BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies
Por:
Marciano B.E., Huang C.-Y., Joshi G., Rezaei N., Carvalho B.C., Allwood Z., Ikinciogullari A., Reda S.M., Gennery A., Thon V., Espinosa-Rosales F., Al-Herz W., Porras O., Shcherbina A., Szaflarska A., Kiliç S., Franco J.L., Gómez Raccio A.C., Roxo Jr. P., Esteves I., Galal N., Grumach A.S., Al-Tamemi S., Yildiran A., Orellana J.C., Yamada M., Morio T., Liberatore D., Ohtsuka Y., Lau Y.-L., Nishikomori R., Torres-Lozano C., Mazzucchelli J.T.L., Vilela M.M.S., Tavares F.S., Cunha L., Pinto J.A., Espinosa-Padilla S.E., Hernandez-Nieto L., Elfeky R.A., Ariga T., Toshio H., Dogu F., Cipe F., Formankova R., Nuñez-Nuñez M.E., Bezrodnik L., Marques J.G., Pereira M.I., Listello V., Slatter M.A., Nademi Z., Kowalczyk D., Fleisher T.A., Davies G., Neven B., Rosenzweig S.D.
Publicada:
1 ene 2014
Resumen:
Background Severe combined immunodeficiency (SCID) is a syndrome characterized by profound T-cell deficiency. BCG vaccine is contraindicated in patients with SCID. Because most countries encourage BCG vaccination at birth, a high percentage of patients with SCID are vaccinated before their immune defect is detected. Objectives We sought to describe the complications and risks associated with BCG vaccination in patients with SCID. Methods An extensive standardized questionnaire evaluating complications, therapeutics, and outcomes regarding BCG vaccination in patients given a diagnosis of SCID was widely distributed. Summary statistics and association analysis was performed. Results Data on 349 BCG-vaccinated patients with SCID from 28 centers in 17 countries were analyzed. Fifty-one percent of the patients had BCG-associated complications, 34% disseminated and 17% localized (a 33,000- and 400-fold increase, respectively, over the general population). Patients receiving early vaccination (=1 month) showed an increased prevalence of complications (P =.006) and death caused by BCG-associated complications (P <.0001). The odds of experiencing complications among patients with T-cell numbers of 250/µL or less at diagnosis was 2.1 times higher (95% CI, 1.4-3.4 times higher; P =.001) than among those with T-cell numbers of greater than 250/µL. BCG-associated complications were reported in 2 of 78 patients who received antimycobacterial therapy while asymptomatic, and no deaths caused by BCG-associated complications occurred in this group. In contrast, 46 BCG-associated deaths were reported among 160 patients treated with antimycobacterial therapy for a symptomatic BCG infection (P<.0001). Conclusions BCG vaccine has a very high rate of complications in patients with SCID, which increase morbidity and mortality rates. Until safer and more efficient antituberculosis vaccines become available, delay in BCG vaccination should be considered to protect highly vulnerable populations from preventable complications. © 2013 American Academy of Allergy, Asthma & Immunology.
