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Published on: September 14, 2011
Spectrum of Childhood Tuberculosis in BCG Vaccinated and Unvaccinated Children
R Gupta1, A Garg2, V Venkateshwar1
1Associate Professor, (Department of Pediatrics), AFMC, Pune.
Insights
Childhood tuberculosis is a significant issue in India. While BCG vaccination showed no impact on pulmonary tuberculosis, unvaccinated children had a higher risk of neuro-tuberculosis, highlighting the need for improved immunization coverage.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Childhood tuberculosis (TB) is a critical public health challenge in India.
- The study investigates the effectiveness of Bacillus Calmette-Guérin (BCG) vaccination in preventing childhood TB and identifies associated risk factors.
Purpose of the Study:
- To assess the impact of BCG vaccination on the incidence and type of tuberculosis in children under 12 years.
- To identify underlying risk factors contributing to childhood tuberculosis in the study population.
Main Methods:
- A study was conducted on 100 children under 12 years diagnosed with tuberculosis.
- Diagnosis followed the World Health Organization (WHO) and Indian Academy of Pediatrics (IAP) consensus statements.
- Data on BCG vaccination status, contact history, clinical presentation, and risk factors were collected.
Main Results:
- The majority of childhood tuberculosis cases (42%) occurred in children under four years.
- BCG scar presence was observed in 77% of cases, suggesting suboptimal vaccination coverage.
- While no significant difference was found in pulmonary or extra-pulmonary TB types between vaccinated and unvaccinated groups, unvaccinated children had a significantly higher incidence of neuro-tuberculosis (p=0.011).
Conclusions:
- BCG vaccination did not show a statistically significant protective effect against pulmonary tuberculosis in this cohort.
- A significantly higher incidence of neuro-tuberculosis was observed in BCG-unvaccinated children.
- Poor socioeconomic status, malnutrition, and inadequate immunization coverage were identified as key underlying risk factors for childhood tuberculosis, necessitating targeted interventions.
Background:
Childhood tuberculosis remains a major public health problem in India. We evaluated the impact of BCG vaccination on childhood tuberculosis and the underlying risk factors.
Methods:
100 consecutive children below 12 years diagnosed to have tuberculosis based on the WHO and IAP consensus statement were included in the study.
Result:
Majority(42%) of children with tuberculosis were below four years of age. History of contact with a case of tuberculosis was present in 41 cases. BCG scar was present in 77 cases indicating a poor coverage/uptake of BCG vaccination. Pulmonary form of tuberculosis was seen in 52 and extra pulmonary form in 41 cases. Tubercular lymphadenitis was seen in seven cases, of which more than 70 % were in BCG vaccinated group. There was no statistically significant difference in the type of tuberculosis (pulmonary or extra pulmonary) and BCG vaccination. In the extra pulmonary form, 13 children had neuro-tuberculosis, of which 66% were in BCG unvaccinated group, which was statistically significant (p=0.011). The underlying risk factors were poor socioeconomic status (62%), malnutrition (61%) and poor immunization coverage.
Conclusion:
Higher incidence of pulmonary tuberculosis in BCG vaccinated group was not statistically significant. However, high incidence of neuro-tuberculosis in BCG unvaccinated group was statistically significant. The underlying risk factors were poor socio-economic status, malnutrition and poor immunization coverage and should be taken into consideration in order to prevent morbidity and mortality due to tuberculosis in children.
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