1) In Rio de Janeiro, Brazil, the specific mortality from tuberculosis is higher than 20 per cent in the first year of life of those children who are exposed to tuberculosis contagion immediately after birth. The socio-economic level of a large part of the population and the welfare organizations are not yet adequate to provide facilities to isolate children from tuberculous families in a practical way. 2) The peroral BCG vaccination of children exposed to tuberculosis, in the first 10 days of life and with doses from 60 to 90 milligrams, apparently reduced the specific mortality from tuberculosis in the first year of life to 4.68 per cent. 3) This partial result speaks in favour of the necessity to enforce the BCG vaccination of newborns exposed to tuberculosis, and monthly re-vaccinations with 100 milligrams of BCG, up to the sixth month of life should be carried out when the source of infection still exists. 4) The monthly use of BCG reaching total doses of 190 and 590 milligrams of vaccine, in 61 children ranging from two to six months of age was carried out with good tolerance, and without any ill consequences to the children, both when the weight and the lymphatic system were concerned. 5) Of these 61 children, 34 (Group 1), were in contact at home with an open case of tuberculosis from birth up to 37 months. Twenty-two were exposed to only one source of infection; 11 to two sources; and one to three sources. All of these children lived under unfavourable financial and sanitary conditions. 6) In this vaccinated group, followed from 24 to 36 months by physical examinations, x-ray films, eventual bacteriological examinations and tuberculin tests (Mantoux), no deaths occurred, either from tuberculosis or any other illness. 7) During the observation period, eight children at one time or another showed suspicious radiologic findings of active primary tuberculosis, in coincidence with a hypersensitive allergic reaction to tuberculin, however, without any clinic or bacteriological evidence of disease (on three gastric lavages). Fourteen other children had only strong positive tuberculin reaction and, were considered for this reason as having primary phase tuberculosis, although clinic or radiologic evidence of disease could not be detected. Twelve children showed no clinical or radiological signs of disease and the tuberculin reaction was moderate and of the regressive type, apparently failing to reveal the existence of active primary infection. 8) Twenty-seven children (Group 2), who received from 290 to 590 milligrams of BCG were exposed to sputum negative patients (direct smear or animal inoculation) or to patients without any expectoration. Twenty-one were exposed to one tuberculous person; four to two persons and, two to one closed case during the first days of life and to an open case in the second year of life. 9) Among the children of Group 2, two deaths occurred within the first year of life, but both children had negative x-ray films and were diagnosed before death as having alimentary toxicosis with diarrhea and dysenteric enteritis. Another child (32 months) without any x-ray, allergic, or clinical signs of tuberculosis died from post-measles bronchopneumonia two years after the source case had been considered clinically cured and had negative sputum as demonstrated by two animal inoculations. 10) Of the 24 other children in Group 2, four were healthy up to 36 months, but lack of cooperation on the part of the families later on, made impossible a definite conclusion in regard to their health. Of the 20 other children, one had transitory radiologic evidence of right para-hilar involvement, which was interpreted as active, regressive primary. Nine children had hypersensitive (strong) tuberculin allergy which was considered as a sign of primary infection, although the physical and radiologic findings were normal. Ten did not have any evidence of virulent tuberculous infection. All of these 24 cases were followed from 24 to 37 months. 11) The results obtained with the Concurrent BCG Vaccination, during two years of observation, seem to indicate that in the 61 cases studied (particularly the 34 newborns of Group 1), there was a considerable decrease in the incidence of primary tuberculosis among vaccinated children in contact with tuberculosis in their early life. Moreover, no deaths occurred in this group up to the second year of life and the occurrence of active primary infections was low, recognized only by radioscopy and positive tuberculin reaction. These results represent only the beginning of an investigation which will take into consideration the BCG vaccination in a manner not yet contemplated in human beings.
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Jun 27, 2018
Rachel A Mann + 5
Open Access