BCG VACCINATION

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

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

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

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

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 <2500 g at birth congenital immunodeficiency leukemias, lymphomas, malignancies

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 > 3 mm vaccination failure-scars < 3 mm

COMPLICATIONS Ulcerations > 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