Dose Of BCG Research Articles

Vaccination coverage and its determinants among migrant children in Guangdong, China

BackgroundGuangdong province attracted more than 31 million migrants in 2010. But few studies were performed to estimate the complete and age-appropriate immunization coverage and determine risk factors of migrant children.Methods1610 migrant children aged 12–59 months from 70 villages were interviewed in Guangdong. Demographic characteristics, primary caregiver’s knowledge and attitude toward immunization, and child’s immunization history were obtained. UTD and age-appropriate immunization rates for the following five vaccines and the overall series (1:3:3:3:1 immunization series) were assessed: one dose of BCG, three doses of DTP, OPV and HepB, one dose of MCV. Risk factors for not being UTD for the 1:3:3:3:1 immunization series were explored.ResultsFor each antigen, the UTD immunization rate was above 71%, but the age-appropriate immunization rates for BCG, HepB, OPV, DPT and MCV were only 47.8%, 45.1%, 47.1%, 46.8% and 37.2%, respectively. The 1st dose was most likely to be delayed within them. For the 1:3:3:3:1 immunization series, the UTD immunization rate and age-appropriate immunization rate were 64.9% and 12.4% respectively. Several factors as below were significantly associated with UTD immunization. The primary caregiver’s determinants were their occupation, knowledge and attitude toward immunization. The child’s determinants were sex, Hukou, birth place, residential buildings and family income.ConclusionsAlarmingly low immunization coverage of migrant children should be closely monitored by NIISS. Primary caregiver and child’s determinants should be considered when taking measures. Strategies to strengthen active out-reach activities and health education for primary caregivers needed to be developed to improve their immunization coverage.

Determinants of routine immunization coverage in Bungudu, Zamfara State, Northern Nigeria, May 2010

INTRODUCTION: Immunization is a cost-effective public health intervention to reduce morbidity and mortality associated with infectious diseases. The Nigeria Demographic and Health Survey of 2008 indicated that only 5.4% of children aged 12-23 months in Bungudu, Zamfara State were fully immunized. We conducted this study to identify the determinants of routine immunization coverage in this community. METHODS: We conducted a cross-sectional study. We sampled 450 children aged 12-23 months. We interviewed mothers of these children using structured questionnaire to collect data on socio-demographic characteristics, knowledge on immunization, vaccination status of children and reasons for non-vaccination. We defined a fully immunized child as a child who had received one dose of BCG, three doses of oral polio vaccine, three doses of Diptheria-Pertusis-Tetanus vaccine and one dose of measles vaccine by 12 months of age. We performed bivariate analysis and logistic regression using Epi-info software. RESULTS: The mean age of mothers and children were 27 years (standard error (SE): 0.27 year) and 17 months (SE: 0.8 month) respectively. Seventy nine percent of mothers had no formal education while 84% did not possess satisfactory knowledge on immunization. Only 7.6% of children were fully immunized. Logistic regression showed that possessing satisfactory knowledge (Adjusted OR=18.4, 95% CI=3.6-94.7) and at least secondary education (Adjusted OR=3.6, 95% CI=1.2-10.6) were significantly correlated with full immunization. CONCLUSION: The major determinants of immunization coverage were maternal knowledge and educational status. Raising the level of maternal knowledge and increasing maternal literacy level are essential to improve immunization coverage in this community.

Women Autonomy, Nutritional and Immunization Status of their Children

This paper examines the impact of women’s autonomy on their children’s nutritional and immunization status. The main objectives of the paper are to see the women’s decision making power in different socio-economic conditions and how far different levels of decision making power influence their children’s nutritional health and immunization status. We have used third round of National Family Health Survey data and the sample size are based on 39,879 women, aged (15-49) years having their last children aged (0-59) months. Women’s autonomy has been assessed through the four aspects of decision making, namely on own health care, large household purchase, mobility to relatives’ house or other family members’ house and ability to spend husband’s money. Children’s nutritional health status has been assessed through ‘z’ score value of weight for age and height for age. Immunization status has been assessed through the criteria of one dose of BCG, 3 doses of DPT and Polio and one dose of measles taken within the 12-23 months. Socio-economic variables are type of residence, women’s educational and occupational status, type of ethnic group and wealth index of the family. The study reveals that the welfare of children depends on the consciousness and awareness of the mother. Awareness is directly related with the mothers white colored job and this job is dependent on women’s higher education. We can take welfare of children as an indicator of autonomy of mothers because autonomy of mothers has the highest effect on nutritional and immunization status of children.

