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Lymphadenitis following intradermal BCG vaccination  

Baek, Hey Sung (Department of Pediatrics, College of Medicine, Hanyang University)
Chang, Ji Young (Department of Pediatrics, College of Medicine, Hanyang University)
Moon, Su Ji (Department of Pediatrics, College of Medicine, Hanyang University)
Oh, Sung Hee (Department of Pediatrics, College of Medicine, Hanyang University)
Publication Information
Clinical and Experimental Pediatrics / v.49, no.1, 2006 , pp. 46-50 More about this Journal
Abstract
Purpose : Intradermal BCG vaccine has not well been accepted by pediatric practitioners due to BCG lymphadenitis. Therefore, this study was undertaken to find out the incidence of lymphadenitis following intradermal BCG vaccination and its clinical outcome. Methods : One thousand and fifty infants, who received intradermal BCG(French 1173 P2, Korea Tuberculosis Association) vaccination in the Well Baby Clinic of Hanyang University Hospital from July 2001 to January 2004, were included in the study. Severe local reactions at the injection site and any mass noted on surrounding areas were reported to, and evaluated by, pediatricians. Surgical procedures, either surgical resection or needle aspiration, were recommended when lymph nodes progressed to suppurate without regression. Results : Twenty infants(1.9 percent) developed lymphadenitis 2 to 8 months following vaccination. The incidence of BCG lymphadenitis was significantly higher in infants born with intrauterine period of <38 weeks and birth weight of <2,700 g. The lymph nodes became suppurative in 7/17 infants (41.2 percent) and four infants required surgical procedures with which the rate for the requirement of surgical procedures among intradermal BCG vaccinnes approximated to be 0.45 percent. There was no correlation between the size of lymph nodes and suppuration, however surgical procedures were required significantly more often for lymph nodes of greater than 3 cm in diameter. Conclusion : The incidence of BCG lymphadenitis following intradermal BCG(French 1173 P2, Korea Tuberculosis Association) vaccinations would be more than 1.9 percent, when considering cases of lymphadenits not reported. More efforts need to be paid to decrease the incidence of BCG lymphadenitis in order to promote intradermal BCG vaccination in Korea.
Keywords
BCG vaccine; Lymphadenitis; Vaccination; Tuberculosis;
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1 Colditz GA, Brewer TF, Berkey CS, Wilson ME, Burdick E, Fineberg HV, et al. Efficacy of BCG vaccine in the prevention of tuberculosis. Meta-analysis of the published literature. JAMA 1994;271:698-702   DOI
2 Kim SJ, Kim CH, Sohn YM, Lew WJ. Kang MK. Prevalence survey of lymphadenitis after BCG vaccination. Program and Abstract, the 48th Annual Fall Meeting of the Korean Pediatric Society; 1998 Oct 16-17; Seoul. Seoul : The Korean Pediatric Society, 1998:69
3 Jin BW, Hong YP, Kim SJ. A contact study to evaluate the BCG vaccination programme in Seoul. Tubercle 1989; 70:241-8   DOI   ScienceOn
4 Kim HI, Baik HG. Clinical analysis of lymphadenitis after BCG vaccination. J Korean Surg Soc 1995;49:417-24
5 Merry C, Fitzgerald RJ. Regional lymphadenitis following BCG vaccination. Pediatr Surg Int 1996;11:269-71   DOI
6 Hengster P, Schnapka J, Fille M, Menardi G. Occurrence of suppurative lymphadenitis after a change in BCG vaccination. Arch Dis Child 1992;67:952-5   DOI   ScienceOn
7 Kim KH, Lee SJ, Lee K. PPD conversion rate and complications according to the different time of BCG vaccination. J Korean Pediatr Soc 1987;30:487-90
8 Teo SS, Smeulders N, Shingadia DV. BCG vaccine-associated suppurative lymphadenitis. Vaccine 2005;23:2676-9   DOI   ScienceOn
9 Na KH, Rim SS, Kim EY, Kim KS, Kim YW. Factors affecting clinical course of BCG lymphadenitis. Korean J Pediatr Infect Dis 2001;8:181-90   DOI
10 Caglayan S, Yegin O, Kayran K, Timocin N, Kasirga E, Gun M. Is medical therapy effective for regional adenitis following BCG vaccination- Am J Dis Child 1987;141:1213-4
11 Park IS, Han DK, Lim HJ, Oh SH. Lee H. Comparison of Tuberculin skin test results and adverse reactions following BCG vaccination in various infant groups of different ages. J Korean Pediatr Soc 1993;36:1300-7
12 Wasz-Hockert O, Backman A, Lotte A. Osteitis caused by BCG vaccination of newborn. Bull Int Union Tuberc 1979; 54:325-31
13 Lotte A, Wazs-Hockert O, Poisson N, Engbaek H, Landmann H, Quast U, et al. Second IUALTD study on complications induced by intradermal BCG vaccination. Bull Int Union Tuberc Lung Dis 1988;63:47-59
14 Noah PK, Pande D, Johson B, Ashley D. Evaluation of oral erythromycin and local isohiasic instillation therapy in infants with Bacillus Camette-Guerin lymphadenitis and abscess. Pediatr Infect Dis J 1993;12:136-9   DOI   ScienceOn
15 Moreno L, Gottrand F, Herbaux B, Savage C, Ferriaux JP. Vertebral osteitis following BCG vaccination in a previously healthy child. Eur J Pediatr 1990;149:668.   DOI   ScienceOn
16 Bergdahl S, Fellander M, Robertson B. BCG osteomyelitis. Experience in Stockholm region over the 1961-74. J Bone Joint Surg 1976;58:212-6.
17 Ministry of Health and Welfare, The Korean Institute of Tuberculosis. The 7th national tuberculosis prevalence survey in 1995 in Korea. 1995:8-12
18 The WHO Position Paper on BCG Vaccine. Weeakly Epidemiological Record 2004;79:27-38.
19 Kroger L, Brander E, Korppi M, Wasz-Hockert O, Backman A, Kroger H, et al. Osteitis after newborn vaccination with three different Bacillus Calmette-Guerin vaccines : twenty-nine years of experience. Pediatr Infect Dis J 1994; 13:113-6   DOI   ScienceOn
20 Stuckey J. Prevalence of BCG-related adenitis in healthy children, Maputo Ctiy, Mozamgique. UNICEF report October 1988
21 Lotte A, Watz-Hockert O, Poisson N. Dumitrescu N, Verron M, Couvet E. BCG complications : Estimates of the risk among vaccinated subjects and statistical analysis of their characteristics. Adv Tuberc Res 1984;21:107-93
22 Oguz F, Mujgan S, Alper G, Alev F, Neyzi O. Treatment of Bacillus Camette-Guerin associated lymphadenitis. Pediatr Infect Dis J 1992;11:887-8   DOI   ScienceOn
23 Oh JT, Kim IG, Han SJ, Hwang EH. Management of BCG lymphadenitis. J Korean Assoc Pediatr Surg 1997;3:143-7
24 The Korean Pediatric Society. General recommendations on immunizations. 5th ed. Seoul : Kwang Moon Co, 2002:35-47
25 Hwang JS, Choi YY, Ma JS, Hwang TJ. A clinical study on BCG lymphadenitis. J Korean Pediatr Soc 1997;40:614-8
26 Ministry of Health and Welfare, Adverse events and management following BCG vaccination. Document No. 655 1995:40-818
27 Milstien JB, Gibson JJ. Quality control of BCG vaccine by WHO : a review of factors that my influence vaccine effectiveness and safety. Bull World Health Organ 1990;68:93- 108