Outbreak of Bacillus Calmette-Guerlin-associated lymphadenitis and abscesses in Jamaican children

An outbreak of axillary lymphadenitis and abscesses after Bacillus Calmette-Guerlin (BCG) vaccination (Pasteur Paris, Batch N5122) occurred in 139 Jamaican children between January and July, 1988. The overall rate of this complication was 0.95 percent. The attack rate was 1.92 percent among the 0- to 6 week age group and 0.6 percent in the 7- to 52-week age group. Of 139 patients there were 77 males and 62 females and the mean age at presentation was 4 months. The mean size of the BCG scar, duration of healing and Mantoux reaction size differed significantly in patients compared with those of control infants (P less than 0.01). Mycobacterium bovis was isolated from 11 patients. Immunologically index patients and controls differed significantly only with respect to T lymphocyte subpopulation percentages and concanavalin A stimulation indices. Evaluation of the BCG vaccine did not reveal either increased potency or microbial contamination. We conclude that increased susceptibility to the Pasteur strain of BCG might have contributed to the increased incidence of complications in these Jamaican children and hence caution should be exercised in switching one vaccine for another as is often done in the developing countries. (AU)

An outbreak of severe BCG axillary lymphadenitis in Saint Lucia, 1982-83

An epidemic of BCG auxillary lymphadenitis affected at least 37 children, primarily infants, in Saint Lucia in late 1982 and early 1983. Eleven infants had spontaneous rupture or required incision and drainage of supportive lymph nodes. Cases developed auxillary lymphadenitis from 1-22 weeks after immuniazation with Connaught BCG vacine, first introduced into the country in September, 1982. No single factor could be reliably implicated as the sole cause of the epidemic. More potent BCG vaccines, such as the Connaught product, give better protection but more reactions than weaker BCG vaccines and may reduce patient compliance with the Expanded Programme on Immunization in general. Those in BCG programmes should be alert to adverse reactions and scrupulous in storing, reconstituting, and administering the correct dose of BCG vaccine intradermally. Keeping good vaccination records and vials of each lot of vaccine used can help to determine whether epidemics of adverse reactions are occuring and what their cause might be. (AU)