Sensitivity of neonates to tuberculin after BCG vaccination.

Abstract

Birth size in Indian ethnic sub-groups born in Britain. Arch Dis Child 1985;60:868-70. 2 Woods DL, Malan AF, Heese H de V. Patterns of retarded fetal growth. Early Hum Dev 1979;3:257-62. SIR,-The ratio of mid-arm circumference to occipitofrontal circumference in the newborn baby appears from the paper by Dr Nigel Meadows and his colleagues to be a useful marker of intrauterine growth retardation, especially in areas -where a large multiethnic population causes significant variations in birth weight.Their findings of a similar ratio in Asian (presumably referring to parents from countries of the Indian subcontinent) as in black and white babies is important. In Britain Asian babies are on average of lower mean birth weight, but it iswrong to assume, as is often implied, that intrauterine growth retardation necessarily plays a major part. These Asian families are heterogeneous in their geographical origins, culture, diet, social predicaments, etc. The extent to which prenatal undernutrition can be held accountable for the shape of the fetal growth curve during the latter part of the third trimester (on which birth weight distribution depends) will depend on interactions between these influences. For example, in Leicester in the early 1980s it could not be shown that the lower mean birth weight in Asian babies than in those of European origin (2998 and 3320 g respectively: p<O-00l) was due to undernutrition of the mothers during pregnancy.'2 Yet studies in Birmingham at about the same time suggested that the Asian mothers were more nutritionally at risk, thereby increasing the likelihood of lowering birth weight.3 More Asian babies will inevitably have birth weights in the lower centile channels of European populations, but not necessarily for pathological reasons. It is this very dilemma that Dr Meadows and his colleagues are attempting to resolve using the ratio of mid-arm circumference to occipitofrontal circumference, which is independent of birth weight. This index also seems a valuable tool to differentiate the underfed "small for dates" baby from the proportionately small.Chinese babies were not included-in the study of Dr Meadows and others. We therefore offer some data on the ratio of mid-arm circumference to occipitofrontal circumference in normal, term Chinese babies to complement their-findings. These 175 babies (95 boys; 80 girls) weighing >2500 g with a mean birth weight of 3220 g were born at 37-42 weeks to healthy mothers. Occipitofrontal circumference and mid-arm circumference were determined by standard methods at a mean age of 7 days. The mean ratio (SD) was'0-31 (0 02), significantly higher than the value of 0-29 found in the black, Asian, and white babies (p<0-001;Student's t test). Whether this was due to greater arm circumference (reflecting better intrauterine nutrition), a smaller head circumference, or even differences in measuring techniques cannot be determined from available information. The authors' conclusion that the mid-arm circumference to occipitofrontal circumference shows no i...

Mycobacterium tuberculosis Infection after Travel to or Contact with Visitors from Countries with a High Prevalence of Tuberculosis

“…In addition, demographic information (the date and place of birth, sex, race, and ethnicity) and information about bacille Calmette Guérin (BCG) vaccination and any previous skin test results was obtained. Physical examination was not performed to search for a visible BCG vaccination scar because such scars may be variably present (12,13) and when present may not necessarily be associated with a delayed sensitivity response to skin testing (12)(13)(14)(15).…”

Tuberculin skin testing: Determinants and reaction

“… 23 However, studies have shown that > 90% of infants who received BCG vaccination developed significant reaction within 2 months. 19,24–26 Lifschitz 18 found that in 250 infants who received BCG vaccination at birth 50% reverted to tuberculin‐negative status within 6 months, and in almost all cases within 1 year. In 106 Sri‐Lankan infants who were BCG vaccinated, only 18% were PPD positive after 1 year, and by the age of 5 years no effect of BCG could be detected.…”