Dose of Calmette-Guérin bacillus vaccination in infants.

Abstract

To The Editors: A half-dose Calmette-Guérin bacillus (BCG) vaccination for infants in the first year of life is recommended, because of lower local adverse reactions and comparable efficacy. 1, 2 Also BCG vaccine at 3 months of age results in more satisfactory immunoresponse than at birth. 3 We conducted a study in our well baby clinic to evaluate tuberculin sensitivity, BCG scar and side effects after 0.1 and 0.05 ml of BCG at 3 months of age. Sixty infants (31 male, 29 female) were vaccinated randomly with 0.1 ml of BCG vaccine (Pasteur Mérieux, vaccine BCG lyophilize, Mérieux seed derived from 1077 strain, Lot No. R 6046-1). The other group (n = 60; 21 male; 39 female) was vaccinated with 0.05 ml of BCG vaccine. They were followed up until 6 months of age for local reactions. All babies were healthy and received 0.1 ml of 5 tuberculin units of purified protein derivative by intradermal injection. At 6 months of age in the first group, the tuberculin skin test was negative (<5 mm induration) only in 1 infant, 5 to 10 mm in 42 infants (70%) and >10 mm in 17 infants (28.3%). BCG scar size was >3 mm in all infants. In the second group the tuberculin skin test was negative in 15 infants (25%), 5 to 10 mm in 36 infants 60%) and >10 mm in 9 infants (15%). In this group BCG scar was negative (<3 mm) in 25 infants 41.5%). None had any complications (i.e. local subcutaneous abscess, lymph adenopathy) in both groups. There was statistically significant relationship between two groups according to tuberculin positivity and scar size (P < 0.001) In the medical literature it has been reported that 0.1 ml of BCG vaccine caused a higher rate of tuberculin positivity and larger mean scar size but more side effects than 0.05 ml of vaccine. 4, 5 We did not observe any complications in the infants. We believe that the timing and dose of BCG vaccination in infants should be reevaluated. M. D. Charles Crist Emel Gür, M.D., M.D. Ahmet Arvas, M.D.