Evaluation of the Immune Response to Interferon Gamma Release Assay and Tuberculin Skin Test Among BCG Vaccinated Children in East of Egypt

Beshir, Mohamed Refaat; Zidan, Alaa Ebrahim; El-Saadny, Hosam Fathi; Ramadan, Ronnie; Karam, Nehad Ahmed; Amin, Ezzat; Mohamed, Marwa; Abdelsamad, Nahla Mohamed

doi:10.1097/md.0000000000003470

Cited by 10 publications

(7 citation statements)

References 15 publications

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“…The pediatric age group in the current study was asymptomatic in 100% of the cases, which is different from other studies [29]. However, there is an assumption that the Bacillus Calmette-Guérin (BCG) vaccine might reduce the clinical presentation of COVID-19 infection in the pediatric age group [20,30] as BCG is an obligatory vaccine in Egypt, including and its booster doses among young children [31,32]. The same results were encountered in a small study coming from upper Egypt, including 36 patients with mild/moderate COVID-19 infection and 30 patients with severe/critical conditions.…”

Section: Discussioncontrasting

confidence: 69%

Clinical features and laboratory characteristics of patients hospitalized with COVID-19: single centre report from Egypt

Kassas

Asem

Abdelazeem

et al. 2020

J Infect Dev Ctries

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Introduction: The recently discovered novel coronavirus disease (COVID-19) has emerged in Wuhan, China, since January 2020. Egypt reported a low incidence of infection when compared with other countries. The aim of the study was to assess the characterization of COVID-19 infection among the Egyptian population. Methodology: Data were collected from a single COVID-19 quarantine hospital in Cairo. A total number of 195 cases were included with their clinical, laboratory, and radiological data. Results: Three different age groups behaved differently for COVD-19 infection. The pediatric age group was asymptomatic entirely, the middle age group (18-50 years) were asymptomatic in 53.3% of cases, while 77.9% of those above 50 years were symptomatic (p ≤ 0.001). The latter group had a high incidence of COVID-pneumonia in (83.1%), and moderate to critical presentations were encountered in 66.3% of them. Neutrophil to lymphocyte (N/L) ratio correlated directly with the age and case severity. C-reactive protein (CRP) and computed tomography scan chest (CT-chest) had added value on COVID-19 diagnosis in suspected cases. Conclusions: In Egypt, patients above 50 years are at a higher risk for symptomatic COVID-19 infection and leaner for moderate to critical COVID-19 presentation. The triad of CT-chest, CRP, and N/L ratio could be an integrated panel for assessing disease severity.

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Section: Discussioncontrasting

confidence: 69%

Clinical features and laboratory characteristics of patients hospitalized with COVID-19: single centre report from Egypt

Kassas

Asem

Abdelazeem

et al. 2020

J Infect Dev Ctries

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“…After its advent in 1921, the live attenuated BCG vaccine remains the most widely used vaccine until today despite its limitations and highly variable efficacy in providing protection against childhood pulmonary TB. 10 Our results showed that only 76 % of enrolled infants had BCG scar, while the remaining 24% had scar failure versus 17 % (in 100 studied Sudanese infants), and 18 % (in 150 studied Egyptian children) as reported by Kheir et al 11 and Beshir et al 12 respectively, who used the Danish strain of BCG vaccine. It has been reported that scar failure may occur in 10% to 20 % of BCG vaccinated infants and is more common with immunization within 48 hours of life.…”

