SUPPURATIVE lymphadenitis following intradermal BCG vaccination of preschool children

Regional lymph-node abscesses often occur among infants and young children following BCG vaccination, and the purpose of this study was to find ways to avoid glandular complications, or at least minimize their frequency, without jeopardizing the success of vaccination.Over 1,700 children ranging in age from 6 months to 7 years were vaccinated by one of nine different procedures obtained by various combinations of two strengths of vaccine, two depths of injection, and three volumes of vaccine, in an attempt to reproduce, experimentally, some of the kinds of variation that may occur in practical programmes. Follow-up examinations were made at 10 weeks and at one year, the local and glandular responses being observed and measured and the degree of tuberculin sensitivity assessed by an intradermal 10 TU test.BOTH THE DOSE OF VACCINE AND THE AGE OF THE CHILD WERE FOUND TO HAVE A STRIKING EFFECT ON THE FREQUENCY AND SEVERITY OF LYMPHADENITIS: the larger the dose and the younger the child, the higher the frequency of enlarged or perforated axillary lymph nodes. Furthermore, there was a close association between the findings at the two follow-up periods: with only one exception, children with negligible enlargement of the nodes at the 10-week examination had negligible findings at one year, whereas all the children with enlarged and adherent nodes at 10 weeks had evidence of perforation at one year.THE SIZE OF THE VACCINAL LESION WAS ALSO AFFECTED BY VACCINE DOSE AND BY AGE OF CHILD: the lesion was larger in the younger children and with the stronger doses. The degree of tuberculin sensitivity was affected only slightly by the variations in dose and still less by the age of the child.The size of the wheal raised by intradermal injection of vaccine was found to vary with the age of the child and with the depth of injection as much as it varied with the volume of vaccine injected. There can be no doubt that gauging the dose by the size of the wheal, rather than by the calibrations on a non-leaking syringe, is a very inaccurate procedure. When the dose of vaccine can be accurately measured, a stronger vaccine can be given (and perhaps a stronger degree of immunity attained) without causing an intolerable frequency of suppurative lymphadenitis.