Transcript Routine BCG vaccination to newborns

Jean Marie Camille Guerin
[Routine BCG vaccination to newborns- Future
challenges
Prof. Fahad Abdullah Al Zamil
Professor and Consultant, Pediatric Infectious Diseases
Head of Infectious Diseases Unit
College Of Medicine
King Saud University
2nd Middle East Vaccination Congress
Abu Dhabi, United Arab Emirates
December 14-15, 2012
Tuberculosis Epidemiology
WHO Surveillance Data
Case / 100,000
No. (million)
Incidence
140
8.8
Smear (+)
62
3.9
HIV (+)
11
0.674
Prevalence
245
15.4
Death
28
1.75
33% of people
2 billions
Latently Infected
Age-Age-specific risk of progression to TB disease after primary
infections
Age at primary
infection
No disease(%)
Pulmonary(%)
Miliary/CNS(%)
˂1 year
50
30-40
10-20
1-2 years
75-80
10-20
2.5
2-5 years
95
5
0.5
5-10 years
98
2
˂0.5
˃10 years
80-90
10-20
˂0.5
Marais, et al. Am J Respir Crit Care Med 2006; 173:1078
TB Epidemiology
• About 11% of world new TB cases occurred in
children <15 years old (884,000 of 8.3 million
in 2000), with variability among countries (36% developed,15-20% developing countries)
• Children receive less attention in TB control
program because of paucibacillary disease
• 60% among infant and children <5 years
• TB remains a major public health problem in
KSA
• Incidence is not significantly decreasing in the
last 10 yeas
• 46% of incident cases were among Non-Saudis
with twice the rate, but not clear if due to
reactivation of LTB or infection after arrival
% of MDR-TB among new TB cases 1994-2007
TB-KSA
TB-KSA
TB trend, KSA-Saudi
TB trend-KSA-Non Saudi
Source: Annals of Saudi Medicine, Volume 32, Issue 1, January 2012
Source: Indian Journal Of Pathology and Microbiology, Vol. 55; Issue 2, April-June 2012
Severe suppurative adenopathy post-BCG vaccination.
Inoculation site abscess post-BCG vaccination.
Suppurative BCG lymphadenitis in right axillary region. The lymph node
measures 5 cm in diameter, and is fluctuant in centre and the overlying
skin is inflamed
Outbreak of BCG related lymphadenitis in Saudi children
at a university hospital after a change in BCG vaccine
Abdulkarim Al Rabiaah, Sarah Alsubaie, Elham Bukhari, Fahad Al Zamil,
Ashry, Gad
aDepartment of Pediatrics, College Of Medicine, King Saud University, Saudi
Arabia.
Conclusion: We conclude that increased susceptibility to the BCG SSI vaccine
might have contributed to the increased incidence of lymphadenitis in these
children. Hence, caution should be exercised in switching from one vaccine to
another, as is often done in developing countries.
Source: Annals of Saudi Medicine, Volume 32, Issue 1, January 2012
BCG Lymphadenitis: A 6 year experience in two
Saudi hospitals
Conclusion:
An increase in BCG lymphadenitis was observed in our population, with an
incidence higher than expected. The cause of this increase is likely secondary
to changes in the vaccine strain. Medical treatment appears to be effective
when used in conjunction with needle aspiration for enlarged lymph nodes.
Further research is needed to clarify the exact incidence, etiology and
optimal management of BCG lymphadenitis.
Source: Indian Journal Of Pathology and Microbiology, Vol. 55; Issue 2, April-June 2012
Treatment of Calmette-Guérin bacillus
adenitis: a metaanalysis
Goraya JS, Virdi VS
Abstract
Various treatments have been used to decrease the risk of suppuration; the most
troublesome complication of Calmette-Guerin bacillus adenitis, but results are
controversial. Metaanalysis of four randomized controlled trials revealed no significant
difference in the frequency of suppuration between the treatment and control groups
for all treatments [relative risk (RR), 1.10; 95% confidence interval (CI), 0.88 to 1.38],
erythromycin (RR 1.04; 95% CI 0.79 to 1.37) and isoniazid (RR 1.35; 95% CI 0.84 to
2.18). Therefore medical treatment does not reduce the frequency of suppuration in
Calmette-Guerin bacillus adenitis.
Source: Pediatr Infect Dis J. 2001 Jun;20(6):632-4
Correspondence
Safety of Intradermal Bacillus Calmette-Guerin
vaccine for neonates in Eastern Saudi Arabia
Ahmed R. Alsuwaidi
Department of Pediatrics
United Arab Emirates University
Al Ain, United Arab Emirates
We have observed a similar high incidence (4.3) per 1000 among children in Al Ain,
United Arab Emirates where the same strain is currently used.
Source: Saudi Medical Journal Vol. 33, July 2012; 797-798
Why the world failed to control TB?
• Nature of organism leading to latency with
huge pool of people with LTBI acting as
reservoir for TB disease if reactivated
• Prolonged treatment course
• TB not priority, disease of the poor
• Lack of new drugs, vaccine development
except recently
Research and development
• New diagnostics
• New medications (10 new or repurposed) under
trials/ new regimens with short duration
• New vaccines ( 9 candidate vaccine in phase 1 or
2 trials)
Conclusions
• TB remains global health threat
• TB control is hampered by lack of effective vaccine, prolonged
treatment course emergence of MDRTb, HIV epidemic and availability
of affordable treatment
• The near future will witness major breakthrough in TB therapy in the
form of novel drugs and shorter duration of therapy
• Caution should be exercised in switching from one vaccine to another,
as is often done in developing countries.
• An increase in BCG lymphadenitis was observed in our population,
with an incidence higher than expected. The cause of this increase is
likely secondary to changes in the vaccine strain. Medical treatment
appears to be effective when used in conjunction with needle
aspiration for enlarged lymph nodes.
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Conclusions (Continue)
Giving BCG at birth to our newborn
babies, is it the ideal
time?????????????????????????