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Tuberculin response in preterm infants after BCG vaccination at birth
1Neonatal Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates.
Insights
BCG vaccination in preterm infants showed a low scar rate and inconsistent tuberculin reactions. Further research is needed before routine BCG vaccination is recommended for premature babies.
Area of Science:
- Immunology
- Neonatal Medicine
- Public Health
Background:
- Bacille Calmette-Guérin (BCG) vaccination is a standard immunization for tuberculosis prevention.
- The efficacy of BCG in preterm infants and its correlation with scar formation and tuberculin sensitivity require further investigation.
Purpose of the Study:
- To evaluate the rate of BCG scar formation and tuberculin purified protein derivative (PPD) test conversion in preterm infants.
- To assess the relationship between BCG scarring and PPD test results in this population.
Main Methods:
- A cohort of 101 preterm infants (26-37 weeks' gestation) vaccinated with BCG at birth was studied.
- Scar assessment and tuberculin PPD testing were performed 2-4 months post-vaccination.
- Data on scar presence and PPD induration size were analyzed.
Main Results:
- 32% of infants lacked a visible BCG scar.
- Among those tested with PPD, 31% were negative and 37% showed induration <= 5 mm.
- Infants without BCG scars predominantly had PPD induration <= 5 mm (86%).
- A positive BCG scar correlated with a higher rate of PPD induration > 5 mm.
Conclusions:
- Routine BCG vaccination at birth for preterm infants may not be indicated.
- The current study suggests a potential link between BCG scarring and tuberculin sensitivity.
- Larger studies are necessary to confirm these findings and guide vaccination policies for preterm neonates.
Abstract:
A total of 101 preterm infants between 26 and 37 weeks' gestation who received BCG vaccination at birth were evaluated between two and four months after vaccination. Altogether 32% of these infants had no visible BCG scar. All infants were then tested with tuberculin purified protein derivative (PPD) but only 70 returned for the test to be read 48-72 hours later. The test was negative in 22 (31%) and there was an induration of < or = 5 mm in another 26 (37%) of the infants. Of 22 infants with no BCG scar, 19 (86%) had an induration of < or = 5 mm. In infants with a positive BCG scar a significantly higher number had an induration of PPD > 5 mm. There were no significant differences between the rate of scarring and tuberculin conversion in the infants born before or after 32 weeks' gestation. It is considered that routine BCG vaccination at birth on preterm infants is not indicated until a much larger study has been performed.