Evaluation of patients with primary immunodeficiency associated with Bacille Calmette-Guerin (BCG)-vaccine-derived complications

First vaccination after birth: serious adverse events of Bacillus Calmette-Guérin (BCG) in real-world

The Bacillus Calmette-Guérin (BCG) vaccine is a free vaccine in China, and more than 300 million newborns have been vaccinated. Inevitably, the BCG vaccine will have some rare adverse events on the first day of life (24 hours after birth), but related reports are extremely rare. In this commentary, the authors searched the Chinese legal documents database for documents related to serious adverse events caused by BCG from January 2010 to January 2022. Fourteen pediatric cases were identified, including 7 preterm infants and 7 full-term infants. The events included 4 cases of interstitial pneumonia, 3 cases of lymphadenitis, 3 cases of septicemia, 1 case of myocarditis, 1 case of muscle atrophy, 1 case of epilepsy, and 1 case of disseminated BCG vaccine. The mortality rate of preterm infants was 100% and that of full-term infants was 28.6% (2/7). All deaths occurred within one day. The BCG vaccine has good safety for the vast majority of newborns.

To our knowledge, we present the largest case series of BCG vaccine-induced serious adverse events in neonates.

The BCG vaccine has good safety for the vast majority of newborns.

The incidence of serious adverse events with BCG vaccine may be as low as eight per million.

Prevalence of primary immunodeficiency syndromes in tuberculous meningitis: A case-control study

BACKGROUND

Only a proportion of patients with tuberculosis develop tuberculous meningitis. We hypothesize that inherent abnormalities in the host's innate or adaptive immune system may affect the outcome in tuberculous meningitis. In this study, we evaluated the proportion of underlying primary immunodeficiency in patients with tuberculous meningitis and its impact on the outcome.

METHODS

Newly-diagnosed cases with tuberculous meningitis and healthy controls were included. Patients with HIV disease were excluded. Blood specimen were subjected to immunological assessment to detect primary immunodeficiency syndrome/s. We estimated serum levels of IgG, IgA, IgM, IgE and IgD along with complement C3, C4, and C5 assay. Absolute lymphocyte count was obtained from an automated three-part cell counter. Flow cytometry was used to enumerate the following lymphocyte subsets: T Cell (CD3, CD4, CD8), B cell (CD19/CD20), and Natural killer cells (CD16 and CD56). Cases were followed for 6 months. Modified Barthel Index was used as a measure of disability.

RESULTS

We included 55 cases with tuberculous meningitis and 30 healthy controls. We notedthat among immune parameters, absolute lymphocyte count and CD4 T-cell count in the tuberculous meningitis group was lower; higher serum IgG levels were noted in the poor outcome group. On multivariate regression analysis, none of the immunological, clinical or radiological features were found to predict a poor outcome.

CONCLUSION

Host's immune factors contribute to the pathogenesis of tuberculous meningitis. Absolute lymphocyte count and CD4+ T-cell count were lower in tuberculous meningitis cases. Higher serum IgG levels may be associated with a poor outcome. A study with a larger sample size is needed to confirm our findings.

Vaccination for Patients with Inborn Errors of Immunity: a Nationwide Survey in Japan

We conducted a nationwide survey of inborn errors of immunity (IEI) in Japan for the second time in 10 years, focusing on protective measures for IEI patients against infectious diseases. Questionnaires were sent to various medical departments nationwide, and a total of 1307 patients were reported. The prevalence of IEI was 2.2 patients per 100,000 population, which was comparable with the previous nationwide study. The most common disease category was autoinflammatory disorders (25%), followed by antibody deficiencies (24%) and congenital defects of phagocyte number or function (16%). We found that a significant number of patients received contraindicated vaccines, principally because the patients were not diagnosed with IEI by the time of the vaccination. Regarding diseases for which BCG vaccination is contraindicated, 43% of patients had actually received BCG, of which 14% developed BCG-related infections. BCG-related infections were mainly observed among patients with CGD and MSMD. In order to prevent IEI patients from receiving inadequate vaccines, continuous education to parents and physicians is needed, along with the expansion of newborn screening, but efforts to screen IEI at the site of vaccination also remain important.