The Current Status of BCG Vaccination in Young Children in South Korea / 결핵및호흡기질환

BACKGROUND: Delivery of Bacille Calmette-Gurein (BCG) Tokyo vaccine, with the multipuncture device, has been much preferred over BCG Pasteur, with the intradermal method, possibly due to the easier manner of administration, a desire to avoid any trouble with scars, as well as side effects and higher profits to providers in South Korea. METHODS: To determine BCG scar status in 0~6 year old children vaccinated with two BCG vaccines (Pasteur BCG vaccine with intradermal method and BCG Tokyo vaccine with percutaneous method), the data from the national BCG scar survey in 2006 was analyzed. RESULTS: Based on the national survey, the high proportion that were vaccinated with BCG Tokyo vaccines with the multipuncture method (64.5%) was noted in 0~6 year old Korean children. From inspection of scar formation, as an indicator of vaccination, the median number of the visible pin scars from the percutaneous method was 16 (interquartile range, 12~18) in the Korean children, and pin scars decreased as the age of the children increased (p<0.001). CONCLUSION: The findings in this survey clearly showed a growing preference of parents for the BCG Tokyo vaccines by the multipuncture method in South Korea.

Tuberculin Survey to Estimate the Prevalence of Tuberculosis Infection of the Elementary Schoolchildren under High BCG Vaccination Coverage / 결핵및호흡기질환

BACKGROUND: Although the prevalence of tuberculosis infections (PTBI) is one of the basic epidemiologic indices, no survey has been carried out since 1995 because the nation-wide tuberculosis prevalence survey was changed to a surveillance system. Subjects without a BCG scar are examined in a tuberculin survey. However, it is very difficult to select these subjects under high vaccination coverage. It is important to evaluate the impact of BCG vaccinations on the tuberculin response and estimate the PTBI regardless of the BCG vaccination status. METHODS: A nation-wide, school-based cross-sectional tuberculin survey was carried out among first graders in elementary school in 2006. A total of 5,148 children in 40 schools were selected by quota sampling. Tuberculin testing with 0.1 ml of two tuberculin units of PPD RT23 was carried out on 4,018 children. The maximum transverse diameter of induration was measured 48 to 72 hours later. The presence of a BCG scar was checked separately. RESULTS: There were no BCG scars in 6.3% of the subjects. The mean induration size of tuberculin testing was 3.7+/-4.4 mm, which included 1,882 (46.8%) subjects with an induration size of 0 mm. The PTBI was 10.9% (439 subjects) using a cut-off point of > or =10 mm (conventional method). The annual risk of tuberculosis infections (ARTI) was 1.9% when the mean age of the subjects was assumed to be 6 years. There was no difference in the PTBI according to the presence or absence of a BCG scar [11.2% vs 7.6% (OR: 1.54, 95% CI: 0.98m2.43)]. Using a mirror image technique with 16 mm as the cut-off point, the PTBI and ARTI had decreased to 2.4% and 0.4% respectively. CONCLUSION: PTBI and ARTI, as estimated by conventional methods, appear to be high among BCG vaccinated children. A mirror image technique is more suitable for estimating the indices in a country with an intermediate burden of tuberculosis than the conventional method.

Serum Fatty Acid and Carnitine Levels in Obese Children with Fatty Livers

PURPOSE: The prevalence of obese children has recently increased. Obesity is known to be associated with complications such as hypertension, fatty liver, hyperlipidemia, and insulin resistance. L-carnitine is an essential cofactor for the transport of long chain fatty acids into mitochondria for beta-oxidation. The purpose of this study is to measure serum free fatty acid and carnitine levels, and evaluate the role of L-carnitine as a therapeutic drug in obese children with fatty liver. METHODS: Nine obese children, ranging from seven to 18 years of age, and 10 normal children were examined. Serum lipid(total cholesterol, triglyceride, HDL-cholesterol, and LDL-cholesterol) and fatty acid levels were analyzed. Serum total, free, and acyl carnitine levels were performed also by a new enzymatic cycling technique. RESULTS: Long chain fatty acids(myristic acid, palmitoleic acid, palmitic acid, linoleic acid, oleic acid, and stearic acid)were significantly increased in obese children compared to the control group. Total, and acyl carnitine levels were significantly increased in obese children compared to the control group. CONCLUSION: Serum free fatty acid and carnitine levels were significantly increased in obese children with fatty liver compared to the normal control. This may suggest that L-carnitine can be used as antilipidemic agent to decrease fatty acid and lipid levels for obese children. Prospective studies will investigate serum fatty acid and carnitine levels after treatment of L-carnitine in obese children in the future.