Use Of BCG Vaccine Research Articles

Bladder cancer

Advances in diagnosis and treatment have improved survival rates, bladder preservation, and quality of life in patients with bladder cancer. Flow cytometry and flexible endoscopy have enhanced early diagnosis, and intravesical use of BCG vaccine has decreased the rate of recurrence and progression of superficial bladder cancer. Systemic chemotherapy is effective in patients with invasive and metastatic bladder cancer. Although these advances are encouraging, continued investigation is required to further improve bladder preservation and survival rates, and clinical application of laser therapy and phototherapy needs to be fully developed.

Why Hasn't BCG Proved Dangerous in HIV-Infected Patients?

To the Editor.— The recent article 1 on the use of BCG vaccine in the control of tuberculosis is an important, authoritative statement that places in perspective the weaknesses in BCG protection and outlines its proper role in the prevention and control of tuberculosis, at least in the developed world. Especially welcome are the discontinuation of recommendations for giving BCG to health care workers and the (implied) recommendation that all high-risk reactors by American Thoracic Society/Centers for Disease Control criteria, 2 especially health care workers, receive preventive therapy whether or not they have a history of BCG vaccination! I am, however, concerned about the role of BCG in individuals at high risk of human immunodeficiency virus (HIV) infection, especially in areas with a high prevalence of HIV and frequent use of BCG. While stating that BCG should not be given to persons whose immunologic responses are impaired and while admitting

Revised recommendations for the use of BCG vaccination

Revised recommendations for the use of BCG vaccination

Field Experiment with BCG Vaccine in Malawi

A field trial to determine the value of BCG vaccine as a means of reducing the incidence and spread of bovine tuberculosis was carried out over a period of five years with Malawi Zebu cattle kept under village conditions. 204 cattle were vaccinated twice as young calves; 210 cattle acted as controls. The cattle were physically checked and tuberculin tested at regular intervals throughout the experimental period. The cattle were slaughtered and examined post mortem. Bacteriological samples were taken from all animals. The results of the tuberculin testing and of the post-mortem and bacteriological examinations showed no significant differences between the vaccinated and control cattle. The possibility of the vaccine having a beneficial effect in preventing the progression of the disease was also investigated, but there was no significant difference between the two groups. Previous experiments on the use of BCG vaccine in cattle are discussed and it is concluded that the vaccine has no preventive effect against infection with Mycobacterium bovis, Afro-Asian strain.

First Results of the Field Use of Bcg Vaccine to Control Bovine Tuberculosis in Malawi

The results of meat inspection findings in slaughter cattle vaccinated as calves with BCG vaccine are compared with unvaccinated animals. All the cattle originated from the northern part of Malawi where there is a high incidence of bovine tuberculosis. Vaccinated cattle had a lower incidence of tuberculosis lesions and carcase condemnations than non-vaccinated animals. On fit la comparaison en tre les résultats d’une enquête sur la viande de bétail abattu qui avait été vacciné avec du BCG au Stade de veaux et celle d’animaux non vaccinés. Tout le bétail était originaire du nord du Malawi où l’on trouve une incidence élevée de tuberculose bovine. On nota une incidence plus faible de lésions tuberculeuses et d’animaux condamnés que chez les animaux non vaccinés. Resultate der Fleischbeschaubefunde bei Rindern, die als Kälber BCG Vakzine erhalten hatten, verglichen mit unvakzinierten. Alle stammten aus dem nördlichen Teil Malawis, wo Rindertuberkulose häufig vorkommt. Bei vakzinierten Rindern waren tuberkulöse Affektionen seltener und weniger Schlachtgut musste ausgeschieden werden als bei nicht vakeinierten. Se comparan los resultados de los hallazgos de la inspección de carne en animales de matanza que se habían vacunado con BCG cuando terneros con animales que no habían sido vacunados. Todo el ganado procedió de la parte norte de Malawi, en que existe una elevada incidencia de tuberculosis bovina. El ganado vacunado tuvo una menor incidencia de lesiones tuberculosas y de condenación de carne que el ganado no vacunado.

Systemic Infection Following BCG Therapy

BCG vaccination has been widely used for tuberculosis prophylaxis, and complications in normal individuals have rarely been reported.¹Recently, there has been widespread interest in the use of BCG vaccine as immunotherapy in patients with cancer. This therapy, however, may lead to serious complications.²A patient with malignant melanoma who received multiple BCG injections illustrates the occurrence of systemic BCG infection in an anergic individual. <h3>Patient Summary</h3> A 61-year-old white man was diagnosed as having malignant melanoma by biopsy in 1963. At that time, the melanoma was localized to the patient's right leg, and he underwent a surgical resection with node dissection. He remained free of detectable disease for seven years. Two years before admission, he developed recurrent melanoma in the right leg. Some lesions were surgically removed, and the patient received two courses of chemotherapy with dimethyltriazeno imidazole carboxamide and bis-chlorethyl nitrosourea with no apparent effect

Letter: BCG vaccine treatment of Hodgkin disease.

