Question of the Week

Question :

Posted On : 15 Apr 2006

A three months boy has not formed BCG scar. Does he need 2nd dose of BCG?

Expert Answer :

No expert answer available.

Answer Discussion :

dr.serdar

no wait till 6 mo. age if yet not developed scare repeat the vaccination again

18 years ago

nikhil agrawal

18 years ago

pediatriconcall

Formation of scar is neither necessary nor is the only indication of success of BCG vaccine. However it is the only simple and convenient way of determining success of BCG vaccine. It may take 3-6 months for the scar to form. If no scar is visible at all after 6 months one needs to do Mantoux test. If negative, one should give repeat BCG

19 years ago

While it is correct to ‘assume’ failed BCG vaccination if no scar is seen 90 days after inoculation, it does not necessarily mean that it had actually failed to induce some immune response that can be proved by laboratory tests. Since it is clinically impossible to distinguish between failed vaccination and failure to develop scar in spite of immune response, the better clinical option is to inoculate BCG a second time
Scientifically speaking, it would be ideal to test them with PPD and to classify them as those with no response {meaning no prior immune response}, with positive response but induration of 5 to 10 mm {most probably immune response due to earlier BCG} or induration of 15 mm or more {most probably infected with Myco-bacterium tuberculosis}. The first group deserves a second attempt with BCG.
Those children with M. tuberculosis infection {15 mm or more induration certainly, and perhaps those with 11 to 14 mm also} should, in my opinion, be given INH ‘chemoprophylaxis’
Indian Pediatrics 2000,37: 332-333

19 years ago

DR PRADEEP MATTOO

It is probably correct to ‘assume’ failed BCG vaccination if no scar is seen 90 days after inoculation. However, it does not necessarily mean that it had actually failed to induce some immune response. Since it is clinically impossible to distinguish between failed vaccination and failure to develop scar in spite of immune response, the better clinical option is to inoculate BCG a second time.

19 years ago

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