Immunization status of children and the influence of social factors: A hospital based study in western Uttar Pradesh

Despite the ongoing National Immunization Program, the immunization coverage is still not satisfactory, particularly in U.P. Moreover, there is a wide disparity in coverage, indicating the influence of various social, economic and cultural factors. The present study was conducted to know the immunization status of children, 12–23 months of age, in the Rohilkhand region of U.P. and to assess the effects of various factors influencing it. The present study was carried out as a cross sectional study, between September 2012 and February 2013 at the pediatric OPD of SRMS Institute of Medical Sciences, Bareilly. The subjects of the study were OPD children. A total of 450 children, aged 12–23 months were included. Immunization status, with regard to the doses of BCG, OPV, DPT and measles vaccine given in the 1st year was assessed by interviewing parents and checking immunization cards. Information about various social factors was also taken. Percentages and Chi square test were used for analyzing data. Overall, 40.66% children were found completely immunized, 45.11% were partially immunized, while 14.22% had received no immunization. The factors, which had a significant impact on immunization status were gender of the child, family's income and parental education. Birth order, religion and habitation were not found to have significant impact on the immunization status of children. There is need for improving economic and educational status of families for reducing the burden of vaccine preventable diseases.

Uptake of neonatal BCG vaccination in England: performance of the current policy recommendations

BCG uptake among infants in England has not been measured since targeted infant vaccination replaced universal schoolchildren vaccination in 2005, mainly because of the challenges in defining denominators. We estimated...

Lepromatous leprosy treated with combined chemotherapy and immunotherapy (injection BCG): three case reports

Lepromatous leprosy is associated with suppressed cell-mediated immunity (CMI). This results in failure of the body to mount an efficient immune response and may render chemotherapy ineffective. The lack of sufficient response may mimic drug resistance. Three case reports in which the immunity was stimulated by administering Injection BCG are presented. All three patients were initially anergic and showed no reaction at the Mantoux testing site, showing an inability to mount type IV hypersensitivity and characterized by live bacilli in smears. Following 1-4 doses of Injection BCG, all three showed dead bacilli in smears. The first case, a 61-year-old man with lepromatous leprosy who continued to show live bacilli in smears after prolonged chemotherapy, was administered a total of four BCG injections, following which he achieved clearance. The second, a 40-year-old man with borderline lepromatous leprosy and severe type 2 reactions, achieved bacterial clearance and control of severe reactions following a single injection. The third, a 67-year-old man with histoid leprosy, achieved effective bacterial killing with a single dose of Injection BCG. All three patients achieved good results when chemotherapy was combined with Injection BCG. Following Injection BCG, all three showed a reaction at the Mantoux testing site. Suppressed CMI may be responsible for the lack of response in recalcitrant cases of lepromatous leprosy. These case reports would lead to the trend in combination therapy (immunotherapy combined with chemotherapy) for such cases, and help lower the tendency for inappropriate diagnosis of drug-resistant leprosy.

BCG immunotherapy as an adjunct to chemotherapy in BL-LL patients – its effect on clinical regression, reaction severity, nerve function, lepromin conversion, bacterial/antigen clearance and ‘persister’ M. leprae

