Bacille Calmette-Guérin immunization in normal healthy adults

Bacille Calmette-Guérin (BCG) vaccine was administered to 20 purified protein derivative (PPD) skin test-negative and human immunodeficiency virus serology-negative, healthy adults 18-65 years old. Local adverse reactions were monitored and intermediate-strength PPD skin test responses were evaluated 2 months and 1 year after vaccination. All vaccinees developed erythema, induration, and tenderness at the vaccination site. Muscular soreness was reported by 15 subjects, local ulceration with drainage by 14, and tender regional adenopathy by 2. BCG organisms were isolated from the ulcer of the only vaccinee who was cultured. PPD skin tests revealed induration in all subjects. Normal healthy adults at risk of occupational exposure to tuberculosis and considering BCG immunization should be fully informed about the local reactions seen after BCG administration and the high rate of persistent PPD skin test responses. Since viable organisms can be recovered from ulcer drainage, vaccination sites should be covered to reduce nosocomial transmission of the vaccine strain.