Recommendations for pediatric tuberculosis vaccination in Italy

Abstract

Bacillus Calmette-Guerin (BCG) vaccine is still the only vaccine approved for the prevention of tuberculosis (TB), and is widely used in highly endemic countries, where all newborns receive a single intradermal dose immediately after birth; however, the recommendations concerning its use in Europe vary widely from country to country. This document describes the recommendations of a group of Italian scientific societies concerning its pediatric use in Italy, the persistence of the protection it provides, its safety, its interference with tuberculin skin test (TST) responses, and the children who should be vaccinated. The experts conclude that BCG vaccination provides a good level of protection against tuberculous meningitis and disseminated forms, and a fair level of protection against pulmonary disease; the protective effective lasts at least 10 years, and revaccination offers no advantages over a single administration. The vaccine is safe in immunocompetent subjects, and affects the response to a TST for at least 6 y On the basis of these observations, we recommend its use in Italy in all TST-negative immunocompetent newborns and breastfeeding infants aged <6 months, and all TST-negative children aged between 6 months and 5 y who come from highly epidemic areas, or whose parents come from highly endemic areas, or who have been in contact with a family member with active TB without contracting the disease themselves.

Pediatric Tuberculosis in Italian Children: Epidemiological and Clinical Data from the Italian Register of Pediatric Tuberculosis

“…Therefore, recent literature suggests that high-risk children should be vaccinated with BCG, as is already done in some European countries ( i.e. , United Kingdom, France, and Scandinavian countries) [ 10 , 11 , 12 , 13 , 14 ]. In our study, the protective role of the BCG vaccination was not performed by a multivariate analysis because there was a high proportion of missing data on the BCG vaccination.…”

Mandatory Childhood Vaccinations in Poland—The Art of Preventing the Preventable

“…The most common adverse effects are not lifethreatening or severe and include abscess, lymphadenopathy, excessive infiltration, ulceration, and erythema [74]. Rarely, a BCG vaccine may result in purulent lymphadenitis or a BCG infection [8] with almost all patients suffering from these complications being HIV positive [74]. The vaccine is considered safe [73] and used in Poland and worldwide [69].…”