Bacillus Calmette-Guérin Cases Reported to the National Tuberculosis Surveillance System, United States, 2004–2015

Abstract

TOC summary: Clinical history can discern probable BCG cases from TB cases, enabling optimal clinical management.

First insight into the whole-genome sequence variations in Mycobacterium bovis BCG-1 (Russia) vaccine seed lots and their progeny clinical isolates from children with BCG-induced adverse events

“…Adverse events following immunization with BCG are considered underreported since assays to confirm isolates as BCG are still relatively rare. Moreover, based on the routine laboratory diagnostics and even molecular techniques, it is difficult to associate the clinical BCG isolates with the particular vaccine lot administered [15][16][17][18][19][20]. Therefore, the contribution of BCG genomic heterogeneity to the viability and residual virulence of vaccine populations in vivo remains unclear in terms of the development of BCG-related disease that otherwise can be associated with immune responses and human genetics.…”

“…The attenuated BCG vaccines are believed safe and effective mainly to prevent the most severe meningitis and miliary forms of childhood TB associated with high mortality in infants and young children, especially in high TB-burden countries [1,2]. However, adverse events following immunization with BCG in 1-10% of vaccinees are likely to be substantially underreported since assays to confirm isolates as BCG are still relatively rare [15][16][17][18][19][20] despite the advent of molecular techniques and commercially available kits for BCG identification [21]. In Russia, the estimated frequency of complications per 100,000 BCGimmunized decreased from 35.3 in 2005 to 11.2 in 2013 [22].…”

Delayed-onset disseminated BCG disease causing a multi-system illness with fatal mycotic aortic aneurysm

“…This study also reported mycotic aneurysms in 5.7% of systemic BCG cases and found that those with vascular involvement had a mortality rate roughly four times baseline (16.7% vs 4.5%). A study looking at 118 BCG cases reported to the US National Tuberculosis Surveillance System from 2004 to 2015 reported that genitourinary and skeletal systems were most commonly affected, with only 3% of cases having pleural, and none meningeal involvement (Wansaula et al, 2019).…”

Disseminated M. bovis Infection and Vertebral Osteomyelitis following Immunotherapy for Bladder Cancer

“…Diagnosis of Pott's disease or disseminated BCG in general can be challenging. Extrapulmonary findings of disseminated BCG are difficult to detect with sputum smears, with only 4 of 118 total cases reported to the CDC from 2004 to 2015 testing positive [ 10 ]. Emphasis must be placed on sampling multiple locations suspected of disease and using genetic assay such as spacer oligonucleotide, mycobacterial interspersed repeating units, and variable number of tandem repeats [ 4 ].…”