Clinical Outcome of Children with Post Bacillus Calmette and Guerin Vaccination Complications: A Single Center Experience


Background: Bacillus Calmette ET Guerin (BCG) vaccine, compulsory in endemic areas, remains the only available vaccine for prevention of Tuberculosis (TB) despite its modest protective value. Complications may arise in healthy/ immunocompromized hosts. Methods: Children presenting with BCG vaccine related complications in the form of local/distant complications were enrolled from 2007-2010 at Cairo University Pediatric hospital. Objectives: assess outcome of BCG related complications in a group of children with post vaccination incidents, identify risk factors for complications among vaccinated children and identify cases of underlying Primary Immunodeficiency (PID) among presenting cases. Results: Fifty one eligible patients were included, forty three were proved immunocompetent, and eight had underlying primary immunodeficiency disorders. Presentations included localized axillary lymphadenopathy, cervical sinuses, granulomatous lesions and disseminated forms Faulty injection sites were strongly associated with complications (p value < 0.001).Patients without underlying PID had larger scar size and younger age at presentations (p values: 0.02, 0.0001 respectively).Resolution of lesions was observed in 97 % (95% CI 97% ± 3%) of cases without underlying PID versus fatal outcome in all cases with underlying immune defects. Conclusion: Local BCG related complications do not necessarily indicate underlying PID, disseminated complications are more serious and warrant further investigations. If PID is suspected, vaccination should be deferred to avoid its potentially fatal outcome.

Share and Cite:

N. Galal, "Clinical Outcome of Children with Post Bacillus Calmette and Guerin Vaccination Complications: A Single Center Experience," World Journal of Vaccines, Vol. 2 No. 1, 2012, pp. 50-54. doi: 10.4236/wjv.2012.21007.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] K. B. Walker, M. J. Brennan, M. M. Ho, J. Eskola, G. Thiry, J. Sadoff, R. Dobbelaer, L. Grode, M. A. Liu, U. Fruth and P. H. Lambert, “The Second Geneva Consensus: Recommendations for Novel Live TB Vaccines,” Vaccine, Vol. 28, No. 11, 2010, pp. 2259-2270. doi:10.1016/j.vaccine.2009.12.083
[2] G. A. Colditz, C. S. Berkey, F. Mosteller, T. F. Brewer, M. E. Wilson, E. Burdick and H. V. Fineberg, “The Efficacy of Bacillus Calmette-Guerin Vaccination of New- borns and Infants in the Prevention of Tuberculosis: Meta-Analyses of the Published Literature,” Pediatrics, Vol. 96, No. 1, 1995, pp. 29-35.
[3] World Health Organization (WHO), “The Work of WHO in the Eastern Mediterranean Region: Annual Report of the Regional Director,” 2009.
[4] G. Sethuraman, V. Ramesh, M. Ramam and V. Sharma, “Skin Tuberculosis in Children: Learning from India,” Dermatologic Clinics, Vol. 26, No. 2, 2008, pp. 285-294. doi:10.1016/j.det.2007.11.006
[5] N. Rezaei, A. Aghamohammadi and L. Notarangelo, “Pri- mary Immunodeficiency Diseases: Definition, Diagnosis, and Management,” Springer, Berlin, 2008.
[6] R. S. Geha, L. D. Notarangelo, J. L. Casanova, H. Chapel, M. E. Conley, A. Fischer, L. Hammarstr?m, S. Nonoya- ma, H. D. Ochs, J. M. Puck, C. Roifman, R. Seger and J. Wedgwood, “Primary Immunodeficiency Diseases: An Up- date from the International Union of Immunological So- cieties Primary Immunodeficiency Diseases Classification Committee,” The Journal of Allergy and Clinical Immu- nology, Vol. 120, No. 4, 2007, pp. 776-794. doi:10.1016/j.jaci.2007.08.053
[7] R. Awad, “BCG Vaccine and Post-BCG Complications among Infants in Gaza Strip, 1999,” Eastern Mediterra- nean Health Journal, Vol. 7, No. 1-2, 2001, pp. 211-220.
[8] WHO, “Regional Epidemiological Data on Tuberculosis,” Eastern Mediterranean Health Journal, Vol. 2, 1996, pp. 164-166.
[9] N. Ritz, “Too Much of a Good Thing: Management of BCG Vaccine Overdose,” Vaccine, Vol. 27, No. 41, 2009, pp. 5562-5564. doi:10.1016/j.vaccine.2009.07.043
[10] D. Murphy, “Adverse Reactions to Mycobacterium Bovis Bacille Calmette-Guérin (BCG) Vaccination against Tuberculosis in Humans, Veterinary Animals and Wildlife Species,” Tuberculosis, Vol. 88, No. 4, 2008, pp. 344-357. doi:10.1016/
[11] K. Farsinejad, “Lupus Vulgaris at the Site of BCG Vaccination: Report of Three Cases,” Clinical and Experimental Dermatology, Vol. 34, No. 5, 2009, pp. e167-e169. doi:10.1111/j.1365-2230.2008.03041.x
[12] A. Santos, “Severe Axillary Lymphadenitis after BCG Vac- cination: Alert for Primary Immunodeficiencies,” Journal of Microbiology, Immunology and Infection, Vol. 43, No. 6, 2010, pp. 530-537. doi:10.1016/S1684-1182(10)60082-5
[13] M. Sadeghi-Shabestari and N. Rezaei, “Disseminated Bacille Calmette-Guérin in Iranian Children with Severe Combined Immunodeficiency,” International Journal of Infectious Diseases ,Vol. 13, No. 6, 2009, pp. e420-e423. doi:10.1016/j.ijid.2009.02.008
[14] D Shingadia and H. Baumer, “Tuberculosis, Diagnosis, Prevention and Management,” Archives of Disease in Childhood Education & Practice, Vol. 92, No. 1, 2007, pp. 27-29. doi:10.1136/adc.2006.110577
[15] J. P. Guthmann, D. Antoine, L. Fonteneau, D. Che and D. Lévy-Bruhl, “Assessing BCG Vaccination Coverage and Incidence of Paediatric Tuberculosis Following Two Major Changes in BCG Vaccination Policy in France,” Euro-surveillance, Vol. 16, No. 12, 2011.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.