BCG vaccination in patients with severe combined
immunodeficiency: Complications, risks, and vaccination
policies

J 2014

BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies

MARCIANO, Beatriz E.; Chiung Yu HUANG; Gyan JOSHI; Nima REZAEI; Beatriz Costa CARVALHO et al.

Základní údaje

Originální název

BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies

Autoři

MARCIANO, Beatriz E.; Chiung Yu HUANG; Gyan JOSHI; Nima REZAEI; Beatriz Costa CARVALHO; Zoe ALLWOOD; Aydan IKINCIOGULLARI; Shereen M. REDA; Andrew GENNERY; Vojtěch THON; Francisco ESPINOSA-ROSALES; Walleed AL-HERZ; Oscar PORRAS; Anna SHCHERBINA; Anna SZAFLARSKA; Sebnem KILIC; Jose L. FRANCO; Andrea C. GÓMEZ RACCIO; Persio ROXO; Isabel ESTEVES; Nermeen GALAL; Anete Sevciovic GRUMACH; Salem AL-TAMEMI; Alisan YILDIRAN; Julio C. ORELLANA; Masafumi YAMADA; Tomohiro MORIO; Diana LIBERATORE; Yoshitoshi OHTSUKA; Yu-Lung LAU; Ryuta NISHIKOMORI; Carlos TORRES-LOZANO; Juliana T.L. MAZZUCCHELLI; Maria M.S. VILELA; Fabiola S. TAVARES; Luciana CUNHA; Jorge A. PINTO; Sara E. ESPINOSA-PADILLA; Leticia HERNANDEZ-NIETO; Reem A. ELFEKY; Tadashi ARIGA; Heike TOSHIO; Figen DOGU; Funda CIPE; Renata FORMANKOVA; Enriqueta M. NUNEZ-NUNEZ; Liliana BEZRODNIK; Jose Goncalo MARQUES; María I. PEREIRA; Viviana LISTELLO; Mary A. SLATTER; Zohreh NADEMI; Danuta KOWALCZYK; Thomas A. FLEISHER; Graham DAVIES; Bénédicte NEVEN a Sergio D. ROSENZWEIG

Vydání

Journal of allergy and clinical immunology, New York, Mosby-Elsevier, 2014, 0091-6749

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30102 Immunology

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Impakt faktor

Impact factor: 11.476

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/14:00077681

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

Primary immunodeficiency; severe combined immunodeficiency; vaccine; BCG; mycobacteria; newborn screening; hematopoietic stem cell transplant; immune reconstitution syndrome

Štítky

EL OK

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 8. 12. 2014 10:57, Soňa Böhmová

Anotace

V originále

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 (<= 3 1 month) showed an increased prevalence of complications (P = 5.006) and death caused by BCG-associated complications (P < .0001). The odds of experiencing complications among patients with T-cell numbers of 250/mu L 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/mL. 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.

Citovat

@article{1212343,
   author = {Marciano, Beatriz E. and Huang, Chiung Yu and Joshi, Gyan and Rezaei, Nima and Carvalho, Beatriz Costa and Allwood, Zoe and Ikinciogullari, Aydan and Reda, Shereen M. and Gennery, Andrew and Thon, Vojtěch and EspinosaandRosales, Francisco and AlandHerz, Walleed and Porras, Oscar and Shcherbina, Anna and Szaflarska, Anna and Kilic, Sebnem and Franco, Jose L. and Gómez Raccio, Andrea C. and Roxo, Persio and Esteves, Isabel and Galal, Nermeen and Grumach, Anete Sevciovic and AlandTamemi, Salem and Yildiran, Alisan and Orellana, Julio C. and Yamada, Masafumi and Morio, Tomohiro and Liberatore, Diana and Ohtsuka, Yoshitoshi and Lau, YuandLung and Nishikomori, Ryuta and TorresandLozano, Carlos and Mazzucchelli, Juliana T.L. and Vilela, Maria M.S. and Tavares, Fabiola S. and Cunha, Luciana and Pinto, Jorge A. and EspinosaandPadilla, Sara E. and HernandezandNieto, Leticia and Elfeky, Reem A. and Ariga, Tadashi and Toshio, Heike and Dogu, Figen and Cipe, Funda and Formankova, Renata and NunezandNunez, Enriqueta M. and Bezrodnik, Liliana and Marques, Jose Goncalo and Pereira, María I. and Listello, Viviana and Slatter, Mary A. and Nademi, Zohreh and Kowalczyk, Danuta and Fleisher, Thomas A. and Davies, Graham and Neven, Bénédicte and Rosenzweig, Sergio D.},
   article_location = {New York},
   article_number = {4},
   doi = {https://doi.org/10.1016/j.jaci.2014.02.028},
   keywords = {Primary immunodeficiency; severe combined immunodeficiency; vaccine; BCG; mycobacteria; newborn screening; hematopoietic stem cell transplant; immune reconstitution syndrome},
   language = {eng},
   issn = {0091-6749},
   journal = {Journal of allergy and clinical immunology},
   title = {BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies},
   volume = {133},
   year = {2014}
}

TY  - JOUR
ID  - 1212343
AU  - Marciano, Beatriz E. - Huang, Chiung Yu - Joshi, Gyan - Rezaei, Nima - Carvalho, Beatriz Costa - Allwood, Zoe - Ikinciogullari, Aydan - Reda, Shereen M. - Gennery, Andrew - Thon, Vojtěch - Espinosa-Rosales, Francisco - Al-Herz, Walleed - Porras, Oscar - Shcherbina, Anna - Szaflarska, Anna - Kilic, Sebnem - Franco, Jose L. - Gómez Raccio, Andrea C. - Roxo, Persio - Esteves, Isabel - Galal, Nermeen - Grumach, Anete Sevciovic - Al-Tamemi, Salem - Yildiran, Alisan - Orellana, Julio C. - Yamada, Masafumi - Morio, Tomohiro - Liberatore, Diana - Ohtsuka, Yoshitoshi - Lau, Yu-Lung - Nishikomori, Ryuta - Torres-Lozano, Carlos - Mazzucchelli, Juliana T.L. - Vilela, Maria M.S. - Tavares, Fabiola S. - Cunha, Luciana - Pinto, Jorge A. - Espinosa-Padilla, Sara E. - Hernandez-Nieto, Leticia - Elfeky, Reem A. - Ariga, Tadashi - Toshio, Heike - Dogu, Figen - Cipe, Funda - Formankova, Renata - Nunez-Nunez, Enriqueta M. - Bezrodnik, Liliana - Marques, Jose Goncalo - Pereira, María I. - Listello, Viviana - Slatter, Mary A. - Nademi, Zohreh - Kowalczyk, Danuta - Fleisher, Thomas A. - Davies, Graham - Neven, Bénédicte - Rosenzweig, Sergio D.
PY  - 2014
TI  - BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies
JF  - Journal of allergy and clinical immunology
VL  - 133
IS  - 4
SP  - 1134-1141
EP  - 1134-1141
PB  - Mosby-Elsevier
SN  - 00916749
KW  - Primary immunodeficiency
KW  - severe combined immunodeficiency
KW  - vaccine
KW  - BCG
KW  - mycobacteria
KW  - newborn screening
KW  - hematopoietic stem cell transplant
KW  - immune reconstitution syndrome
N2  - 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 (<= 3 1 month) showed an increased prevalence of complications (P = 5.006) and death caused by BCG-associated complications (P < .0001). The odds of experiencing complications among patients with T-cell numbers of 250/mu L 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/mL. 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.
ER  -

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