Multidrug therapy in leprosy has failed to eliminate the problem of persister bacilli. Clearance of bacterial antigens is extremely slow which could predispose to continued nerve damage even after release from treatment. In the present study the immunomodulatory efficacy of BCG vaccine administered post-MDT in BL-LL leprosy patients was investigated in depth with a view to determining if augmenting chemotherapy with immunotherapy would help in faster clearance of M. leprae/antigens, bring down the level of persisters and minimise the occurrence/severity of reaction and nerve damage. This is a placebo-controlled study in treated BL-LL patients. The patients are matched with respect to age, sex, bacteriological index and history of reaction, stratified and allocated to the two groups. One group (Gr A) received two doses of BCG-MOSCOW (3-33 x 10(5) cells) and the other (Gr B) normal saline (0.85%), injected intra-dermally at 3 month intervals. The Primary outcomes assessed at the end of 6 months were bacterial/antigen clearance, lepromin conversion, granuloma clearance and the occurrence of persisters. The secondary outcomes were clinical regression, occurrence and severity of reaction and changes in nerve functions. A total of 107 BL-LL patients comprised of 49 in Gr A and 58 in Gr B; of which 36 and 42 respectively completed the study as per protocol, and are included in the final analysis. The study findings show that both the primary and the secondary out comes were comparable in the two groups. Two doses of BCG administered post-MDT (Gr A) did not significantly alter the level of persisters or help in hastening the bacterial/antigen clearance, clinical regression of lesions and granuloma clearance. Lepromin conversion rates were also comparable. While the frequency of lepra reaction/neuritis following the intervention was comparable, the severity of reactions was significantly higher in Gr A. On the positive side neural functions assessed by nerve conduction studies showed that deterioration of motor nerve conduction was significantly lower in the BCG arm. Since all patients developing moderate to severe reactions, immediately received a course of corticosteroids, it is possible that timely use of it might have helped.

Immunization Coverage: Role of Sociodemographic Variables

Children are considered fully immunized if they receive one dose of BCG, three doses of DPT and polio vaccine each, and one measles vaccine. In India, only 44% of children aged 12–23 months are fully vaccinated and about 5% have not received any vaccination at all. Even if national immunization coverage levels are sufficiently high to block disease transmission, pockets of susceptibility may act as potential reservoirs of infection. This study was done to assess the immunization coverage in an urban slum area and determine various sociodemographic variables affecting the same. A total of 210 children were selected from study population using WHO's 30 cluster sampling method. Coverage of BCG was found to be the highest (97.1%) while that of measles was the lowest. The main reason for noncompliance was given as child's illness at the time of scheduled vaccination followed by lack of knowledge regarding importance of immunization. Low education status of mother, high birth order, and place of delivery were found to be positively associated with low vaccination coverage. Regular IEC activities (group talks, role plays, posters, pamphlets, and competitions) should be conducted in the community to ensure that immunization will become a “felt need” of the mothers in the community.

Does BCG revaccination protect against the development of asthma?

Single BCG vaccination has been considered as a protective factor against asthma. However the effect of a second dose of BCG on the prevalence rate of asthma and asthma-allergic rhinitis-eczema comorbidity has not been studied exclusively among adolescents. In this ISAAC protocol-based cross sectional study we assessed the association between one single versus two doses of BCG among 2213 individuals aged 13-14 years old. We found no association between BCG revaccination and asthma, associated (OR=0.68, 95% CI, 0.37-1.25) or not to allergic rhinitis and/or atopic eczema (OR=1.07, 95% CI, 0.84-1.36).

Diagnostic et prise en charge des événements indésirables survenant au décours des instillations endovésicales de BCG pour le traitement des tumeurs de vessie n’infiltrant pas le muscle (TVNIM) : revue du comité de cancérologie de l’Association française d’urologie

Intravesical BCG immuno-therapy with maintenance therapy is considered as the standard treatment for non-muscle invasive bladder cancer with high risk of recurrence and progression. In practice, adverse events (AEs) of BCG therapy could restrict its prescription by urologists. The aim of this article was to present a review of these AEs and of their management. A bibliographic research in French and English using Medline(®) and Embase(®) with the keywords "BCG", "bladder", "complication", "toxicity", "adverse reaction", "prevention" and "treatment" was performed. The main mechanism of AEs of BCG are infectious (cystitis, fever), immuno-allergic (granulomatous prostatitis, epididymo-orchitis, and granulomatous reactions) and auto-immune (arthralgies, rash). Management of AEs is based on their pathophysiological mechanisms. Classifications of BCG therapy AEs based on clinical features allow to adapt their treatments. The combination of antibiotics directed against BCG, steroid or non-steroidal anti-inflammatory medication and symptomatic treatment is currently the triad on which is set up the appropriate treatment of severe AEs. Reductions of BCG doses and ofloxacin medication after instillation decrease the frequency and severity of minor and moderate AEs. Severe or more than 7 days long infectious AEs, immuno-allergic AEs or auto-immune during more than 7 days impose cessation of BCG immuno-therapy.

