Desmond Tutu TB Centre, Dept of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, Western Cape Province, South Africa
Max Planck Institute for Infection Biology, Berlin, Germany.
Eur Respir Rev. 2022 Jun 28;31(164). doi: 10.1183/16000617.0046-2022. Print 2022 Jun 30.
During the 1930 Lübeck bacille Calmette-Guérin (BCG) disaster, 251 neonates received three oral BCG doses accidentally contaminated by virulent ; 67 (26.7%) infants died of tuberculosis. BCG reversion to pathogenicity did not occur. Detailed examinations clarified contested aspects of tuberculosis pathogenesis. Gastrointestinal infection was seldom "silent" and did not cause typical primary pulmonary lesions. In 15 infants, primary pulmonary foci were found but these resulted from vaccine ingestion and aspiration and were not caused by gastrointestinal infection spreading to the lungs without trace of its journey, as claimed by prominent researchers such as Calmette and von Behring. Further, among 60 infants in whom evaluation was completed, a "silent" gastrointestinal infection without an intestinal primary focus was found in only one. Lymphohaematogenous-disseminated tuberculosis caused death in 24/67 (35.8%) infants and tuberculous meningitis in a further 17/67 (25.4%). Gastrointestinal tuberculosis complications caused death in 26/67 (38.8%) infants. Half of the tuberculosis-attributed deaths had occurred by 3 months, 93% by 6 months and 100% by 12 months; remarkably no further deaths or tuberculosis recurrences occurred within 5 years post-vaccination/infection. These findings provide graphic confirmation that the early introduction of chemoprophylaxis in recently -infected young children is critical and urgent.
在 20 世纪 30 年代的吕贝克卡介苗（BCG）灾难中，251 名新生儿意外接受了 3 剂口服 BCG 疫苗，这些疫苗被污染了强毒；其中 67 名（26.7%）婴儿死于结核病。BCG 返祖为致病性并没有发生。详细的检查澄清了结核病发病机制方面有争议的问题。胃肠道感染很少是“无症状的”，不会引起典型的原发性肺病变。在 15 名婴儿中，发现了原发性肺病灶，但这些病灶是由疫苗摄入和吸入引起的，而不是由胃肠道感染无迹可寻地传播到肺部引起的，这与卡尔梅特和冯·贝林等著名研究人员的说法相悖。此外，在 60 名评估完成的婴儿中，只有 1 名出现“无症状”的胃肠道感染而无肠道原发性病灶。淋巴血液播散性结核病导致 67 名婴儿中的 24 名（35.8%）死亡，结核性脑膜炎导致进一步的 17 名（25.4%）死亡。胃肠道结核病并发症导致 67 名婴儿中的 26 名（38.8%）死亡。一半的结核病死亡发生在接种/感染后 3 个月内，93%发生在 6 个月内，100%发生在 12 个月内；值得注意的是，接种/感染后 5 年内没有发生进一步的死亡或结核病复发。这些发现生动地证实了在最近感染的幼儿中早期引入化学预防是至关重要和紧迫的。
