PubMed · 7896404
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V Sane, S V Thakkar, N Sane. 1994. Generalized BCG tuberculosis.. https://pubmed.ncbi.nlm.nih.gov/7896404/
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The implementation of a selective neonatal BCG immunisation policy adopted in south east London boroughs of Lambeth, Southwark, and Lewisham in 1992 has been audited. A survey conducted 18 months after the policy was implemented showed that only 11% of infants identified as eligible for neonatal BCG immunisation had been immunised. The results of the survey were fed back to neonatal units, which were encouraged to improve access to BCG immunisations for eligible infants. A second survey 17 months later showed that 14% of eligible infants had been immunised. Difficulties in applying complex selection criteria, rapid turnover of trained staff in acute units, and short neonatal stay were thought to contribute to the poor uptake of the selective programme delivered in the neonatal units. A community based BCG immunisation service has been commissioned to improve uptake.
Tuberculosis (TB) causes more deaths worldwide than any other infectious disease: in 1995, TB caused an estimated 3 million deaths, of which 170,000 (6%) occurred among children aged <15 years (1,2). Diagnosing TB in children often is difficult and relies on clinical judgement and use of algorithms that include chest radiography and the tuberculin skin test (TST). However, interpretation of TST reactivity can be complicated by many factors other than infection with Mycobacterium tuberculosis. For example, previous Bacille Calmette-Guérin (BCG) vaccination or exposure to nontuberculous mycobacteria can result in positive TST reactions indistinguishable from those caused by M. tuberculosis (3). In contrast, such factors as human immunodeficiency virus (HIV) infection, poor nutritional status, and recent viral or bacterial infections or vaccination with live virus can reduce response to the TST (4). To assess the use of the TST for diagnosing pediatric TB in a population with high BCG coverage, a TST survey was conducted during July-August 1996 among children aged 3-60 months in Botswana (1991 population: 1.3 million). The findings indicate that most positive TSTs (induration > or =10 mm) among children in Botswana can be attributed to TB infection rather than previous BCG vaccination and that the TST remains useful for diagnosing pediatric TB in Botswana.
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