Chacon-Cruz Enrique, Arellano-Estrada Jorge Luis, Lopatynsky-Reyes Erika, Alvelais-Palacios Jorge, Becka Chandra
Hospital General de Tijuana - Pediatrics, Paseo Centario S/N Zona del Rio, Tijuana, Baja-California 22010, Mexico.
Health Jurisdiction of Tijuana - Epidemiology, Tijuana Baja-California, Mexico.
Ther Adv Vaccines. 2017 Aug;5(4-5):103-107. doi: 10.1177/2051013617741585. Epub 2017 Nov 15.
Vaccination against tuberculosis with live-attenuated Bacillus Calmette-Guérin (BCG) is widely used even though its effectiveness is controversial. BCG-lymphadenitis (BCG-LA) is its most common complication. Some studies have proposed that BCG-LA can be associated with primary immunodeficiencies (PIs). This study's aim is to see whether patients who developed BCG-LA (named as 'LA') developed more infections than BCG-vaccinated children without BCG-LA (named as 'NON-LA').
From January 2009 to April 2014, 31 LA children were seen at the outpatient clinic of the General Hospital of Tijuana, Mexico. Among them, 22 (70.97%), 5 (16.13%) and 4 (12.9%) had axillary, supraclavicular, or both BCG-LA, respectively. No treatment was given and complications were not seen. Per LA subject, a NON-LA not >1 month of age difference and same gender was paired and followed for 3 years to look for ambulatory infections (AINFs), acute otitis media (AOM) and hospitalizations. Surveillance per patient was performed by phone monthly, and they were seen at the clinic every 4 months. All patients were HIV-negative and had no family history of PI. Statistical analyses used were relative risk (RR) with confidence intervals (CI), test for independent variables and test.
In total 62 subjects were enrolled: 31 LA paired with 31 NON-LA. Between them, there were no differences in age, day care attendance and breastfeeding. There were no differences in the total number of AINF per patient (LA: 18.61 avg. ± 5.03 SD NON-LA: 18.19 avg. ± 4.17 SD, RR = 1.06, 95% CI = 0.33-0.66), AOM total episodes (LA: 30 NON-LA: 26, RR = 0.87, 95% CI = 0.31-0.68) and hospitalizations (LA: 5 NON-LA: 4, RR = 1, 95% CI = 0.25-0.74).
This cohort strongly suggests that BCG-LA in healthy children is not associated with more episodes of AINF and hospitalizations, when paired and compared with children BCG-vaccinated without BCG-LA.
尽管减毒活卡介苗（BCG）对结核病的预防效果存在争议，但仍被广泛使用。卡介苗淋巴结炎（BCG-LA）是其最常见的并发症。一些研究表明，BCG-LA可能与原发性免疫缺陷（PI）有关。本研究旨在观察发生BCG-LA的患者（称为“LA组”）是否比未发生BCG-LA的卡介苗接种儿童（称为“非LA组”）发生更多感染。
2009年1月至2014年4月，墨西哥蒂华纳总医院门诊共诊治31例LA组儿童。其中，22例（70.97%）、5例（16.13%）和4例（12.9%）分别发生腋窝、锁骨上或双侧BCG-LA。未给予治疗，未观察到并发症。为每名LA组受试者配对一名年龄相差不超过1个月且性别相同的非LA组受试者，并随访3年，以观察门诊感染（AINF）、急性中耳炎（AOM）和住院情况。每月通过电话对每名患者进行监测，每4个月在诊所对其进行检查。所有患者HIV检测均为阴性，且无PI家族史。采用的统计分析方法为相对危险度（RR）及其置信区间（CI）、自变量检验和检验。
共纳入62名受试者：31例LA组与31例非LA组配对。两组在年龄、日托出勤情况和母乳喂养方面无差异。每名患者的AINF总数（LA组：平均18.61±5.03标准差；非LA组：平均18.19±4.17标准差，RR = 1.06，95%CI = 0.33 - 0.66）、AOM总发作次数（LA组：30次；非LA组：26次，RR = 0.87，95%CI = 0.31 - 0.68）和住院次数（LA组：共5次；非LA组：共4次，RR = 1，95%CI = 0.25 - 0.74）方面均无差异。
该队列研究有力地表明，与未发生BCG-LA的卡介苗接种儿童配对并比较时，健康儿童中的BCG-LA与更多的AINF发作次数和住院次数无关。