Filiaciones:
Marciano B.E.:
Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Huang C.-Y.:
Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Joshi G.:
Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Rezaei N.:
Pediatric Center of Excellence, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
Carvalho B.C.:
Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
Allwood Z.:
Immunology Department, Great Ormond Street Hospital for Children, London, United Kingdom
Ikinciogullari A.:
Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara, Turkey
Reda S.M.:
Department of Pediatric Allergy and Immunology, Children's Hospital, Ain Shams University, Cairo, Egypt
Gennery A.:
Paediatric Immunology Department, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
Thon V.:
Department of Clinical Immunology and Allergy, Medical Faculty of Masaryk University, St Anne's University Hospital, Brno, Czech Republic
Espinosa-Rosales F.:
National Institute of Pediatrics, Mexico City Federal District, Mexico City, Mexico
Al-Herz W.:
Department of Pediatrics, Kuwait University, Al-Sabah Hospital, Kuwait City, Kuwait
Porras O.:
Department of Immunology and Rheumatology, National Children's Hospital dr. Carlos Sáenz Herrera, San Jose, Costa Rica
Shcherbina A.:
Department of Clinical Immunology, Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
Szaflarska A.:
Department of Clinical Immunology and Transplantology, Children's University Hospital, Krakow, Poland
Kiliç S.:
Pediatric Immunology Division, Uludag University Medical Faculty, Bursa, Turkey
Franco J.L.:
Primary Immunodeficiency Group, University of Antioquia, Medellin, Colombia
Gómez Raccio A.C.:
Immunology Unit, Children's Hospital Ricardo Gutierrez, Buenos Aires, Argentina
Roxo Jr. P.:
Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
Esteves I.:
Primary Immunodeficiency Center, Lisbon Academic Center, Santa María Hospital, Lisbon, Portugal
Galal N.:
Cairo University, Cairo, Egypt
Grumach A.S.:
Faculty of Medicine of ABC, Santo André, São Paulo, Brazil
Al-Tamemi S.:
Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
Yildiran A.:
Department of Pediatric Immunology-Allergy, Ondokuz Mayis University, Atakum-Samsun, Turkey
Orellana J.C.:
Division of Allergy and Clinical Immunology, Santísima Trinidad Children's Hospital, Córdoba, Argentina
Yamada M.:
Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Morio T.:
Tokyo Medical and Dental University, Tokyo, Japan
Liberatore D.:
Pediatric Immunology, Italian Hospital, Buenos Aires, Argentina
Ohtsuka Y.:
Hyogo College of Medicine, Hyogo, Japan
Lau Y.-L.:
Department of Pediatrics and Adolescent Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
Nishikomori R.:
Department of Pediatrics, Kyoto University Hospital, Kyoto, Japan
Torres-Lozano C.:
Department of Clinical Immunology and Allergology, Western National Medical Center, Guadalajara, Mexico
Mazzucchelli J.T.L.:
Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
Vilela M.M.S.:
Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
Tavares F.S.:
Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
Cunha L.:
Federal University of Minas Gerais, Minas Gerais, Brazil
Pinto J.A.:
Federal University of Minas Gerais, Minas Gerais, Brazil
Espinosa-Padilla S.E.:
National Institute of Pediatrics, Mexico City Federal District, Mexico City, Mexico
Hernandez-Nieto L.:
National Institute of Pediatrics, Mexico City Federal District, Mexico City, Mexico
Elfeky R.A.:
Department of Pediatric Allergy and Immunology, Children's Hospital, Ain Shams University, Cairo, Egypt
Ariga T.:
Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Toshio H.:
Department of Pediatrics, Kyoto University Hospital, Kyoto, Japan
Dogu F.:
Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara, Turkey
Cipe F.:
Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara, Turkey
Formankova R.:
Charles University, University Hospital Motol, Prague, Czech Republic
Nuñez-Nuñez M.E.:
Department of Clinical Immunology and Allergology, Western National Medical Center, Guadalajara, Mexico
Bezrodnik L.:
Immunology Unit, Children's Hospital Ricardo Gutierrez, Buenos Aires, Argentina
Marques J.G.:
Primary Immunodeficiency Center, Lisbon Academic Center, Santa María Hospital, Lisbon, Portugal
Pereira M.I.:
Division of Allergy and Clinical Immunology, Santísima Trinidad Children's Hospital, Córdoba, Argentina
Listello V.:
Division of Allergy and Clinical Immunology, Santísima Trinidad Children's Hospital, Córdoba, Argentina
Slatter M.A.:
Paediatric Immunology Department, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
Nademi Z.:
Paediatric Immunology Department, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
Kowalczyk D.:
Department of Clinical Immunology and Transplantology, Children's University Hospital, Krakow, Poland
Fleisher T.A.:
Immunology Service, DLM, National Institutes of Health, Bethesda, MD, United States
Davies G.:
Immunology Department, Great Ormond Street Hospital for Children, London, United Kingdom
Neven B.:
Immunology-Hematology and Rheumatology Service, Necker Hospital, Paris, France
Rosenzweig S.D.:
Primary Immunodeficiency Clinic and Infectious Diseases Susceptibility Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
All Open Access, Bronze
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