There is no need to re-vaccinate the child even if there is no scar. Which type of immunity is mainly induced by giving BCG vaccine? BCG vaccine predominantly induces cell mediated delayed-type hypersensitivity type of immunity. References: 1. Immunization Handbook for Medical Officers. Park K. Principles of epidemiology and epidemiologic methods. Epidemiology of communicable diseases. Delayed-type hypersensitivity, mycobacterial vaccines and protective immunity.
Lancet ;—9. You are here Home Blogs sheeloopoonam yahoo. See omnystudio. The Melbourne Vaccine Education Centre MVEC is an educational website, developed with the aim of providing up-to-date immunisation information for both healthcare professionals and members of the public. Please refer back to the website to ensure all reference information is current and up-to-date.
Intradermal vaccination. What is it? Anatomy and function of the skin The skin is a very complex organ that is made up of 3 main layers — the epidermis, dermis and the hypodermis. Which vaccines can be given intradermally? Use a short 10mm gauge needle with a short bevel and a 1ml insulin syringe Wear protective eye wear when administering BCG vaccine as eye splashes can ulcerate Identify the correct injection site see Table 1 above Stretch the skin between a finger and your thumb Insert the bevel into the dermis with the bevel facing upwards, to a distance of approx.
Who can administer intradermal vaccines? Date: April Materials in this section are updated as new information becomes available.
Episode play icon. This being the case, it was concluded that the BCG-PC vaccine was as "effective"as the BCG-ID at stimulating immunity and that it had the additional advantages the ease of application and the fact that it did not leave scars.
At the start of the seventies, however, debate began over the validity of tuberculin-based test results as accurate markers of protection against tuberculosis, based on the fact that DTH skin test response varies according to the strain used, the population vaccinated, the type of instrument used for vaccination and the administration technique; in the case of the percutaneous vaccine, the number of needles and punctures made by different apparatus also make a difference.
When the results of studies performed with children are compared with the results of studies involving adolescents, great variation is observed in DTH skin test response, being always lower among young children 14 than among adolescents and adults.
The BCG vaccines that are prepared for percutaneous use contain 40 to 50 times more viable bacilli than do vaccines formulated for intradermal use. It is believed that the low rates of adverse events associated with BCG-PC vaccines are due to the number of bacilli administered. Both DTH skin test response assay results and adverse event rates are directly related to the number of viable bacilli effectively inoculated.
In the United Kingdom, inadvertent application of a vaccine formulated for percutaneous use intradermally was responsible for an elevated rate of local abscess formation. The Moureau-Rio de Janeiro strain used in Brazil is highly immunogenic, both in school-age children and infants, although among infants, the vaccine induces less DTH skin test response stimulation.
There are large variations between individuals in terms of DTH skin test response and, if tuberculin testing is repeated, some individuals exhibit reversal of previous results while others return the same results as at first testing. While DTH skin test response has been much used in research to assess the response to BCG vaccination, this test is not considered an accurate marker for immunity.
Studies performed on experimental animals and on humans demonstrated that DTH skin test response has no relationship with protection and that individuals who react strongly to PPD may be less well protected against tuberculosis compared to those who do not exhibit a positive DTH skin test response.
Towards the end of the nineties, the first questions were raised about the benefits of the percutaneous technique; instigated by the fact that this technique is associated with reduced induction of both DTH skin test response and of specific lymphocyte M. In experimental animals, the production of IF-g and IL-2 has been associated with resistance to a number of different intracellular parasites and IF-g increases the capacity of macrophages to destroy M. The precise protective mechanisms acting against tuberculosis are not yet entirely understood, however, there is evidence that the best marker for evaluating the effectiveness of vaccines against tuberculosis is IF-g production; for the following reasons:.
While these factors suggest that IF-g ought to be the best marker for tuberculosis immunity, there are large variations in the production of this cytokine among both healthy and sick people. Levels of IF-g may be elevated in healthy adults who have been in contact with sick people, in adults with tuberculosis with minimal lesions and in children with progressive tuberculosis.
Adults with moderate or severe stages of the disease exhibit low IF-g product ion levels, but it is not yet known if this lowered IF-g production is the cause or the consequence of the progression of the disease. It is believed that tuberculosis protection is more closely linked to IF-g titers and to the titers of cytokines produced by Th2 lymphocytes than to the absolute titers of each cytokine. The response to BCG varies according to previous mycobacteria sensitization.
