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Interference of preceding BCG vaccination with BCG immunotherapy in L2C-guinea pig leukemia.

Guinea pigs of inbred strain 2 were vaccinated with BCG 1331 Copenhagen (K-Nr. 240-1) six to seven weeks before intradermal application of about 10(5) leukocytes from a highly leukemic animal in mixture with 10(7) colony forming units (CFU) of BCG. This presensitization with BCG totally abolished or strongly reduced the antitumor activity of L2C-cells adjoining BCG. Increase of bacterial mass applied from 1 X 10(7) to 2 X 10(8) CFU did not restore the antileukemic effect of BCG as observed in unvaccinated guinea pigs by a significant delay of death in a portion of animals and by the occurrence of long-term survivors. Since local reaction to BCG occurred much earlier in presensitized than in unvaccinated animals, we speculate that the destruction of tumor cells and hence the antigenic stimulus was too premature in presensitized animals to build up a BCG-mediated antitumor immunity.

Animals

[Intradermal BCG vaccination of the ,ewborn in the 1972-1975 period].

The study included 1015 children vaccinated BCG at birth in the "Gh. Marinescu" Maternity Hospital of Bucharest during the 1972-1975 period. The Romanian lyophilized BCG vaccine prepared in sodium glutamate in doses of 0.10 mg/0.1 ml was used. Of these children 543 were vaccinated in the Maternity Hospital and 472 by the vaccination teams of the Institute of Phthisiology, Bucharest. During the first two years 660 of these children were controlled at various intervals. Sensitivity to 2 U PPD was moderate during the first year, the mean diameter being of 4-5.3 mm in the children vaccinated before discharged from hospital and of 3.5-6.7 mm in diameter in the children vaccinated after discharge. At the age of 1 and 2 years the mean diameter did not exceed 3 mm. The vaccinal scar was present in more than 95% of the children in the first year, the mean diameter ranging between 3.6 and 4.8 mm. No postvaccinal complications were recorded. The authors consider that the results obtained can be taken as criteria for assessing the operational and technical effectiveness of BCG in neonates.

Age Factors

[BCG vaccination and leukemia. Epidemiologic studies on the effect of BCG vaccination on leukemia].

The possible influence of BCG vaccination on leukemia mortality of infants was investigated by various authors. The methods used were prospective trials, retrospective studies and epidemiological analyses. In some of these studies a protective effect of BCG vaccination was observed, in other studies no influence was found. Up to now this problem is subject to controversial discussions. An epidemiological analysis of the Austrian data using trend analyses, regression analyses and analyses of rank correlation showed an inverse correlation between BCG vaccination rate of newborns and leukemia mortality in the age group 0--5 years. From this correlation a protection rate of 0.77 could be calculated.

Austria

Depression of tuberculin reaction in mild and moderate protein-calorie malnourished children following BCG vaccination.

Following BCG vaccination, mild to moderate protein-calorie malnourished children of the marasmic type were tuberculin tested with two types of tuberculin. The indurations of these malnourished children were compared to those of a similarly treated cohort of well-nourished controls. A large group of children who were initially malnourished became well-nourished over the time interval between BCG vaccination and tuberculin testing and these children were compared to the other two cohorts. A significant difference was found between the indurations of the malnourished and the well-nourished. The group which changed nutritional status had an average induration between that of the other two groups. Feeding for two days with a high protein-calorie mixture did not significantly increase the indurations of the malnourished. Supplementation with vitamin A had no discernible effect.

BCG Vaccine

[Biologic effect of atypical mycobacteria against a background of BCG vaccination].

A study was made of the specific sensitivity to tuberculin in the animals vaccinated with BCG in case of their additional sensitization with various atypical mycobacteria. The mentioned experimental study appeared to be necessary for the purpose of a more proper treatment of the epidemiological date referred to the sensitivity of man to tuberculin and sensitins against the background of mass BCG vaccination. Preliminary BCG vaccination of the animals with their subsequent infection with atypical mycobacteria altered the allergic response to the antigens from the mycobacteria increasing the response reactions not only to tuberculin, but also to sensitins from mycobacteria of the I--III groups by Runyon's classification, closely connected in antigenic respect with mycobacteria tuberculosis. Skin reactions to sensitins from the saprophytic mycobacteria which had in their composition much less common antigens with mycobacteria tuberculosis, remained at the low level. Sensitization with atypical mycobacteria of animals preliminarily vaccinated with BCG failed to cause significant influence on the production of immunity to the subsequent virulent infection with tuberculosis.

Animals

Neonatal vaccination with 'universal strength' BCG vaccine.

'Universal strength' BCG vaccine was given to 219 neonates and 2 months later 159 infants were Mantoux-tested with 5 Tu PPD-S and their BCG scars measured. The results showed a satisfactory conversion rate of over 90%. Though 30% of the lesions discharged, this only lasted for a few days and the vaccine was well tolerated and acceptable for use in neonates.

BCG Vaccine

[Investigations carried out to ascertain the dose-effect relationship of a BCG vaccine, strain 1331 Copenhagen, in neonates and young infants (author's transl)].

