Too much of a good thing: Management of BCG vaccine overdose
Department of Paediatrics, The University of Melbourne, VIC 3052, Australia.Vaccine (Impact Factor: 3.62). 09/2009; 27(41):5562-4. DOI: 10.1016/j.vaccine.2009.07.043
A 14-year-old girl was inadvertently immunised with an excessively large dose of BCG-Connaught vaccine (1.0 ml instead of 0.1 ml). Examination of the patient a few hours later revealed a subcutaneous fluctuant tender lump at the injection site. This was surgically excised within 12h of immunisation and she was treated with isoniazid and rifampicin for six weeks. The patient developed no complications, other than a minor surgical scar. This case highlights the importance of the correct administration and dosing of BCG vaccine and suggests a management option that may prevent the severe local and systemic complications that are frequently associated with BCG overdose.
Article: Clinical Toxicology
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ABSTRACT: Tuberculosis is a major health problem worldwide. Vaccination is a main strategy in reducing the transmission rate. Adverse reactions associated with BCG vaccination have been well documented, but events due to accidental overdose and/or improper vaccination are scarce in the literature. We herein report three pediatric cases who were vaccinated improperly with an overdose BCG, developed cold abscesses at the injection sites and were treated with isoniazid only or combined with rifampicin for six months. Physicians and other vaccine providers/administrators should be encouraged to report events of overdose and/or improper administration to constitute a guideline about treatment since there is no consensus regarding treatment of such complications.
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ABSTRACT: Background: Bacillus Calmette ET Guerin (BCG) vaccine, compulsory in endemic areas, remains the only available vaccine for prevention of Tuberculosis (TB) despite its modest protective value. Complications may arise in healthy/ immunocompromized hosts. Methods: Children presenting with BCG vaccine related complications in the form of local/distant complications were enrolled from 2007-2010 at Cairo University Pediatric hospital. Objectives: assess outcome of BCG related complications in a group of children with post vaccination incidents, identify risk factors for complications among vaccinated children and identify cases of underlying Primary Immunodeficiency (PID) among presenting cases. Results: Fifty one eligible patients were included, forty three were proved immunocompetent, and eight had underlying primary immunodeficiency disorders. Presentations included localized axillary lymphadenopathy, cervical sinuses, granulomatous lesions and disseminated forms Faulty injection sites were strongly associated with complications (p value < 0.001).Patients without underlying PID had larger scar size and younger age at presentations (p values: 0.02, 0.0001 respectively).Resolution of lesions was observed in 97 % (95% CI 97% ± 3%) of cases without underlying PID versus fatal outcome in all cases with underlying immune defects. Conclusion: Local BCG related complications do not necessarily indicate underlying PID, disseminated complications are more serious and warrant further investigations. If PID is suspected, vaccination should be deferred to avoid its potentially fatal outcome.
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