Mycobacterium bovisOsteitis Following Immunization with Bacille Calmette-Guérin (BCG) in Korea

Abstract

BackgroundMycobacterium bovis Bacille Calmette-Guérin (BCG) osteitis, a rare complication of BCG vaccination, has not been well investigated in Korea. This study aimed to evaluate the clinical characteristics of BCG osteitis during the recent 10 years in Korea.MethodsChildren diagnosed with BCG osteitis at the Seoul National University Children's Hospital from January 2007 to March 2018 were included. M. bovis BCG was confirmed by multiplex polymerase chain reaction (PCR) in the affected bone. BCG immunization status and clinical information were reviewed retrospectively.ResultsTwenty-one patients were diagnosed with BCG osteitis and their median symptom onset from BCG vaccination was 13.8 months (range, 6.0–32.5). Sixteen children (76.2%) received Tokyo-172 vaccine by percutaneous multiple puncture method, while four (19.0%) and one (4.8%) received intradermal Tokyo-172 and Danish strain, respectively. Common presenting symptoms were swelling (76.2%), limited movement of the affected site (63.2%), and pain (61.9%) while fever was only accompanied in 19.0%. Femur (33.3%) and the tarsal bones (23.8%) were the most frequently involved sites; and demarcated osteolytic lesions (63.1%) and cortical breakages (42.1%) were observed on plain radiographs. Surgical drainage was performed in 90.5%, and 33.3% of them required repeated surgical interventions due to persistent symptoms. Antituberculosis medications were administered for a median duration of 12 months (range, 12–31). Most patients recovered without evident sequelae.ConclusionHighly suspecting BCG osteitis based on clinical manifestations is important for prompt management. A comprehensive national surveillance system is needed to understand the exact incidence of serious adverse reactions following BCG vaccination and establish safe vaccination policy in Korea.

Long-term follow-up of osteomyelitis caused by Bacille Calmette-Guérin vaccination in immunocompetent children

“…In 2016, Taiwan National Health Insurance program postponed the timing of vaccination to 5-8 months after birth in the hope of reducing the incidence of osteomyelitis or osteitis despite a lack of direct evidence for a connection between the timing of the vaccination and onset of condition. Consistent with previous studies 11,12 , the age at onset in our study ranged from 9 to 20 months. The time between vaccination and onset ranged from 6.5 to 19 months and had a mean duration of 11.9 months, which was similar to the 13.9 months identified in previous data in a systemic review.…”

“…This paper details the long-term outcomes of three out of the four patients. Consistent with the finding of previous studies [10][11][12] , their clinical manifestations seemed promising and favourable. Furthermore, we agree that monitering for serious adverse reactions following BCG vaccination and long-term outcomes is required.…”

“…By contrast, those with BCG osteomyelitis often present with relatively localised symptoms. Of the various symptoms, local tenderness, swelling, and antalgic posturing are the three most commonly reported in the literature [10][11][12] . The clinical manifestations of our cases were comparable with those of previous studies.…”

Chest Wall Abscess with Bone Invasion in Infant after BCG Vaccination

“…Osteomyelitis is a systemic adverse reaction that rarely occurs after administration of the BCG vaccine. Although complications from BCG vaccination generally have a good prognosis, without proper diagnosis and treatment they can lead to severe sequelae [3,4]. We report a case of an 11-month-old male infant who developed a BCG-induced Mycobacterial abscess in the chest wall and osteomyelitis of the rib after administration of the BCG vaccine.…”

“…The rate of complications after inoculation of the BCG vaccine is relatively low; the reported complications include local skin reactions, abscesses, regional lymphadenitis, osteomyelitis, and disseminated infections [1]. The most common complications include formation of a subcutaneous abscess around the inoculation site and regional lymphadenitis [2,3]. Osteomyelitis is a systemic adverse reaction that rarely occurs after administration of the BCG vaccine.…”