Osteitis after newborn vaccination with three different Bacillus Calmette-Guérin vaccines

Kröger, Liisa; Brander, E; Korppi, Matti; Wasz-Höckert, O; Backman, A; Kröger, Heikki; Launiala, K; Katila, Marja–Leena

doi:10.1097/00006454-199402000-00007

Cited by 68 publications

(84 citation statements)

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“…An immediate reduction of osteitis cases was observed after the policy changed 89 and was confirmed in the follow-up studies in 1994. 91 In 2002, however, BCG-Glaxo was replaced by BCG-Danish in Finland and a sharp rise in the lymphadenitis cases was noted. 91 A similar observation was also made in the UK.…”

Section: © 2 0 0 9 L a N D E S B I O S C I E N C E D O N O T D I S mentioning

confidence: 99%

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BCG Vaccines: Their mechanisms of attenuation and impact on safety and protective efficacy

Liu

Tran²,

Leung³

et al. 2009

Human Vaccines

123

117

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by MDR strains that are also resistant to a fluoroquinolone and at least one second-line injectable agent (amikacin, kanamycin and/or capreomycin), caught the world's attention after an outbreak in KwaZulu-Natal, South Africa, where 52 of 53 infected patients died. 2 HIV co-infection was a contributing factor in most of these deaths, and indeed, a deadly association between HIV and TB has been known almost since the start of the HIV-epidemic. Of the 1.7 million people who died from TB in 2006, an estimated 200,000 were co-infected with HIV. 1 Because of these situations, effective approaches alternative to antibiotics are urgently needed for the control of TB.Bacille Calmette-Guérin (BCG), an attenuated strain of Mycobacterium bovis (M. bovis), is currently the only available vaccine against TB. Since 1974, BCG vaccination has been included in the WHO Expanded Program on Immunization. 3 It is estimated that more than 3 billion individuals have been immunized with BCG and over 100 million doses of BCG are administered annually, making it the most widely used vaccine in humans. 3 Meta-analysis studies have confirmed that BCG protects children, providing >80% efficacy against severe forms of TB, including tuberculous meningitis and miliary TB. 4,5 In contrast, evidence for protection against pulmonary TB in adolescents and adults remains contentious as efficacy estimates from clinical trials, observational case control studies and contact studies range from 0 to 80%. 6,7 The reasons for the variable protective efficacy are unknown but several hypotheses have been proposed, including differences among the vaccine strains used in clinical studies, exposure of trial populations to environmental mycobacteria, nutritional or genetic differences in human populations, differences in trial methods, and variations among clinical M. tb strains. 8-13 These explanations are not mutually exclusive and all may contribute to the heterogeneity in vaccine efficacy.A key aspect of this issue may concern the nature of BCG attenuation. Although it is generally considered safe and has been used as a human vaccine since the 1920s, the mechanisms of BCG attenuation remain largely unknown. This is further complicated by the fact that BCG is not a single strain, but instead comprises a number of substrains that exhibit phenotypic and biochemical differences. 14 BCG strains also exhibit differences in residual virulence level. [15][16][17] However, side effects were often attributed to variations in the viability of vaccines during preparation procedures (e.g., freezedrying). 14 In other words, the observed differential virulence among Mycobacterium bovis Bacille Calmette-Guérin (BCG) was developed as an attenuated live vaccine for tuberculosis control nearly a century ago. Despite being the most widely used vaccine in human history, the mechanisms of attenuation of BCG remain poorly understood. BCG is not a single organism, but comprises a number of substrains that differ in genotypes and phenotypes. The impacts of these differences on BCG...

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Section: © 2 0 0 9 L a N D E S B I O S C I E N C E D O N O T D I S mentioning

confidence: 99%

“…91 In 2002, however, BCG-Glaxo was replaced by BCG-Danish in Finland and a sharp rise in the lymphadenitis cases was noted. 91 A similar observation was also made in the UK. When BCG-Glaxo was in use, cases of BCG-associated osteitis had never been reported in the UK.…”

Section: © 2 0 0 9 L a N D E S B I O S C I E N C E D O N O T D I S mentioning

confidence: 99%

BCG Vaccines: Their mechanisms of attenuation and impact on safety and protective efficacy

Liu

Tran²,

Leung³

et al. 2009

Human Vaccines

123

117

View full text Add to dashboard Cite

show abstract

“…10 Disseminated BCG infection is uncommon, occurring in one per million vaccinations, and is associated with severe abnormalities in cellmediated immunity. 11 In Canada, BCG is given to infants in communities with an average annual rate of culture-positive pulmonary tuberculosis greater than 30 per 100 000; this has generally applied to some First Nations communities. Between 1993 and 2002, 21 BCG vaccinerelated adverse events were reported in Canada.…”

Section: Discussionmentioning

confidence: 99%

“…The largest review of cases of BCG osteomyelitis from Finland found that a minority of cases were multifocal (4%), and these cases were more likely to be associated with an underlying immune defect. 11 The most common sites were the metaphysis and epiphysis of long bones. The leg was often implicated (58% of patients).…”

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confidence: 99%

Nonresponding osteomyelitis in a two-year-old boy

Khan

Stimec

Kitai

2015

CMAJ

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“…Vaccine strain may influence BCG-related adverse events and should be considered when these are monitored and reported. 30,31 We did not have data available on the incidence of tuberculosis among non-vaccinated HIV-infected infants, since routine vaccination coverage was almost universal.…”

Section: Infants With Unknown Hiv Infection Status But Who Have Signsmentioning

confidence: 99%

Disseminated bacille Calmette-Guerin disease in HIV-infected South African infants

Hesseling

Johnson

Jaspan

et al. 2009

Bull World Health Org

102

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Osteitis after newborn vaccination with three different Bacillus Calmette-Guérin vaccines

Cited by 68 publications

References 0 publications

BCG Vaccines: Their mechanisms of attenuation and impact on safety and protective efficacy

BCG Vaccines: Their mechanisms of attenuation and impact on safety and protective efficacy

Nonresponding osteomyelitis in a two-year-old boy

Disseminated bacille Calmette-Guerin disease in HIV-infected South African infants

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