Multiple Puncture and Intradermal BCG Vaccination: A Quantitative Comparison in Terms of Allergy Production

Abstract

The present study was set up in connection with the WHO/UNICEF-assisted BCG vaccination campaign in the Philippines in order to measure and compare the degree of tuberculin sensitivity produced by the intradermal and by a modified multiple puncture method of vaccination. In Manoag Municipality, 2,632 school children were given an intradermal tuberculin test with 0.0001 mg. of PPD (Mantoux 5 TU) and the 1,754 non-reactors to this test were given BCG vaccine alternately by the intradermal and the multiple puncture methods. Sixteen weeks later the vaccinated children were retested with 5 TU. In reading the reactions, precautions were taken to assure that the reader could not know which method of vaccination had been used in each child. The tuberculin reactions of children vaccinated intradermally averaged 12.0 mm. in diameter—a level of allergy almost as high as that produced by natural infection: the tuberculin reactions of children vaccinated by multiple puncture averaged only 7.4 mm. in diameter. As a result of this study, intradermal vaccination replaced the multiple puncture method for the mass BCG campaign in the Philippines. Grateful acknowledgment is made to Dr. Sixto A. Francisco, Chief of the Tuberculosis Division, Philippine Department of Health and members of his staff, whose interest and assistance made the present field work possible; and to the staff of the WHO Tuberculosis Research Office, Copenhagen, for critical comments and help in preparing the paper.