To the Editor.— I feel obliged to respond to the MEDICAL NEWS article about the use of BCG vaccine in Hodgkin disease (227:131, 1974). I consider Dr. McIlvanie's comment, We have been killing people with chemotherapy for so many years to be somewhat irresponsible if correctly quoted. Not only has survival improved markedly in drug-treated patients, 1,2 but many patients remain disease-free after ending all therapy for periods now approaching ten years, a phenomenon not observed before aggressive chemotherapy. These data are derived from many hundreds of patients in multiple institutions. It is difficult to understand, therefore, how a physician could draw this negative conclusion based on two patients, both of whom received what most experienced physicians would consider an inappropriate sequence, and therefore inadequate, trial of chemotherapy. In addition, both these patients are apparently not entirely free of disease; their short follow-up period would certainly warrant more cautious optimism. Since

Use of BCG Vaccine

Use of BCG Vaccine

BCG Study at a State School for Mentally Retarded

SUMMARY In 1947, a study was begun to determine insofar as possible the merits of BCG vaccine as a preventive for tuberculosis. The study was confined to resident patients of Lincoln (Illinois) State school, an institution for mental retardates. Selection of participants was based on negative findings in chest x-ray films and tuberculin tests. Five hundred thirty-one of the participants were given BCG vaccinations. Four hundred ninety-four were designated controls. In April, 1948, 522 of the vaccinated patients were re-tested with Old Tuberculin 1:1000. Of the 262 who were doubtful or negative, 258 were re-vaccinated. An evaluation was made on November 15, 1960, showing that 12 of the BCG vaccinated individuals had developed tuberculosis, with four deaths from the disease. Eight of the control group had developed tuberculosis, with two deaths from the disease. Although the findings of the study are inconclusive, they are sufficient to give pause to the use of BCG vaccine as employed in this study within or as a substitute for an effective tuberculosis case-finding and treatment program.

Use of BCG Vaccine

Use of BCG Vaccine

Tuberculin Sensitivity and Tuberculosis in Nursing and Medical Students

In the 25 year period from 1934 to 1959, 2,497 medical students and 1,223 nursing students have been adequately studied while in school. Tuberculin records of an additional 148 nursing students were lost, but all had adequate x-ray film study. The percentage of tuberculin reactors at matriculation and graduation has decreased greatly during this period. The lowest percentages of reactors have occurred since 1949 for nursing students, and since 1950 for medical students, indicating less risk of infection in the study of nursing and medicine than in previous years. Seventeen cases of clinically significant tuberculosis have developed in medical students while in school, 16 of them before June, 1950, and one in 1953. Nine cases have occurred in nursing students, all prior to 1949. This recent low morbidity has occurred without the use of BCG vaccination. It is the result of education, early diagnosis and treatment, improved methods of treatment, and management of tuberculosis as a contagious disease. Tuberculin testing increases in importance as the number of infected individuals decreases. Nursing and medical students still run a greater risk of tuberculous infection than other student populations and continued vigilance is still necessary.

The use of BCG vaccine in mantoux-positive and Mantoux-negative persons in East Africa

