BCG VACCINATION

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BCG VACCINATION
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• Bacillus Calmette-Guérin (or Bacille
  Calmette-Guérin, BCG) is a vaccine against
  tuberculosis that is prepared from a strain of
  the attenuated (weakened) live bovine
  tuberculosis bacillus, Mycobacterium bovis, that
  has lost its virulence in humans by being
  specially cultured in an artificial medium for
  years.
• The bacilli have retained enough strong
  antigenicity to become a somewhat effective
  vaccine for the prevention of human tuberculosis.
• At best, the BCG vaccine is 80 effective in
  preventing tuberculosis for a duration of 15
  years
• however, its protective effect appears to vary
  according to geography

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• Antituberculous vaccination prophylaxis, by
  strengthening the body resistance to specific
  protection offered by vaccination
• 50-80- most important benefit of being able to
  avoid serious illness especially in children
  (disseminated forms, meningitisTB)
• WHO recommends the use of BCG in newborn babies
  soon after birth-binding policy

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• WHO recommended obligatory vaccination in
  countries with high prevalence of tuberculosis
• National Immunization Program - BCG vaccination
  requirements at least 95 of newborns
• Following the emergence of HIV infection and
  HIV-TB is common association returns to BCG
  vaccination in developing countries

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INDICATIONS

• 1. All newborns and infants up to 12 months and
  revaccination of those who do not have 6 months
  post-vaccination scars greater than 3 mm
• EXCEPTION new born to mothers positive in
  sputum these get first chemotherapy (or
  antituberculous therapy, if appropriate) and then
  vaccinated.
• 2. Infants and children with negative TST
  tuberculin
• a) are at increased risk of close and prolonged
  exposure to pulmonary tuberculosis in adults with
  untreated or treated inefficiently and can not be
  removed from the source of infection or can not
  receive long-term chemoprophylaxis or
• b) are continuously exposed to persons with HIV
  and RMP resistant forms of tuberculosis .
• 3. Children born by HIV positive mothers,
  already infected, requiring BCG vaccination
  immediately after birth because
• - confers cross-protection against atypical
  mycobacteria

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CONTRAINDICATIONS

• Extensive skin disease or burns (acute
  dermatological disease)
• persons with a positive tuberculin skin test
• HIV positive
• moderate or severe febrile illness
• six months after viral hepatitis
• active tuberculosis
• weight lt2500 g at birth
• congenital immunodeficiency
• leukemias, lymphomas, malignancies

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Technique

• Vaccine is administered strictly intradermal
• Injecting - 1 / 3 medium left arm,
  posterior-external face
• local vaccination reaction 2-4 weeks- red node
  sometimes also ulceration
• successful vaccination scars gt 3 mm
• vaccination failure-scars lt 3 mm

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COMPLICATIONS

• Ulcerations gt 3 months
• Local abscess- after subcutaneous administration
  
• loco-regional adenopathies with necrosis
• Koch phenomenon- the local allergically reaction
  with rapid evolution to ulceration
• generalized infections or osteitis
• Leukocytosis with eosinophilia
• Moderate increase of VSH