Direct BCG vaccination in Burundi, Dahomey and Mauritania. A study of local complications.

Until recently it was believed that BCG vaccine given to persons strongly sensitive to tuberculin would cause local complications detrimental to health. In mass BCG campaigns, therefore, the accepted practice has been to give a tuberculin test before vaccination in order to exclude tuberculin reactors from vaccination. This two-step procedure not only is costly but considerably reduces the campaign coverage.Recent investigations indicate that direct BCG vaccination-i.e., vaccination without previous tuberculin testing-does not produce unpleasant local reactions to any great extent. This procedure might therefore be adopted in countries with limited financial resources. The present study was designed to investigate the frequency of large local reactions resulting from direct BCG vaccination under campaign conditions in Africa, where there is a pressing need to economize available resources.The accelerated vaccination reactions observed in persons who reacted strongly to tuberculin were no larger than the tuberculin reactions that they would have experienced in a traditional campaign using a low-dose tuberculin test for pre-vaccination screening. These accelerated reactions quickly diminished, and after four weeks they were practically the same size in both reactors and non-reactors. The incidence of axillary lymph-node enlargement was also the same in reactors and non-reactors. It was therefore concluded that local vaccination reactions would not occur to an extent that might render direct BCG vaccination unacceptable, even in a mass vaccination campaign.