Abstract
Through this study, we aimed to determine the Bacillus Calmette-Guerin (BCG) vaccination uptake by scar formation rate following newborn BCG vaccinations and tuberculin conversion in a tertiary hospital setting in Dubai, United Arab Emirates. A retrospective cohort analysis was conducted on 945 babies vaccinated with BCG during 1 January and 31 December 2017. All babies were administered with intradermal 0.05 ml of BCG in the left deltoid. The descriptive variables include vaccination coverage. The outcome data includes follow up at 2, 4, and 6 months for scar formation, Mantoux test results, and revaccination data. Out of 945 babies, 911 (96.4%) were vaccinated by trained nurses with BCG after birth and before being discharged. This was following written consent from parents who were well informed by the details of the vaccinations. The non-vaccinated babies 34 (3.6%) were from different resident nationalities and the parents declined the BCG vaccine. Reason for such decline is not documented but it is likely because in their home country such vaccines are not routinely given. The number of babies who did not return for follow up was 483 (53%). These babies were followed by other centers or outside the country hence were not included in the study. The number of babies followed up with no record on BCG scar was 334 out of the total number of 482 (78%). BCG scar formation was recorded in 84 babies (19.6%) followed up. Scar formation failure was recorded in 10 (2.3%). Six babies (60%) of those who had no scar had Mantoux test performed. The association between absence of scar and negative Mantoux results were highly significant (P< 0.05) with 100% of babies having negative Mantoux results, therefore, no immunity. It is concluded that BCG scar is poorly recorded similarly to other high-income countries. There is a good correlation between lack of BCG scar and no immunity to Tuberculosis. Improvement of newborn BCG uptake is importantly needed. It is recommended to introduce mandatory recording of the outcome of BCG scar formation and resultant outcomes in the vaccinations books. Training of personnel administering the BCG vaccination is an important element for successful vaccination in this vulnerable age group.
Highlights
Tuberculosis (TB) is a serious global health emergency due to its high mortality and morbidity rates [1]
The Bacillus Calmette-Guérin (BCG) vaccine is a live attenuated vaccine strain developed from Mycobacterium bovis which is commonly found in cows [10]
The majority were vaccinated with BCG (96.4%) after birth while only 3.6% (n=34) were not vaccinated with BCG by the request of the parents who declined BCG vaccine
Summary
Tuberculosis (TB) is a serious global health emergency due to its high mortality and morbidity rates [1]. United Arab Emirates (UAE) government considers TB as a major health problem. TB prevalence remains low in the UAE, estimated 1/100,000, due to mandatory residence screening and vaccination programs. The BCG vaccine is a live attenuated vaccine strain developed from Mycobacterium bovis which is commonly found in cows [10]. It produces lifelong cellular immunity against TB and its complications in children including Tuberculous Meningitis which causes serious brain damage [1]. BCG vaccines have shown to have non-TB benefits in childhood survival rates [11]. A single dose of 0.05 ml in a 26 G needle is administered in the critical intradermal layer of Hanieh Tabatabaei and Sam Hassan: Newborn BCG Vaccinations: Scar Formation and Tuberculin
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