1405 neonates and infants were vaccinated with BCG Vaccine (strain 1331 Copenhagen) at five clinics in the Federal Republic of Germany. Doses in logarithmic increments from 22000 to 250000 VU (viable units)/0.1 ml were given by strictly intradermal injection. Carrying out the post-vaccinal tuberculin test by the MENDEL-MANTOUX technique, the dose-effect relationship could be demonstrated (Fig. 3). Conversion rates raised from 43% to 76% (Tab. 1); they are furthermore depending from the tuberculin dose and the assessment of the skin reaction. Tests with up to 50 I.U. of purified tuberculin were resulting in conversion rates over 90% for vaccination doses of 100 000 VU and more, any palpable infiltration regarding as a positive result (Fig. 4). The vaccine showed good safety in all concentrations employed concerning reactions at the site of injection. Lympnode enlargement, palable even 12 weeks postvacc., was common. In the course of the trial there was one case of suppurative lymphadenitis among the 262 children who were given the vaccine in the highest concentration (250000 VU). Subsequent trials revealed a rate of this complication in the 1:1000 range. The approval for the vaccine with 100000-300000 VU/dose has subsequently been given by the Federal Bureau for Sera and Vaccines.

BCG Vaccine

Cost-benefit analysis of BCG-vaccination in Austria.

BCG-vaccination in Austria is performed generally in newborn, but only partially in school children. A cost-benefit analysis was performed considering age-dependent immunizations, tuberculosis morbidity, protection rate and duration of protection, costs of vaccination, costs of tuberculosis therapy, frequency of complications due to vaccination and costs for treatment of these complications. This analysis shows an economic balance between costs and benefits with regard to immunication of newborn, i. e., costs of vaccination are approximately compensated by the saved costs of prevented diseases. In contrary vaccination of school children reveals a considerable economic gain. General revaccination of schoolchildren would make BCG-vaccination much more effective in an economic respect.

Adolescent

Inhibition and stimulation of the growth of Krebs-2 carcinoma by BCG vaccine.

The effect of BCG vaccine on the growth of imtransplants of Krebs-2 carcinoma in mice was studied. The simultaneous injection of BCG and tumor cells either inhibited tumor growth (BCG given in admixture with tumor cells) or stimulated it (BCG injected contralateral to the tumor transplantation site). The BCG dose was directly related to the effect. Tumor growth was also stimulated by the ip injection of starch or liquid paraffin. In these experiments, the BCG effect was attributed to the redistribution of cells involved in nonspecific and specific tumor resistance. Shortly after BCG prevaccination, particularly when BCG doses were high and mice were susceptible to vaccine infection, BCG was either without effect or stimulated tumor growth; later, however, tumor growth was inhibited regardless of the BCG dose and the injection site of the BCG. The effect of BCG prevaccination was suggested to be due to: 1)the distraction of macrophages and T-lymphocytes to defend the host against the multiplying mycobacteria, and 2)the activation of the pool of these cells that become capable to participate in antitumor resistance after mycobacteria elimination.

Animals

Comparative studies on the significance of in vitro data of BCG vaccines.

In vitro parameters of BCG vaccine, such as colony-forming units or bacterial weight, are significant with respect to efficacy and occurrence of side effects only for vaccines which are made by one manufacturer according to one method and tested in one laboratory. With respect to colony-forming units from different products, widely varying doses must be applied to gain comparable effects. Similar effects can be expected from the human dose, recommended for each particular product. These conclusions, derived from experiences in vaccination against tuberculosis can also be considered essential for comparative immunotherapy with BCG vaccines.

BCG Vaccine

Acceptability of BCG vaccination.

The acceptability of BCG vaccination varies a great deal according to the country and to the period when the vaccine is given. The incidence of complications has not always a direct influence on this acceptability, which depends, for a very large part, on the risk of tuberculosis in a given country at a given time.

BCG Vaccine

BCG vaccination and the incidence of lymphomas and leukaemia.

BCG vaccination has been claimed to prevent leukaemia, but there is also concern that it might increase the risk of Hodgkin's disease and other lymphomas. Both hypotheses were tested by comparing mortality and registration rates in cohorts of children from the North and South Islands of New Zealand. When school-children were offered vaccination in both islands, subsequent death rates from lymphomas and leukaemia were similar in the two islands. After withdrawal of vaccination in the South Island, mortality and registration rates for Hodgkin's disease remained similar in the two islands, but there was significant excess of deaths from non-Hodgkin lymphomas in the North Island. The difference in the registration rates for these tumours was much smaller than the difference in mortality rates and was not statistically significant. There was no evidence that BCG vaccination in the North Island prevented leukemia. These findings and the results of other studies suggest that proposals for BCG vaccination against leukaemia are unwise.

Adolescent

Tuberculosis studies in Muscogee County, Georgia. Twenty-year evaluation of a community trial of BCG vaccination.

A controlled trial of BCG vaccination was conducted in 1950 in Muscogee County, Ga., and Russell County, Ala. The study population consisted of 64,136 volunteers over the age of 5 years who had satisfactory skin tests with 5 tuberculin units of purified protein derivative and whose chest photofluorograms were considered by two readers to show no significant pulmonary abnormalities. Approximately half of the nonreactors to tuberculin were vaccinated with the Tice strain of BCG by a multiple-puncture method. During a 20-year period of follow-up, 207 cases of tuberculosis were identified among the persons who had been tuberculin reactors in 1950, 36 cases were identified among the controls, and 32 cases were identified among the vaccinees. The average annual case rates per 100,000 were 47.0 for reactors, 13.4 for controls, and 12.6 for vaccinees.

Alabama

Metastatic osteomyelitis following BCG vaccination.

An 8-year-old girl, who had been vaccinated with BCG without subsequent regional reactions, developed osteomyelitis in the left calcaneus 7 months later. The process healed after surgical treatment and chemotherapy for 1 year. Culture from the bone abscess gave growth of mycobacteria which could not be distinguished from BCG.

Abscess