tuberculosis in adults the administration of BCG vaccine, by chance in modified form, is recommended further on.     

BCG vaccination policies in Mexico]

The authors report a 110 cervical cerclage operations for cervical incompetence. Shirodkar's technique was used and cerclage was carried out between the 9th and 20th week of amenorrhea. Out of 110 patients submitted to the procedure, 98 gave birth to a live infant weighing more than 1000 g which amounts to a success rate of 89%. Duration of pregnancy ranged between 26 and 41 weeks. If only pregnancies having proceeded to 37 weeks of amenorrhea are considered, the success rate amounts to 68%.     

Early BCG vaccination and development of atopy

BACKGROUND: The increase in atopic diseases may be partly explicable by a decline of certain infectious diseases, or changes in childhood vaccination programmes, or both. We investigated whether BCG vaccination against tuberculosis influences the development of atopy. METHODS: We did a retrospective cohort study of 216 children with atopic heredity, born in Stockholm between 1989 and 1992, who received BCG vaccination when they were younger than 6 months, and 358 age-matched controls who had not been vaccinated. Both groups attended Sachs' Children's Hospital, Stockholm, Sweden, during 1995-96 for assessment of atopic history and clinical signs of atopic disease. All children also underwent skin-prick testing (SPT) and serum was analysed for allergen-specific IgE antibodies. Serum from parents was also analysed for IgE antibodies. FINDINGS: 77 (36%) children in the BCG group and 145 (41%) in the control group had a positive history or clinical signs of atopic disease. In the vaccinated group, 26 (12%) children had one or more positive SPT, and 61 (31%) had circulating allergen-specific IgE antibodies, whereas in the control group, the numbers were 35 (10%) and 84 (27%) respectively. Atopy was confirmed by serology in parents of almost two-thirds of the children in each group. Other risk factors for atopic disease were evenly distributed between the two groups. INTERPRETATION: Early BCG vaccination in children with atopic heredity does not seem to affect the development of atopic disease before school age.     

Erythema multiforme -- an unusual reaction to BCG vaccination

An eruptive form of erythema multiforme subsequent to BCG vaccination seen in a young Black nurse is reported. In a short review of the literature the author emphasizes that specific and nonspecific complications may occur after inoculation, but that the rare occurrence of these cutaneous manifestations cannot undermine the value of this preventive measure.     

Regional suppurative lymphadenitis after BCG vaccination (author's transl)

In the first half of 1975 there occurred in the Federal Republic of Germany an unusual rise in the incidence of suppurative inguinal lymphadenitis after BCG vaccination of newborns, in immediate time relation with change of the vaccine by its manufacturers, Behringwerke. The attenuated daughter strain G?teborg had been replaced by the effective but also rather aggressive strain Copenhagen 1331. The complication rate was 1.5% in West Berlin. Clinical course, operative technique as well as microbiological and histomorphological features of these cases were analyzed in a joint study. Since it is likely that, after re-admission of the Copenhagen vaccine, such complications may again occur despite reduced micro-organism count, vaccination of newborns should in future be restricted to those at risk.     

Effectiveness of bacillus of Calmette-Guerin (BCG) vaccination against tuberculous meningitis: a case-control study

A hospital-based pair-matched case-control study was carried out at Government Medical College Hospital, Nagpur to estimate the effectiveness of bacillus of Calmette-Guerin (BCG) vaccination against tuberculous meningitis. The study included 92 cases of tuberculous meningitis in the age group of 0-12 years and equal number of controls, matched for age, sex and socio-economic status. The protective effectiveness and prevented fraction were higher for the subjects in the age group of 0-6 years, males and subjects from upper strata of socio-economic class. The overall vaccine effectiveness and prevented fraction were estimated to be 86.54% (70.38-93.88%) and 65.54% (39.22-80.64%) respectively. Results of this study thus indicated that BCG vaccination was highly effective against tuberculous meningitis and played significant role in its prevention, in this population.     

