BCG vaccination status of children with tuberculous meningitis and the use of unsupervised isoniazid prophylaxis.

From 1985 to 1992, 193 children with tuberculous meningitis (TBM) with a median age of 26 months were admitted to the Department of Paediatrics and Child Health, Tygerberg Hospital. Of these children 143 (74%) were documented to have received BCG, either by reference to 'Road to Health' cards or by contact with local authority clinic staff. In a further 18 children a BCG scar was visible. Therefore at least 161 of the children (83%) had received BCG vaccination. As the Western Cape has also been shown to have the highest incidence of TBM in South Africa, there is concern that BCG as currently used does not have a significant protective effect against disseminated tuberculosis. Seventy-seven children (40%) were also reported to have a close household contact who had been treated for pulmonary tuberculosis within the previous 24 months. Only 17 of these children (22%), however, were prescribed prophylactic isoniazid and only 7 of these completed 3 months or more prophylaxis.