The Comparison of the Conversion Rate and Duration after Multipuncture BCG vaccination / 소아알레르기및호흡기학회지

PURPOSE: During the childhood, Mantoux test is very popular for detecting tuberculous infection and also useful for evaluating the immunity against tuberculosis after BCG vaccination. But the response and conversion rate is affected by the age of vaccination, the quality of vaccine, the duration after vaccination and the frequency of the test. Recently percutaneous multipuncture technique of BCG vaccination was introduced and used because of local side effect and technical problem of intradermal BCG vaccination, however there is only a study of conversion rate and side effect at 3month after multipuncture BCG vaccination. We performed this study to evaluate of the difference of the Mantoux reaction and conversion rate according to duration (3month, 9month and 15month) after vaccination, gestational age, sex, and feeding type. METHODS: 174 neonates (155 of full term infants, 19 of preterm infants) who were born Kangnam St. Mary's Hospital were given multipuncture BCG vaccination within 4weeks after birth between July, 1995 and June 1997. All subjects was performed Mantoux test using 5TU PPD (NIH, Korea) at 3month, 9month and 15month. Injecting BCG and interpretating the result of the Mantoux test was done by the same person. RESULTS: 1) The positive rates of Mantoux test which was done 3month , 9month and 15month after vaccination were 38.7%, 58.1%, 71.6% in the full term infant group and 31.6%, 31.6%, 47.4% in the preterm infant group. 2) The size of induration in Mantoux test, which was done 3month, 9month and 15month after vaccination were 7.3 mm, 9.4 mm, and 10.6 mm in the full term infant group and 5.6 mm, 7.7 mm, 9.2 mm in the preterm infant group. The size of induration was significantly lower in the preterm infant group as compared with that of the full term infant group 9month after vaccination. 3) The positive conversion rate, less than 5 mm to more than 10 mm, was 6.3% (3 infants of 48 infants who were negative Mantoux test 3month became positive 9month) and 26.3% (5 infants of 19 infants who were negative 9month became positive 15month) in the full term infant group, and 33.3% (one infant of 5 infants who were negative 9month became positive 15month). 4) There is no difference in conversion rate of Mantoux test according to the sex, feeding type in both groups5) Complication rate for multipuncture is 3.2%, which is leaded by local ulceration and fever in the full term infant group, and 5.3%, which is only fever in the preterm infant group. CONCLUSION: In those result the size of induration and conversion rate is increased as the duration after vaccination, then their smaller size in the preterm group 9month after vaccination maybe due to immunological immaturity of preterm group.

The Clinical Study on Conversion Rate of Mantoux Test, Change of Local Lesion and Complication after Multipuncture BCG Vaccination in Neonates

PURPOSE: Ugly ulcer and keloid formation of injection site has sometimes been a problem in Korea from the cosmetic point of view in intradermal vaccination. Since 3 or 4 years ago, multipuncture BCG vaccination has been used in Korea, there are no data and information about multipuncture BCG vaccination. We therefore performed this study to evaluate of conversion rate, complication and to make criteria of horizontal induration of Mantoux test instead of erythema to use criteria of positive Mantoux test in Japan. METHODS: 124 neonates who were born Kon-Kuk university hospital without family history of tuberculosis were given multipuncture BCG vaccination within 4 weeks after birth between Mar. and Oct. 1995. We observed change of local lesion for 1-3 months after BCG vaccination. All neonates tested a Mantoux test with 5TU of PPD 3 months after multipuncture BCG vaccination. RESULTS: 1) There was no significant difference in conversion rate of Mantoux test by feeding pattern. 2) There was no change of number of puncture site 1-3 months after BCG vaccination. 3) There was no ulcer in change of local lesion. Pusture, scab and redness was decreased 3 months after multipuncture BCG vaccination. Redness of all was replaced pigmentation. 4) The means+/-2SD of diameters of induration, erythema on Mantoux test were 10.4+/-3.0mm in horizontal induration, 13.2+/-4.2mm in horizontal erythema, 8.0+/-3.0mm in vertical induration, 10.9+/-3.5mm in vertical erythema. 5) Criteria for positive tuberculin reaction were diameters of induration, erythema : equal to or greater than 7mm of horizontal induration, equal to or greater than 5mm of vertical induration, equal to or greater than 10mm of horizontal and vertical erythema. 6) The positve conversion tuberculin rate were 87.8% in horizontal induration, 87.5% of vertical induration, 83.8% of horizontal erythema, 69.4% of vertical erythema. 7) Conversion rate of neonates immunized later 21 days after birth were significantly greater than neonates immunized within 21 days after birth. 8) There was no correlate Mantoux test conversion rate and strong reaction of local lesion. 9) There were no specific complication after multipuncture BCG vaccination. 10) There were no severe pain and irritability at multipuncture BCG vaccination. CONCLUSIONS: Multipuncture BCG is a good BCG vaccination that we can use with efficacious effect and slight local lesions instead of intradermal BCG vaccination.