Six years' experience with the discontinuation of BCG vaccination

Trnka, L; Danková, D; Svandová, E

doi:10.1016/0962-8479(93)90056-4

Cited by 23 publications

(18 citation statements)

References 5 publications

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“…La enfermedad diseminada como infección oportunista en pacientes VIH se reporta escasamente en nuestra región, concentrándose en Brasil con una prevalencia aproximada del 8% (7) , en contraste con países de alto ingreso en la era pre TAR (3) . Esta diferencia se explicaría por la posible protección que brindaría una infección previa por MTB y la vacuna BCG (8) , o por un subdiagnóstico de esta condición.…”

Section: Discussionunclassified

Infección por el complejo Mycobacterium aviumintracellulare en pacientes con VIH/SIDA en un hospital peruano: una serie de casos

Huaroto¹,

Astocondor-Salazar²,

Montenegro-Idrogo³

et al. 2017

Rev Peru Med Exp Salud Publica

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RESUMENExiste poca información sobre la presencia del complejo Mycobacterium avium-intracellulare (MAC) en el Perú. Se describen cinco casos de infección por MAC en pacientes con VIH/SIDA del Hospital Nacional Dos de Mayo, Lima-Perú. Los pacientes presentaron, principalmente, fiebre persistente, diarrea crónica, síndrome consuntivo, pancitopenia y citofagocitosis. En todos ellos se identificó bacilos acido-alcohol resistentes en heces, por lo que recibieron tratamiento antituberculoso. El cultivo de heces fue negativo para Mycobacterium tuberculosis y, posteriormente, en todos se identificó a MAC mediante una prueba molecular (Genotype) en el cultivo de heces. Tres pacientes recibieron tratamiento para MAC luego de la identificación; sin embargo, todos fallecieron. Ante presentaciones similares a lo reportado, se sugiere el uso de métodos de mayor rendimiento (hemocultivo, mielocultivo, pruebas moleculares), así como asociar tempranamente drogas con actividad para MAC al esquema antituberculoso con la intención de mejorar el pronóstico de este grupo de pacientes. Palabras clave: Complejo Mycobacterium avium; VIH-1; Síndrome de inmunodeficiencia adquirida (fuente: DeCS BIREME). INFECTION BY THE Mycobacterium avium-intracellulare COMPLEX IN PATIENTS WITH HIV/AIDS IN A PERUVIAN HOSPITAL: A SERIES OF CASES ABSTRACTThere is little information on the presence of the Mycobacterium avium-Intracellulare (MAC) complex in Peru. Five cases of MAC infection are described in patients with HIV/AIDS at the National Hospital Dos de Mayo, Lima -Peru. The patients presented, mainly, persistent fever, chronic diarrhea, consumptive syndrome, pancytopenia and citofagocitosis. In all of them, resistant acid-alcohol bacilli were identified in feces, so they received antituberculous treatment. The culture of feces was negative for Mycobacterium tuberculosis and, later, in all cases MAC was identified using a molecular test (genotype) in the culture of feces. Three patients received treatment for MAC right after identification; however, they all died. Before presentations similar to the reported, we suggest the use of higher performance methods (blood culture, myeloculture, molecular tests), as well as early associating drugs with activity for MAC to antitubercular scheme with the intention of improving the prognosis of this group of patients. Key words: Mycobacterium avium complex; HIV-1; Acquired immunodeficiency syndrome (source: MeSH NLM).1 Servicio de Medicina en Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo. Lima, Perú. INTRODUCCIÓN Elcomplejo Mycobacterium avium-intracellulare (MAC) está comprendido por las especies M. avium y M. intracellulare. Dichas especies están distribuidas ampliamente en el medioambiente -principalmente en el agua y el suelo-, siendo la inhalación y/o ingesta sus probables mecanismos de transmisión (1) . En el paciente VIH coinfectado por MAC se observa una alta frecuencia de colonización y compromiso gastrointestinal, por lo que se postula que sería la mucosa intestinal la vía pr...

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Section: Discussionunclassified

Infección por el complejo Mycobacterium aviumintracellulare en pacientes con VIH/SIDA en un hospital peruano: una serie de casos

Huaroto¹,

Astocondor-Salazar²,

Montenegro-Idrogo³

et al. 2017

Rev Peru Med Exp Salud Publica

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“…A survey carried out 6 years later showed that, although the protective efficacy of BCG was quite high, 80%, there were so few cases of tuberculosis among nonvaccinated children that mass vaccination was no longer considered justifiable on costbenefit grounds. 42 It was stated that cessation of vaccination would facilitate a program of tuberculin testing and preventive chemotherapy. Nevertheless, it was stressed that cost-benefit analysis suffers from a serious imperfection: "The avoidance of one death or of one case of tuberculosis can hardly be calculated in terms of money."…”

Section: Problems Encountered In the Decision To Vaccinate Against Tumentioning

confidence: 99%

“…Nevertheless, it was stressed that cost-benefit analysis suffers from a serious imperfection: "The avoidance of one death or of one case of tuberculosis can hardly be calculated in terms of money." 42 The International Union Against Tuberculosis and Lung Disease (IUATLD) recommends that cessation or modification of BCG vaccination programs should only be considered in countries with well-functioning tuberculosis control and epidemiology programs with an annual notification rate of sputum-smear-positive cases of 5 or less per 100,000 population or less than one case of tuberculous meningitis in children under the age of 5 years per 10 million population or an average annual risk of infection by tubercle bacilli of 0.1% or less. 43 Consideration should also be given to the possibility of an increase in the number of cases due to the HIV pandemic and the safety of the vaccine.…”

Section: Problems Encountered In the Decision To Vaccinate Against Tumentioning

confidence: 99%

Vaccination Against Tuberculosis: Past Problems and Future Hopes

Grange¹

1997

Semin Respir Crit Care Med

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“…This was accompanied by a six-fold increase in tuberculosis in Swedish children (0.18 cases/105 person years versus 1.28 cases/105). A similar study in Czechoslovakia also showed an increase in numbers of cases of tuberculosis [237] but concluded that the advantages and disadvantages of BCG immunisation were in balance [238]. By comparing tuberculous incidence pre-and post-BCG discontinuation, a protective efficacy of 80% was calculated [238].…”

Section: Does It Work?mentioning

confidence: 99%

“…A similar study in Czechoslovakia also showed an increase in numbers of cases of tuberculosis [237] but concluded that the advantages and disadvantages of BCG immunisation were in balance [238]. By comparing tuberculous incidence pre-and post-BCG discontinuation, a protective efficacy of 80% was calculated [238]. Interestingly, the incidence of M. avium-intracellulare lymphadenitis was higher in the BCG-unvaccinated than the vaccinated group [239].…”

Section: Does It Work?mentioning

confidence: 99%