A group of 1,750 African children in Northern Tanganyika were tuberculin tested (Mantoux test with 10 TU of Old Tuberculin). Four days later all were vaccinated intradermally with 0·1 ml. freeze-dried BCG vaccine (Pasteur). The children were examined after seventy-two hours and again after seven weeks. One thousand, six hundred and ten had pre-vaccination tuberculin reactions of less than 5 mm. diameter. In 223 (14 per cent) of these there was a local reaction seventy-two hours after vaccination (‘Koch reaction’), 35 of the reactions being 15 or more mm. diameter. One hundred and forty had pre-vaccination reactions of 5 or more mm. diameter. No early local reaction to vaccination occurred in 11: in the remaining 129 (92 per cent) there was a reaction, 113 having reactions of 15 mm. or more diameter. Of the whole group of 1,750, 53 per cent had no visible reaction to vaccination when examined after seven weeks. There were ulcers in 10 per cent, local abscesses in 3 per cent, enlarged nodes in 5 per cent and either scars or cutaneous nodules at the vaccination site in 30 per cent. Three hundred and fifty-two had ‘Koch reactions’. When examined after seven weeks there was no visible reaction in 20 per cent, ulcers in 20 per cent, local abscesses in 6 per cent, enlarged nodes in 10 per cent and scars or cutaneous nodules in 49 per cent. All the ulcers and abscesses healed and enlarged nodes subsided without causing further trouble. Two cases of progressing tuberculosis are known to have occurred. One child developed cervical adenitis seven months after vaccination and another had enlarged hilar nodes four months after vaccination. Both had been negative to 10 TU before vaccination. No case of progressing tuberculosis is known in the group positive to 10 TU before vaccination. The dangers of vaccinating individuals with tuberculin sensitivity demonstrated by the 10 TU Mantoux test seem to have been exaggerated; but if vaccination is done without preliminary tuberculin testing there will be an increased number of early reactions and persisting skin lesions. These are more irritating than dangerous. The conversion rate at seven weeks among the whole group was only 80 per cent, although in those over 10 years old it was 92 per cent. It is possible that the freezedried vaccine (Pasteur) was not of high potency. If a more potent vaccine is used the proportion of troublesome local reactions with unselective vaccination might be higher than that found in this series.

A twenty-year appraisal of BCG vaccination in the control of tuberculosis.

Few topics in the field of tuberculosis have engendered such divergent opinions as has the use of BCG vaccination in the control of tuberculosis. The views held by the medical profession in the United States on this subject have been either adversely critical, enthusiastic, or skeptical. Unfortunately, some of the unfavorable views have been expressed by those who have had no firsthand experience in this field and whose opinions have been often based on selected reports rather than on a critical review of the available literature. On the other hand, there was little justification for the enthusiasm of some advocates, based as it was on the results either of uncontrolled studies or of studies which were open to criticism. Although the introduction of antimicrobial agents ushered in a new era in the treatment of tuberculosis, the prophylactic value of these agents for man remains to be proved. Foci of tuberculous

BCG Vaccination Against Tuberculosis

Dr. Rosenthal's timely and erudite book on BCG vaccination deals not only with the clinical and immunologic considerations for the use of BCG vaccine, but also with its administration as part of a public health program, its technical production, and a clinical and experimental guide and analysis of its efficacy. At a time when there is a widely felt need for a workable and extensive program of immunization against tuberculosis in the United States, Dr. Rosenthal's case for the adoption of BCG vaccination must needs claim the wide audience among the medical and public health practitioners its scholarly and interesting presentation earns for it.

BCG Vaccination in the Fight Against Tuberculosis

When Wallgren, in 1927, introduced the intracutaneous method, he was establishing a solid basis for the more extensive use of BCG vaccination. He has since presented about forty papers setting forth his views on and experience with that mode of vaccination, and formulating the principles upon which its use today is founded. Thus Wallgren has contributed, perhaps more actively than any other living investigator, to the advancement of protective inoculation against tuberculosis.

Boeck's Sarcoid: Observations on the Use of BCG Vaccine* *Paper read at meeting of California Chapter of The American College of Chest Physicians, May 12, 1951, Los Angeles, California.

1) Local injection of hyaluronidase is capable of intensifying the reaction to the multiple puncture application of BCG vaccine. 2) The intensification of this reaction apparently has no influence on the persistence of tuberculin skin sensitivity. Its effect on the development of such sensitivity is questionable. 3) Therapeutic value of BCG vaccination cannot be completely ruled out, but appears unlikely. 4) A late flare-up at the site of previously negative tuberculin skin test following BCG vaccination is reported and its possible significance suggested.

The use of BCG in mental institutions.

The use of BCG vaccine in mental institutions may, therefore, be summarized as follows: 1. Its use for present patients in mental hospitals is limited by the small proportion of non-reactors to tuberculin. 2. In schools for mental defectives, it may be used in a considerable proportion of the present patient population. 3. The proportion of new patients and new employees eligible for vaccination is not known. Further information is being gathered. 4. Non-reactors to tuberculin should not be employed among patients known to have tuberculosis until they have been successfully vaccinated with BCG.

The BCG Controversy

Tuberculosis can be entirely eliminated, and has been in certain areas, by tuberculin testing, x-raying reactors, and isolation of open cases. BCG would interfere with such programs and might add the danger of large numbers of subclinical tuberculosis among the population at large. Any favorable report of BCG vaccination can be surpassed by reports with the use of accepted methods. For the present I believe we should leave the use of BCG vaccine in the hands of the public health departments, where its use can be controlled, and the results from it properly evaluated. I stress again the urgent need of more alternate-case control studies. Without them we cannot ever know with certainty whether BCG has any value at all.