Nível de exposição ao Mycobacterium tuberculosis em estudantes de medicina de uma universidade do sul de Minas

Objetivos. Verificar o nível de exposição ao Mycobacterium tuberculosis e os fatores de risco associados, utilizando o teste tuberculínico como marcador para tuberculose latente em universitários do curso de medicina da UNIVÁS em Pouso Alegre, MG, Brasil. Métodos. Estudo transversal com 120 estudantes divididos em três grupos: básico, intermediário e internato. Informações relativas ao gênero, faixa etária, presença de cicatriz BCG, segunda dose de BCG, contato prévio com portador de tuberculose e história pessoal de tuberculose foram obtidas por meio de questionário. O teste tuberculínico foi realizado por profissional habilitado e foi definido como positivo quando a enduração foi maior de 5mm. Resultados. A prevalência de expostos ao Mycobacterium tuberculosis foi de 28,3%, sendo mais frequente nos alunos do internato. Observou-se uma maior positividade no gênero feminino (p > 0,05). O teste tuberculínico foi positivo naqueles maiores de 21 anos, com cicatriz vacinal (BCG) e que não tiveram contato com indivíduo com tuberculose, (p > 0,05). Os estudantes que receberam a segunda dose de BCG tiveram maior chance de apresentar teste positivo quando confrontados com os que não foram vacinados (RC = 0,35; 95% IC = 0,1-0,9; p = 0,023). Conclusões. A maior prevalência de tuberculose latente ao final do curso médico sugere que os estudantes de medicina estão possivelmente expostos a transmissão nosocomial de Mycobacterium tuberculosis. Este estudo mostrou a vulnerabilidade desta população em relação à tuberculose e revelou a necessidade de implementação de programas de biossegurança para os estudantes de medicina, além de alertar para o uso de medidas de controle

Antibody response in Hamsters Immunized against experimental Leishmaniasis

Direct agglutination test was used to evaluate the immunogenicity of three different antigens inoculated in hamsters as one , two and three doses which were: Group (1) inoculated with autoclaved killed Leishmania tropica , Group (2) inoculated with BCG vaccine alone while Group (3) inoculated with mixed antigens (autoclaved killed Leishmania "AKL"+ BCG).(4) Control animals inoculated with phosphate buffer saline. The maximum level of antibody titers were evaluated in animal inoculated with one , two or three dose of mixed antigens (320 , 640 and 1280) respectively when it compared with animals inoculated with corresponding doses of AKL antigen (80 , 160 and 320) respectively. While the minimum level of antibody titers were observed in animal inoculated with two and three dose of BCG (20 and 40) respectively. Our findings suggest that administration of BCG with AKL could lead to a potentially associated antibody response in animals, as well as, such response may evaluate the immunogenicity of some antigens.

Antibody response in Hamsters Immunized against experimental Leishmaniasis

Direct agglutination test was used to evaluate the immunogenicity of three different antigens inoculated in hamsters as one , two and three doses which were: Group (1) inoculated with autoclaved killed Leishmania tropica , Group (2) inoculated with BCG vaccine alone while Group (3) inoculated with mixed antigens (autoclaved killed Leishmania "AKL"+ BCG).(4) Control animals inoculated with phosphate buffer saline. The maximum level of antibody titers were evaluated in animal inoculated with one , two or three dose of mixed antigens (320 , 640 and 1280) respectively when it compared with animals inoculated with corresponding doses of AKL antigen (80 , 160 and 320) respectively. While the minimum level of antibody titers were observed in animal inoculated with two and three dose of BCG (20 and 40) respectively. Our findings suggest that administration of BCG with AKL could lead to a potentially associated antibody response in animals, as well as, such response may evaluate the immunogenicity of some antigens.

