Newborn BCG Vaccinations: Scar Formation and Tuberculin Conversion Rates: A Retrospective Study
American Journal of Pediatrics
Volume 5, Issue 1, March 2019, Pages: 1-6
Received: Dec. 20, 2018;
Accepted: Jan. 14, 2019;
Published: Jan. 31, 2019
Views 844 Downloads 173
Hanieh Tabatabaei, College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
Sam Hassan, Department of Pediatrics, Mediclinic City Hospital, Dubai, United Arab Emirates
Through this study, we aimed to determine the Bacillus Calmette-Guérin (BCG) vaccination uptake by scar formation rate following newborn BCG vaccinations and tuberculin conversion in a tertiary hospital setting in Dubai, United Arab Emirates. A retrospective cohort analysis was conducted on 945 babies vaccinated with BCG during 1 January and 31 December 2017. All babies were administered with intradermal 0.05 ml of BCG in the left deltoid. The descriptive variables include vaccination coverage. The outcome data includes follow up at 2, 4, and 6 months for scar formation, Mantoux test results, and revaccination data. Out of 945 babies, 911 (96.4%) were vaccinated by trained nurses with BCG after birth and before being discharged. This was following written consent from parents who were well informed by the details of the vaccinations. The non-vaccinated babies 34 (3.6%) were from different resident nationalities and the parents declined the BCG vaccine. Reason for such decline is not documented but it is likely because in their home country such vaccines are not routinely given. The number of babies who did not return for follow up was 483 (53%). These babies were followed by other centers or outside the country hence were not included in the study. The number of babies followed up with no record on BCG scar was 334 out of the total number of 482 (78%). BCG scar formation was recorded in 84 babies (19.6%) followed up. Scar formation failure was recorded in 10 (2.3%). Six babies (60%) of those who had no scar had Mantoux test performed. The association between absence of scar and negative Mantoux results were highly significant (P< 0.05) with 100% of babies having negative Mantoux results, therefore, no immunity. It is concluded that BCG scar is poorly recorded similarly to other high-income countries. There is a good correlation between lack of BCG scar and no immunity to Tuberculosis. Improvement of newborn BCG uptake is importantly needed. It is recommended to introduce mandatory recording of the outcome of BCG scar formation and resultant outcomes in the vaccinations books. Training of personnel administering the BCG vaccination is an important element for successful vaccination in this vulnerable age group.
Newborn BCG Vaccinations: Scar Formation and Tuberculin Conversion Rates: A Retrospective Study, American Journal of Pediatrics.
Vol. 5, No. 1,
2019, pp. 1-6.
Dhanawade S, Kumbhar S, Gore A, Patil V. Scar formation and tuberculin conversion following BCG vaccination in infants: A prospective cohort study. J Family Med and Prim Care. 2015; 4(3): 384.
Tuberculosis (TB) [Internet]. World Health Organization. 2018 [cited 1 March 2018]. Available from: http://www.who.int/mediacentre/factsheets/fs104/en/.
Trends in Tuberculosis – United States [Internet]. Cdc. 2018 [cited 7 March 2018]. Available from: https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm
Immunization Guidelines - Dubai Health Authority [Internet]. [cited 2018Nov24]. Available from:https://www.dha.gov.ae/Documents/Regulations/Guidelines/Immunization Guidelines.pdf.
Public Health. Tuberculosis by country: rates per 100,000 people [Internet]. GOV.UK. GOV.UK; 2018 [cited 2018Nov24]. Available from: https://www.gov.uk/government/publications/tuberculosis-tb-by-country-rates-per-100000-people.
Glaziou P, Floyd K, Korenromp EL, Sismanidis C, Bierrenbach AL, Williams BG, et al. Lives saved by tuberculosis control and prospects for achieving the 2015 global target for reducing tuberculosis mortality. Bulletin of the World Health Organization. 2011; 89(8): 573–82.
WHO Global TB Report 2017, progress toward ending TB too slow [Internet]. The Union. [cited 2018Nov24]. Available from: https://www.theunion.org/news-centre/news/the-union-response-to-who-global-tuberculosis-report.
Countries with high occurrence of tuberculosis [Internet]. Norwegian Institute of Public Health. [cited 2018Nov24]. Available from: https://www.fhi.no/en/id/infectious-diseases/TB/countries-tuberculosis/.
