BCG revaccination in school children: evolution of the lesion at the vaccination site between 48 hours and 10 weeks

Abstract

Objective: cutaneous reaction after BCG revaccination has been cause of concerns due its magnitude. Would it be intense enough to discourage its use in school-age children? The objective of this study is to describe the evolution of BCG vaccination site between 48 hours and 10 weeks post-revaccination.Methods: a descriptive cohort study was carried out involving 484 children between six and 11 years. The subjects were vaccinated with 0.1 mL of BCG-Moreau. Erythema, induration, pustule, ulcer, crust and final scar were measured within 48h, 72h and weekly until the tenth week, evaluated between July and December 1987. Epi Info 6.0 software was utilized to analyze frequencies, means, median and standard deviations.Results: induration was present in 99.1% and erythema in 91.6% of 438 children evaluated within 48h. Pustules were observed in the first week in 26.1% of 479 children. The first ulcers were seen during the second week. In the tenth week, 69.8% of 463 children showed crusts but only 29.2% completed the healing process.Conclusions: BCG revaccination in school-age children causes intense and early reaction that can be related to Koch phenomenon, even though it does not present the expected reduction in the healing period. The magnitude of the reaction is not enough to discourage its recommendation for school-age children. On the other hand, it is possible that the rapid inflammatory response is an indication of active immune response from the first vaccination.

Trained immunity as a novel approach against COVID‐19 with a focus on Bacillus Calmette–Guérin vaccine: mechanisms, challenges and perspectives

“…115 However, in the majority of cases the extent of a possible skin wound was not severe enough to stop re-vaccination. 116 Indeed, a systematic followup with regard to adverse events should be established for BCG re-vaccination.…”

“…Based on the literature, real Koch's phenomena are overestimated because usual adverse events are often mistaken for Koch’s phenomenon 115 . However, in the majority of cases the extent of a possible skin wound was not severe enough to stop re‐vaccination 116 . Indeed, a systematic follow‐up with regard to adverse events should be established for BCG re‐vaccination.…”

Boosting of Cellular Immunity against Mycobacterium tuberculosis and Modulation of Skin Cytokine Responses in Healthy Human Volunteers by Mycobacterium bovis BCG Substrain Moreau Rio de Janeiro Oral Vaccine

“…Intradermal BCG immunization requires technical skill, and although intradermal reimmunization appears to be safe (11,17), it does not confer additional protection (6,7,9,16), possibly as a result of prompt removal of viable bacilli by …”