Tuberculin sensitivity and morphological immune response in guinea pigs after application of minimal sensitizing dose of BCG vaccine, substrain Sofia SL222

During the investigation of the BCG allergenic potency it is advisable to vaccinate with decreasing doses, estimating the lowest dose that induces tuberculin sensitivity and specific morphological inflammation. Although the biological test does not reveal the mathematical correlation of dose–effect relationships, it is important to look for the determination of the minimal sensitizing dose for every BCG vaccine. In this study, three groups of twenty four guinea pigs were vaccinated with decreasing doses of reconstituted BCG vaccine: 120 ng, 12 ng and 1.2 ng. Tuberculin tests were performed in different groups at the 30th, 60th, 90th and 120th day after BCG injection. The negative tuberculin reactions converted to positive between the 60th and 90th day. The dose of 12 ng elicited the largest tuberculin reactions in the animals. This dose contains 65 viable bacteria and could be regarded as the smallest effective sensitizing dose of the BCG vaccine, substrain Sofia SL222. The morphological examination demonstrated that very low inoculums (1.2 ng or 6 viable cells) were sufficient to induce a specific inflammation after BCG vaccination. The immune response in lungs and bronchus-associated lymphoid tissue (BALT) of all BCG doses applied was strongest on the day 60. In the same term, lymph nodes and spleens were characterized with blast transformed lymphoid follicles with epitheloid and Langhans giant cells even with the smallest injected dose of 1.2 ng.

Health-care provision factors associated with child immunization coverage in a city centre and a rural area in Kabul, Afghanistan

A total of 1327 households were surveyed in Kabul province, Afghanistan to evaluate child immunization coverage and its association with distance to health facilities, attendance at antenatal care, the place of delivery and contact by outreach activity. The proportion of fully immunized children, those who had received at least 1 dose of BCG, 3 doses of DPT, and 1 dose of measles vaccine, was 84.5% in the city centre and 60.7% in the rural area. Fully immunized status was positively associated with close proximity to a health facility (odds ratio [OR] = 1.92, [95%CI, 1.08, 3.39]), and attendance at antenatal care (OR = 1.39, [95%CI, 1.00, 1.93]) in the city centre, and outreach contact (OR = 11.6, [95%CI, 6.92, 19.4]) in the rural area after adjustment for demography, socio-economic factors, participation in health education and experiences of hardship. Attendance at antenatal care in the rural area (OR = 1.91, [95%CI, 1.35, 2.72]), and institutional delivery in the city centre and rural area (OR = 2.83, [95%CI, 1.20, 6.71]; OR = 2.17, [95%CI, 1.01, 4.64], respectively) were positively associated with antigen specific coverage. Improving multiple community conditions including health-care provision and socio-economic factors through close partnership among various sectors promotes the immunization program.

Role of Mycobacterium vaccae in the protection induced by first generation Leishmania vaccine against murine model of leishmaniasis

Various Leishmania antigens showed to induce protection when used with IL-12 as an adjuvant in an animal model of leishmaniasis. Limitations in using IL-12 justify searching for an appropriate adjuvant to accelerate induction of a Th1-type immune response and protection. In this study, the role of Mycobacterium vaccae as an adjuvant mixed with either autoclaved Leishmania major (ALM) or freeze-thawed-killed L. major (KLM) in increasing protection in susceptible and resistant mice was studied. Nineteen groups of BALB/c and 19 groups of C57BL/6 mice, ten mice per group, were immunized three times in 45 days interval with different doses of either KLM or ALM alone or mixed with either BCG or different doses of M. vaccae. Immunized groups of mice and PBS-injected control group were challenged with 2 x 10(6) promastigotes of L. major at the base of the tail. The evolution of the lesion was monitored, and the size of the lesion was measured and recorded weekly. Anti-Leishmania total IgG Ab was titrated before and after challenge. The results showed that immunization of either susceptible or resistant mice with KLM or ALM mixed with low dose of M. vaccae increased protection defined by significantly smaller ulcer size in immunized mice compared with the PBS-injected control group.

BCG revaccination does not protect against leprosy in the Brazilian Amazon: a cluster randomised trial.