Tests performed in vitro have demonstrated that, among adults with a negative reaction to tuberculin testing, a response to soluble M.
Adults who have been previously sensitized, exhibit a wide spectrum of reponses to a the various M. The BCG vaccine induces a Th1 and Th2 response, but, the action of cytotoxic lymphocytes is modulated by the cytokines that are produced by the Th1 lymphocytes. The results of recent studies, performed with both humans and animals, suggest that previous exposure to mycobacteria antigens is associated with increased cytotoxic activity and that, in order to be reliable, the BCG vaccine should be administered before the recipient has been exposed to M.
Among adults, BCG induces a strong Th1 response, however, studies performed with laboratory animals have indicated that early exposure to bacterial antigens may induce a response that predominantly involves Th2 lymphocytes, which are more associated with hypersensitivity that with protective immunity.
This fact is of great concern when it is remembered that the BCG vaccine is recommended for newborn babies. There has yet been little study of the evaluation of newborn babies' immunoresponse to BCG. In newborns, BCG-ID is capable of inducing specific cytotoxic lymphocyte generation, against mycobacteria and cytotoxic activity, as assessed by IL5 and IL10 production is greater among children who exhibit less IF gamma production.
In countries such as Sweden and the United Kingdom, where there is little exposure to mycobacteria, there is a positive correlation between tuberculin testing conversion and IF-g production. The magnitude of the immunoresponse, as measured by the increase in DTH skin test response and IF-g production, before and after BCG vaccination was compared for English and African patients.
One year after vaccination, IF-g was similarly distributed across the two populations. The DTH skin test response increased for both populations, although more intensely so in the United Kingdom and the correlation between DTH skin test response and IF-g production was only confirmed in the United Kingdom, suggesting that exposure to mycobacteria interferes significantly with the immunoresponse to the BCG vaccine.
It is believed that the protection afforded by the BCG vaccine is better correlated with the magnitude of the post-vaccination immunoresponse than with absolute IF-g or DTH skin test response values. It is probable that sensitization due to exposure to other mycobacteria will prove to be the most important factor controlling the variable protection afforded by the BCG vaccine among different populations.
Furthermore, it has been confirmed that the M. Delayed type hypersensitivity skin test responses and lymphoproliferative responses to the various proteins secreted by M. Tuberculosis were evaluated for individuals who had been vaccinated at fpuir different BCG-PC dosages. These results prove that low doses of the BCG vaccine are ineffective at stimulating TH1 immunoresponse. The response to the BCG vaccine varies in accordance with a number of different factors.
In children, both DTH skin test responses and cytokine production in reaction to different strains of the BCG vaccine, administered sub or percutaneously, during the neonatal period or at ten weeks, were more intense for groups vaccinated with the Japanese strain, by BCG-ID and among children vaccinated at ten weeks. Despite some authors having suggested that vaccinating children after two months may improve the immunoresponse to the BCG vaccine, 49 it has already been demonstrated, in Brazil, that even low birth weight neonates exhibit a good immunoresponse after receiving BCG-ID.
In Brazil, increased vaccination coverage with BCG-ID has been clearly associated with reduced tuberculous meningitis in infancy. While the BCG-PC vaccine containing the Moureau-Rio de Janeiro strain has been licensed in Brazil, it has been little used and its effectiveness cannot therefore be confirmed. Advances in the fields of immunology and molecular biology have stimulated research into new vaccination techniques for tuberculosis, however it is unlikely that BCG-ID will be substituted by a new vaccine in the next few years.
Abrir menu Brasil. Jornal de Pediatria. Abrir menu. Rio J. Lucia F. Bricks About the author. BCG vaccine; adverse effects; efficacy; tuberculosis. Bricks PhD. Introduction Despite the fact that the BCG vaccine is one of the most widely used globally, tuberculosis remains one of the most significant public health problems 1,2.
The patient should not expose the area to sunlight or liquids until the vaccine has tried. Criteria on which to base the choice of BCG administration method Globally, the intradermal method is used most widely.
Adverse events associated with the BCG vaccine The intradermal BCG vaccine causes a local reaction which evolves over a long period 10 weeks. Brewer TF. Preventing tuberculosis with bacillus Calmette-Guerin vaccine: a meta-analysis of the literature. Clin Infect Dis.
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