Effect of revaccination with BCG in early childhood on mortality: randomised trial in Guinea-Bissau
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c671 (Published 15 March 2010) Cite this as: BMJ 2010;340:c671All rapid responses
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The study on revaccination by Roth et al from Guinea Bissau(Gambia)
once again confirms that routine BCG revaccination should not be
recommended. Not only revaccination was of no use in the Roth's study, but
there was increased mortality in the children exposed to BCG revaccination
though that may be related to vitamin A supplementation or giving other
vaccinations during the study.
Some countries like Russia, Portugal, Chile, Hungary still use BCG
revaccination against pulmonary tuberculosis on the assumption that better
protection is provided by revaccination (1). But there is no scientific
evidence that BCG revaccination provides better protection. Brazil
suspended revaccination program against TB after the study funded by their
Ministry of Health highlighted its ineffectiveness(2). WHO also recommends
use of one dose of BCG against TB given the lack of evidence supporting
use of additional dose (3). What is really required is early diagnosis,
timely and appropriate treatment, ensuring compliance using DOTS strategy
and tracing contacts (4-6).
References:
1. Lugosi L. Analysis of efficacy of mass BCG vaccination from 1959
to 1983 in TB control in Hungary. Bull IUATLD 1987;62:15-37.
2.Wunsch Filho V, deCastilho EA, Rodrigues CL et al. Effectiveness of
BCG vaccination against tuberculosis management: a case control study in
Sao Paula, Brazil. Bull World Health Org 1994;68:69-74.
3. Karonga Prevention Trial Group. Randomized controlled trial of
single BCG, repeated BCG, combination BCG, killed Mycobacterium leprae
vaccine for prevention of leprosy and tuberculosis in Malawi. Lancet
1996;348:17-24.
4.Sharma S, Sarin R,Khalid UK et al. The DOTS strategy for treatment
of pediatric pulmonary tuberculosis in South Delhi, India. Int J Tuberc
Lung Dis 2008;12:74-80.
5.Sharma S, Sarin R,Khalid UK et al. Clinical profile and treatment
outcome of tuberculous pleurisy in pediatric age group using DOTS
strategy. Indian J Tuberc 2009;56:191-200.
6.Sharma S, Sarin R,Khalid UK et al. Clinical profile and treatment
outcome of tuberculous lymphadenitis in children using DOTS strategy.
Indian J Tuberc 2010;57:4-11.
Competing interests:
None declared
Competing interests: No competing interests
I could not agree more with Charles Weijer. It is simply appalling
that such a study was ever allowed without the required funding for a data
monitoring committee and formal stopping rules.
The excuse will be that the local Ministry of Health agreed. To
those of us who work in developing countries, that is no excuse. We all
know of the weaknesses of our Ministries. Would the researchers have been
able to do such a study in their countries of origen?
Competing interests:
None declared
Competing interests: No competing interests
Re: BCG (revaccination ,vaccination and posology)
Apart from the value,or lack of value of revaccination, one must
suggest that we ought to consider the optimum dose of BCG. Given that
prematurity, exposure to and possibly incubation of viral diseases( which
impair immune response to Mycobacteria,)and immune deficiency diseases
could affect the response of the vaccinated child, we ought to review the
practice of injecting a baby under 90 days with 0.05 ml and on the 90th
day, cheerfully injecting double the amount. Besides the factors noted
above, the weight of the infant should be considered.
JK Anand
Reference:
Anand JK, Multiple vaccination, Lancet 2001;358, 505
Competing interests:
None declared
Competing interests: No competing interests