Publication details
Nutnost posunu BCG vakcinace - poučení z komplikací a úmrtí dětí s vrozenými imunodeficiencemi
| Title in English | Necessity of postpone BCG vaccination - Lesson from complications and deaths of children with primary immunodeficiencies |
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| Authors | |
| Year of publication | 2010 |
| Type | Article in Periodical |
| Magazine / Source | Alergie |
| MU Faculty or unit | |
| Citation | |
| Field | Immunology |
| Keywords | BCG; BCG-osis; Immunization; Interactions of vaccines; Primary immumunodeficiencies; SCID |
| Attached files | |
| Description | The only available vaccine against tuberculosis is the BCG. The BCG vaccines, live attenuated strains of Mycobacterium bovis, were considered to be safe in the immunocompetent host. They are usually administered within the first few days of life as a part of community health program. Nevertheless, profoundly immunocompromised patients may develop disseminated BCG infection after vaccination. For this reason, the BCG vaccine given early after birth became unacceptable. The new immunization schedule is needed. In the Czech Republic systematic search and monitoring of patients with primary immunodeficiencies (PID) was initiated in 1981. The Czech national database of primary immunodeficiencies was established in 1993 and is connected with the European database of primary immunodeficiencies (ESID). The prevalence of PID in the Czech Republic (approximately 10 100 000 inhabitants) is 5.8 to 100 000. Among these patients there are children diagnosed with severe combined immunodeficiency (SCID) and chronic granulomatous disease (CGD) too. According to the Czech national database of PID, 12 out of 14 children with later proved SCID were immunised with BCG vaccine in the first days of life. Nine of them developed disseminated and generalized BCG infections. Five children with SCID died. Moreover, reactivation of BCG was also seen in healthy children after admission of combined vaccines with hepatitis B given at the age of twelve weeks. On the other hand, this was not the case in thousands of children of HBsAg positive mothers who were vaccinated against hepatitis B after delivery in the first place and later immunized with BCG vaccine. Epidemiological surveillance of tuberculosis (TB) and vaccination significantly lower the prevalence and risks of TB. In the Czech Republic, the prevalence of TB is currently 8.4 to 100 000 inhabitants. Unfortunately, temporary interruption of BCG vaccination in three large districts in the period of 1986 to 1993 led into higher incidence of TB and appearance of new cases of aviary mycobacteriosis. These complications were not observed in vaccinated children, indicating protective effect of BCG. We recommend a change of current practice of BCG vaccination considering new immunization schedule with hexavalent vaccine. We advise to postpone BCG vaccination until the second half of the child's first year of life which is in accordance with WHO. |
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