Section: Discussionsupporting

confidence: 61%

Assessment of BCG vaccine immune response in a sample of Egyptian infants

Reda

Mohamed

Fouad

et al. 2021

Egypt J Pediatr Allergy Immunol

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Background:In Egypt, tuberculosis (TB) is considered the third most important public health problem after schistosomiasis and hepatitis C. We sought to investigate the immune response induced by the currently used Bacillus Calmette-Guerin (BCG) vaccine in a sample of Egyptian infants . Methods:A cross sectional study comprising 25 healthy BCG vaccinated infants, 14-24 months old was carried out. They were 15 boys and 10 girls. These infants were subjected to clinical and laboratory evaluation including blood counts, tuberculin intradermal test and in-vitro assessment of T cell response to purified protein derivative (PPD) and phytohemagglutinin (PHA) stimulation with measurement of IFN-γ in the supernatant of cultured mononuclear cells using the AssayMax Human interferon-gamma (IFN-γ) ELISA Kit (Assaypro), USA. Results: Among enrolled infants, 76 % had BCG scar and 28% had positive tuberculin test. IFN γ levels after PPD stimulation (median (IQR): 0.13 (0.09-0.44) ng/ml) and after PHA stimulation (median (IQR): 1 (0.99-1) ng/ml) were significantly higher than basal levels (median (IQR): 0.08 (0.05-0.22) ng/ml), p= 0.001. Only five infants (20 %) had failed IFN γ response after PPD stimulation and these infants showed also lower PHA stimulated p=0.03), in comparison to those with PPD stimulated IFN γ response. BCG scar positive and negative groups were comparable in their immunological parameters. Infants with positive tuberculin test results (n=7) showed significantly higher IFN γ levels after PPD stimulation in comparison to the negative tuberculin group (n=18) (z=-2.09, p= 0.036). Conclusion: In this small cohort, it appears that the current BCG vaccination in Egypt results in an acceptable level of immune response. Absent BCG scar does not indicate failed immunization. Further longitudinal studies on a large number of infants are recommended to estimate the real clinical protection conferred by the currently used vaccine .

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“…In Ghana BCG scar was visible in 89.3% (17) and in Nigeria the BCG scar was visible in 81.5% (18). Absence of BCG scar was reported in Egypt (19) , Korea (20) and West Africa (21), Nigeria (9). Scar failure may be attributed to different factors including the strain of BCG used for vaccination as there are some strains of BCG produced by different manufacturers with no standardized method between them (22), hence the strains may genetically differ (23), and result in different reactivity and immune response that affect protection against TB (22,24).…”

Section: Discussionmentioning

confidence: 94%

Reactivity of tuberculin among Bacillus Calmette-Guérin vaccinated school children, Kassala State, Sudan Fatima A. Khalid1. Elderidiry MM2, MM Mukhta3

Khalid

Eldirdery

Mukhtar

2019

Preprint

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Background Tuberculin skin test (TST) is a delayed hypersensitivity reaction of latent TB infected patients and BCG vaccinated individuals. It is recommended for screening of mycobacterium infection in many countries. Kassala state in eastern Sudan is known as the highest pulmonary TB endemic region in Sudan. Little data is available on the TST reactivity among school children in Kassala. This activity aimed to measure the prevalence of TST reactivity among school children in Kassala as indictor for exposure and response to BCG vaccination. Method Five tuberculin units of PPD were injected intradermally in the left forearm of 2600 children aged 5-15 years attending governmental basic schools in Kassala. BCG scar, child health and nutrition status were assessed before the test. The reactivity of TST was read for 2568 children after 48- 72 hours, interpreted at different cut-off level based on published guidelines. Data were analyzed using SPSS (V. 20.0) Results Tuberculin reactivity was measured to 2568 out of the 2600, 32 were absent during the measurement. Most of children 2100 (81.8%) had no reaction with TST (no induration). Four hundred and sixty eight (18.2%) had induration ranged from 1mm to 28 mm with mean 3.1mm ±3.29, among them, 17 cases had induration ranged from 10- 28mm. prevalence of BCG scar was 1688 (64.9%). TST reactivity was statistically associated with geographical localities, child gender, and age (P<0.001). High percentage of TST reactivity was recorded in females (65.8%) compared to males (34.1%). Furthermore, TST reactivity was increased with the age, among the strong positive reaction, 9/17 were in age 13-15 years. Also TST reactivity was statistically correlated with nutrition and socioeconomic status ((P<0.001). TST reactivity was not affected by BCG vaccine (P>0.05). Conclusion The study provides data on BCG vaccination coverage in Kassala state, the prevalence of non reactivity of TST. No effect of BCG vaccine on reactivity of TST, hence it can be used as the diagnostic tool for detection of LTBI in children. Different confounding factors were associated with TST reactivity including child age, gender and nutrition status, health and socioeconomic status.

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Evaluation of the Immune Response to Interferon Gamma Release Assay and Tuberculin Skin Test Among BCG Vaccinated Children in East of Egypt

Cited by 10 publications

References 15 publications

Clinical features and laboratory characteristics of patients hospitalized with COVID-19: single centre report from Egypt

Clinical features and laboratory characteristics of patients hospitalized with COVID-19: single centre report from Egypt

Assessment of BCG vaccine immune response in a sample of Egyptian infants

Reactivity of tuberculin among Bacillus Calmette-Guérin vaccinated school children, Kassala State, Sudan Fatima A. Khalid1. Elderidiry MM2, MM Mukhta3

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