BackgroundAlthough BCG has been found to impart protection against leprosy in many populations, the utility of repeat or booster BCG vaccinations is still unclear. When a policy of giving a second BCG dose to school children in Brazil was introduced, a trial was conducted to assess its impact against tuberculosis, and a leprosy component was then undertaken in parallel. Objective: to estimate the protection against leprosy imparted by a second dose of BCG given to schoolchildren.Methods and FindingsThis is a cluster randomised community trial, with 6 years and 8 months of follow-up. Study site: City of Manaus, Amazon region, a leprosy-endemic area in Brazil. Participants: 99,770 school children with neonatal BCG (aged 7–14 years at baseline), of whom 42,662 were in the intervention arm (revaccination). Intervention: BCG given by intradermal injection. Main outcome: Leprosy (all clinical forms). Results: The incidence rate ratio of leprosy in the intervention over the control arm within the follow-up, in schoolchildren with neonatal BCG, controlled for potential confounders and adjusted for clustering, was 0.99 (95% confidence interval: 0.68 to 1.45).Conclusions/SignificanceThere was no evidence of protection conferred by the second dose of BCG vaccination in school children against leprosy during the trial follow-up. These results point to a need to consider the effectiveness of the current policy of BCG vaccination of contacts of leprosy cases in Brazilian Amazon region.

Effects of Combined BCG and DHEA Treatment in Preventing the Development of Asthma

Both BCG and dehydroepiandrosterone (DHEA) induce Th1 immune responses and suppress Th2 allergic reactions. To investigate whether the combination of BCG and DHEA has an additive effect on asthma prevention, BALB/c mice (n = 10 per group) were given an intraperitoneal injection of BCG at the beginning of sensitization, and fed mice chow containing DHEA throughout the study. In female mice, the combined administration of 2 × 104 CFUs BCG and 0.01% DHEA effectively suppressed the ovalbumin-induced increase in airway sensitivity to methacholine (56.5 vs. 8.2 mg/mL, p < 0.01), while BCG (13.9 mg/mL) or DHEA (17.9 mg/mL) alone did not. However, the addition of high dose (0.1%) DHEA decreased the efficacy of high dose (2 × 105 CFUs) BCG in suppressing the airway responsiveness and eosinophilia. In male mice, the treatments with BCG and/or DHEA were less effective, and the interferon-γ / interleukin-4 ratio in the splenocyte supernatant was significantly higher and the ovalbumin-specific IgE concentration in the serum was significantly lower as compared to female mice. In conclusion, the combination of low doses of BCG and DHEA had an additive effect in suppressing the development of airway hypersensitivity. Androgens in males and DHEA overdose might reduce the efficacy of BCG.

Neonatal immunization with a single dose of recombinant BCG expressing subunit S1 from pertussis toxin induces complete protection against Bordetella pertussis intracerebral challenge

The currently used pertussis vaccines are highly efficacious; however, neonates are susceptible to whooping cough up to the sixth month. In agreement, DTP-immunized neonate mice were not protected against intracerebral challenge with Bordetella pertussis. Neonate mice immunized with either DTP or a recombinant-BCG strain expressing the genetically detoxified S1 subunit of pertussis toxin do not show a humoral immune response against PT. On the other hand, rBCG-Pertussis induces higher PT-specific IFN-γ production and an increase in both IFN-γ + and TNF-α +-CD4 +-T cells than the whole cell pertussis vaccine and confers protection against a lethal intracerebral challenge with B. pertussis.

Improve protective efficacy of a TB DNA-HSP65 vaccine by BCG priming

Vaccines are considered by many to be one of the most successful medical interventions against infectious diseases. But many significant obstacles remain, such as optimizing DNA vaccines for use in humans or large animals. The amount of doses, route and easiness of administration are also important points to consider in the design of new DNA vaccines. Heterologous prime-boost regimens probably represent the best hope for an improved DNA vaccine strategy. In this study, we have shown that heterologous prime-boost vaccination against tuberculosis (TB) using intranasal BCG priming/DNA-HSP65 boosting (BCGin/DNA) provided significantly greater protection than that afforded by a single subcutaneous or intranasal dose of BCG. In addition, BCGin/DNA immunization was also more efficient in controlling bacterial loads than were the other prime-boost schedules evaluated or three doses of DNA-HSP65 as a naked DNA. The single dose of DNA-HSP65 booster enhanced the immunogenicity of a single subcutaneous BCG vaccination, as evidenced by the significantly higher serum levels of anti-Hsp65 IgG2a Th1-induced antibodies, as well as by the significantly greater production of IFN-γ by antigen-specific spleen cells. The BCG prime/DNA-HSP65 booster was also associated with better preservation of lung parenchyma.The improvement of the protective effect of BCG vaccine mediated by a DNA-HSP65 booster suggests that our strategy may hold promise as a safe and effective vaccine against TB.