[BCG vaccination of the newborn infant with the 131 Copenhagen strain]

Adverse reactions in healthy and immunocompromised children under six years of age vaccinated with the Danish BCG vaccine, strain Copenhagen 1331: implications for the vaccination policy in Sweden

A retrospective analysis of the adverse reactions reported between 1979 and 1991, in the 139,000 children under six years of age vaccinated in Sweden with the Danish BCG vaccine, strain Copenhagen 1331, showed an incidence of 1.9 per 1000 vaccinated children. Regional lymphoglandular swellings and/or abscesses were most commonly reported in 1.4 per 1000. Serious, disseminated, BCG infections developed in four infants vaccinated neonatally. Three of the infants suffered from severe, combined, immunodeficiency syndrome, undiagnosed at the time of vaccination. The incidence of severe, combined, immunodeficiency syndrome was higher in the BCG-vaccinated population (4 per 100,000 infants vaccinated within a year of their births), compared with all newborns in Sweden (1 per 100,000). The mean age at the onset of symptoms was 2.4 months for the seven non-BCG-vaccinated infants versus 1.3 months for the four BCG-vaccinated ones, while the immunodeficiency syndrome was diagnosed at an average age of 7.6 months in those who were not vaccinated versus 5.3 months in those BCG-vaccinated. It is recommended that the selective BCG vaccination of infants at high risk of exposure to tuberculosis should be postponed to six months of age to reduce the risk of inoculating infants suffering from immunodeficiency syndromes.

Occurrence of suppurative lymphadenitis after a change of BCG vaccine

BCG vaccines are the oldest vaccines in use today, but the protective effect of the vaccination is still controversial. The risk of contracting tuberculosis is low compared with the possible complications after this vaccination. In Austria the formerly used BCG vaccine was not available in the required amount and another vaccine was released by the drug authorities. This product, with a more virulent strain, was used between August and December 1990, and this increased the incidence of complications. Eighty four of 1950 vaccinated newborn babies developed severe suppurative lymphadenitis three to 28 weeks after the vaccination, and surgical treatment was found to be necessary. Isoniazid treatment did not prove to be successful when the lymph node exceeded a certain size. Culture was successful in 46% up to week 20; after 20 weeks no culture became positive. All cultured bacteria were isoniazid sensitive. The question of general vaccination is raised and several points were considered before we came to the conclusion that except for high risk groups a general vaccination programme for neonates is not justified in Western countries.

Therapy of regional lymphadenitis following BCG vaccination

In this study we presented 92 cases with regional lymphadenitis (over 1 cm in diameter) which was caused by BCG vaccination generally performed a few days after birth. The patients were divided into four therapy groups. In group I, the lymphadenitis in 26 cases was excised totally by a surgical operation and they improved in a median period of four weeks (average: 4.4). No therapy was applied in 33 patients constituting group II and their periods of improvement were 28 weeks (average: 29.1). Sixteen cases in group III were given isoniazid (INH) 10 mg/kg for six months in addition to total surgical excision and their healing period was 4.5 weeks (average: 4). Seventeen cases in group IV were administered only INH for six months and the median improvement period was found to be 27 weeks (average: 28.2). The statistical differences in terms of the improvement periods between groups I and III, and groups II and IV were found to be insignificant (p greater than 0.05) but these differences were significant between groups I and II, groups I and IV, groups II and III, and groups III and IV (p less than 0.05). These results show that spontaneous healing is possible. Total excision is the best therapy for BCG lymphadenitis in suppurative forms and INH has no effect in shortening the therapy period.