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Administration of the BCG vaccination using the multipuncture method in schoolchildren: a comparison with the
N Al Jarad1, D W Empey, G Duckworth
1East London TB Service, Bristol Royal Infirmary, UK.
Insights
The multipuncture BCG vaccine device showed a lower tuberculin conversion rate and less inflammation than the intradermal method in schoolchildren. Modifications are needed for wider use of this BCG vaccination technique.
Area of Science:
- Immunology
- Public Health
- Pediatrics
Background:
- BCG vaccination is recommended for infants and young children in the UK.
- The multipuncture device (Heaf gun) is currently used for this age group.
- This study evaluated the Heaf gun's use in schoolchildren.
Purpose of the Study:
- To assess tuberculin test conversion rates after BCG vaccination in schoolchildren.
- To evaluate the safety and acceptability of the multipuncture device compared to the intradermal method.
- To compare scar formation and inflammatory responses between the two BCG administration methods.
Main Methods:
- Schoolchildren eligible for BCG vaccination underwent tuberculin testing.
- Participants with low-grade reactions were randomized to receive BCG via multipuncture or intradermal methods.
- Heaf test conversion, inflammation, scarring, and pain were assessed after eight weeks.
Main Results:
- The multipuncture method resulted in a significantly lower Heaf test conversion rate (27.2%) compared to the intradermal method (6.8%).
- BCG scars were less frequently observed with the multipuncture device (81.8%) than the intradermal method (100%).
- The multipuncture method was associated with reduced pain and inflammation.
Conclusions:
- The multipuncture device for BCG administration in schoolchildren yields lower tuberculin conversion rates and inflammatory responses than the intradermal method.
- Further modifications to the multipuncture device are necessary for its broader application in school-aged populations.
- The findings suggest potential for improved BCG delivery in school settings with device refinement.
Background:
BCG vaccination using the multipuncture device (the Heaf gun) is recommended in the UK for infants and very small children only. The aim of this study was to investigate the rate of conversion of the tuberculin test, the safety and acceptability of BCG vaccination using the multipuncture device and to compare it with the conventional intradermal method in schoolchildren.
Methods:
Schoolchildren attending schools in Tower Hamlets who were eligible for BCG vaccination were tuberculin tested using the Heaf gun. Those with grade 0-1 reaction were randomised to receive BCG vaccination using either the multipuncture or the intradermal method. The site of BCG vaccination was inspected after eight weeks for inflammatory changes and scarring. A questionnaire about pain and inflammation at the site of vaccination was completed. The Heaf test was repeated at eight weeks and its results were assessed by an examiner unaware of the results of the previous Heaf test and the method of BCG administration. The Heaf test conversion was deemed to have occurred if there was a change of at least one grade in the response.
Results:
One hundred and sixty nine children (83 girls) of mean age 11.8 years completed the study, of which 81 received BCG by the multipuncture method. The Heaf test did not convert in 22 of 81 (27. 2%) receiving BCG by the multipuncture device compared with six of 88 (6.8%) who received the vaccine by the intradermal method (odds ratio 0.2, 95% confidence interval 0.07 to 0.55). The BCG scar was visible in all children who had intradermal BCG compared with 67 of 81 (81.8%) of the multipuncture group. The multipuncture method was less painful and caused fewer inflammatory changes than the intradermal method.
Conclusions:
In schoolchildren the multi-puncture device for administering BCG caused a lower rate of tuberculin conversion as measured by the Heaf test and less of an inflammatory response than the intradermal method. The method needs to be modified before it is applied on a wider scale to schoolchildren.