Al-Zarouni M, Dash N, Al Ali M, Al-Shehhi F, Pangirahi D. Tuberculosis and MDR-TB in the northern emirates of United Arab Emirates: a 5-year study. The Southeast Asian journal of tropical medicine and public health. 2010; 41(1): 163-168.
BCG Vaccination protocol for newborn infants (CG584) [Internet]. [cited 2018Nov24]. Available from: http://www.royalberkshire.nhs.uk/Downloads/GPs/GP protocols and guidelines/Maternity Guidelines and Policies/Postnatal/BCG for Newborns 2016_V2.0_CG584 .pdf.
Roth A, Gustafson P, Nhaga A, Djana Q, Poulsen A, Garly M et al. BCG vaccination scar associated with better childhood survival in Guinea-Bissau. International Journal of Epidemiology. 2005; 34(3): 540-547.
NHS Choices. NHS; [cited 2018Nov24]. Available from: http://www.meht.nhs.uk/about-us-/policies-and-guidelines/?assetdet82735=14766&p=22.
Kheir A, Alhaj A, Ibrahim S. The sensitivity of BCG scar as an indicator of previous vaccination among Sudanese infants. Vaccine. 2011; 29(46): 8189-8191.
Sample Size Calculator [Internet]. Calculator.net. 2018 [cited 1 March 2018]. Available from: http://www.calculator.net/sample-size-calculator.html.
Barton B, Peat J. Medical statistics. Chichester, West Sussex: Wiley Blackwell/BMJ Books; 2014.
Bryman A. Social research methods. Johanneshov: TPB; 2012.
Mcshane H. Tuberculosis Vaccines: Beyond Bacille Calmette-Guerin. Philosophical Transactions of the Royal Society B: Biological Sciences.2011; 366(1579): 2782–2789.
Hassan S, Hassan Abro A. Renal Tuberculosis in a 14-Years-Old Boy Presented as Pyrexia of an Unknown Origin (PUO): A First Case Report. American Journal of Pedriatics. 2018;4(2): 21-24.
Zimmermann P, Finn A, Curtis N. Does BCG Vaccination Protect Against Nontuberculous Mycobacterial Infection? A Systematic Review and Meta-Analysis. The Journal of Infectious Diseases. 2018; 218(5): 679–87.
Hu Y, Chen Y, Liang H, Wang Y. An Overview of Coverage of BCG Vaccination and Its Determinants Based on Data from the Coverage Survey in Zhejiang Province. International Journal of Environmental Research and Public Health. 2018;15(6): 1155.
Pelzer PT, Mutayoba B, Cobelens FG. BCG vaccination protects against infection with Mycobacterium tuberculosis ascertained by tuberculin skin testing. Journal of Infection. 2018;77(4): 335–40.
Kaur S, Fardi MM, Agarwal KN. BCG vaccination reaction in low birth weight infants. Indian Journal of Medical Research.2002; 116: 64-9.
Frankel H, Byberg S, Bjerregaard-Andersen M, Martins C, Aaby P, Benn C, et al. Different effects of BCG strains – A natural experiment evaluating the impact of the Danish and the Russian BCG strains on morbidity and scar formation in Guinea-Bissau. Vaccine. 2016; 34(38): 4586–93.
Shen CM, Soong WJ, Jeng MJ, Hwang B. Tuberculin response in infants six months after an intradermal Bacille Calmette-Guerin Vaccination. Fu-Jen Journal of Medicine. 2007;5:115–21.
Birk NM, Nissen TN, Ladekarl M, Zingmark V, Kjærgaard J, Jensen TM, et al. The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants. BMC Infectious Diseases. 2017;17(1).
Mangtani P, Nguipdop-Djomo P, Keogh RH, Trinder L, Smith PG, Fine PE, et al. Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK. Health Technology Assessment. 2017;21(39):1–54.
Adinarayanan S, Culp RK, Subramani R, Abbas KM, Radhakrishna S, Swaminathan S. Role of bacille Calmette-Guérin in preventing tuberculous infection. International Journal of Tuberculosis and Lung Disease. 2017; 21(4):420-424.
Funch KM, Thysen SM, Rodrigues A, Martins CL, Aaby P, Benn CS, et al. Determinants of BCG scarification among children in rural Guinea-Bissau: A prospective cohort study. Human Vaccines & Immunotherapeutics. 2018;14(10):2.