Results of the BCG vaccination in Hungary since 1929: evaluation of preventive and immunotherapeutic effectiveness

BACKGROUND: The BCG (Bacille Calmette-Guérin), a living attenuated bacterial vaccine with a characteristic residual virulence, has been used to prevent tuberculosis since 1921 (in Hungary non-systematically since 1929) and applied for immunostimulation in neoplasia since the 1960s. MEASURES: Considering the grave tuberculosis epidemiological situation in Hungary, the BCG revaccination became compulsory up to 20 years old tuberculin negatives since 1959. The Pasteur P1173P2 BCG strain has been used for vaccine manufacturing with improved quality control methods according to the requirements of the WHO. With in systematic BCG primo and revaccination policy 8.1 million BCG vaccination from 1959 to 1983 then further 3.1 million between 1984 and 1996 have been performed. RESULTS: Linear regression analysis demonstrates that the decrease of the TB incidence in children was 3-5 times more rapid (annual average decrease was 25.5%) than in adult since 1959. Multiple regression analysis indicates that the BCG is the strongest explanatory variable decreasing children TB incidence among other antituberculosis measures. The BCG vaccination efficacy ins demonstrated by 2 x 2 table analysis. The systematic BCG vaccination, the living and persisting BCG in the macrophages, confers acquired resistance against virulent TB infections. The immunostimulation in neoplasia has been applied with concentrated BCG developed in Hungary since 1979. The adverse reactions are at accepted frequency. The number of BCG vaccinated subjects was estimated at 1.5 billion from 1948 to 1974 in the world. The yearly number of BCG vaccination in the WHOI-EPI System is estimated 50-100 million. CONCLUSION: The efficacy of the BCG vaccination can only be ensured if the vaccine is manufactured and controlled with standardized methods, and applied in a systematic vaccination programme. The effectiveness has to be evaluated in statistically valid biostatistical models.     

Complications after BCG vaccination in the urban section of Lod? in the years 1994-5

The purpose of this paper was to evaluate the incidence of complications after BCG vaccination in children from urban area of Lód? in 1994-1995 and to give their pathological and prognostic interpretation on the basis of immunological and Gro?r allergometric examinations. The obtained data demonstrate that postvaccinal complications occurred in 46 children, that is 0.7/1000 of vaccinated population. They were observed mainly in newborns (45.7%), whereas they were particularly rare in revaccinated six-year-old children (13%) and schoolchildren (8.7%). In half of the cases there was an evidence of ulceration and suppuration in the site of vaccination, in another half--suppuration of local lymph nodes with or without fistula. Immunological and allergometric examinations were carried out in 21 children with post-vaccinal complications and 21 children with normal post-vaccinal period. In both groups the following were the subjects of evaluation: values of B and T lymphocytes and their CD4 and CD8 subpopulations, lymphocytes proliferative response to mitogenic PHA doses and tuberculin, as well as IgG, IgA and IgM levels. Immunological and allergometric examinations indicated that immunosuppression was neither the cause nor the effect of BCG complications.     

Effectiveness of mass neonatal BCG vaccination in the prevention of pulmonary tuberculosis: a case-control study in Nagpur, India

SETTING: Government Medical College, Nagpur, India, a tertiary care hospital. OBJECTIVE: To estimate the effectiveness of mass neonatal BCG vaccination in the prevention of pulmonary tuberculosis in Nagpur, India. DESIGN: A hospital-based pair-matched case-control study with a case of 1:3, including 144 cases of pulmonary tuberculosis and 432 controls. RESULTS: The overall vaccine effectiveness estimated in the present study was 60% (95% Confidence Interval [CI] 43%-72%). The protective effect was more in males in the age group 21-30 years. The prevented fraction was 39% (95% CI 24%-52%). CONCLUSION: The moderate effectiveness demonstrated in this study needs to be substantiated for other forms of tuberculosis by undertaking community-based case-control studies, before attempting to justify the use of mass neonatal BCG vaccination strategy as a part of the national programme.