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    Home > Active Ingredient News > Infection > Guidelines for the clinical management of adverse reactions of BCG vaccine in 2021

    Guidelines for the clinical management of adverse reactions of BCG vaccine in 2021

    • Last Update: 2021-07-29
    • Source: Internet
    • Author: User
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    Bacille Calmette-Guerin (BCG) is a live attenuated vaccine to prevent tuberculosis.


    Bacille Calmette-Guerin (BCG) is a live attenuated vaccine to prevent tuberculosis.


    Recently, the Chinese Medical Association Tuberculosis Branch, in conjunction with the Chinese National Tuberculosis Association School and the Children’s Tuberculosis Prevention and Treatment Branch, organized experts to conduct in-depth discussions, and formulated and issued the "Guidelines for the Clinical Management of BCG Adverse Reactions", regarding the types of BCG, methods of use, and BCG adverse reactions The performance, diagnosis, treatment and prevention of the disease should be handled in a standardized manner


    1.


    One, classification one, classification

    BCGstrains from 1902 Isolation of abovinesubbranchesrodbacteria, after 13 years 230 after serial passages I obtained attenuated vaccine strain


    BCG strains from 1902 Isolation of a bovine sub branches rod bacteria, after 13 years 230 after serial passages I obtained attenuated vaccine strain


    At present, our country's children child Free immune regulation plan to make use of leather in the injection shot with BCG produced by bacteria strains source in 1948, Chen positive Ren, Wei Tin Hua and Zhu Zongyao in Denmark study tours BCG after manufacture and use of lead into the Denmark 823 substrain


    2.


    1 , vaccination: Birth within 3 months of a baby or TST negative in children


    2.


    3.


    4.


    5.


    6 , replant principles: (1) <3-month-old infant can be directly replant (no contraindications, suspend or situation should not be vaccinated); (2) TST negative of the 3 months to 3 years old children, should replant ; (3) ≥ 3 years old child will not fill species; (4) have been vaccinated with BCG children, even if the card is not formed scar no longer cropping


    3.


    (1) Local adverse reactions BCG is intradermal injection, subcutaneous or intramuscular injection is strictly prohibited


    When intradermal administration is correct, minor local reactions will still occur, usually within 6 months after vaccination
    .
    Mild side effects include redness on the local skin 2 to 3 days after vaccination, no induration on the touch, and subsidence after a few days; 2 to 4 weeks after vaccination, a skin reaction characterized by papules appears at the vaccination site, which gradually softens and forms small white pustules, pustules rupture becomes mild ulcers, multiple crusting within 2 months, scab healed and remain within 3 months after the straight path .
    4 ~.
    6 mm scar marks
    .
    The strong local reaction after BCG inoculation was a local abscess or an ulcer with a diameter of more than 10 mm , and the healing time was more than 12 weeks
    .

    (Two) BCG - itis

    (Two) BCG - itis

    BCG - ITIS   inoculating BCG after the most common adverse reaction, involving the inoculation site ipsilateral axillary lymph, or neck supraclavicular lymph nodes, the lymph nodes can be involved alone or combined lesions armpit
    .
    The lymph nodes are not tender, seldom merge with each other, and are usually not accompanied by fever or weight loss
    .

    BCG - ITIS   inoculating BCG after the most common adverse reaction, involving the inoculation site ipsilateral axillary lymph, or neck supraclavicular lymph nodes, the lymph nodes can be involved alone or combined lesions armpit .
    The lymph nodes are not tender, seldom merge with each other, and are usually not accompanied by fever or weight loss .
     

    (3) Disseminated BCG disease

    (3) Disseminated BCG disease

    Disseminated BCG disease is common in children with primary immunodeficiency disease ( PID )
    .
    Common easily cause disseminated BCG disease PID include: severe disease combined immunodeficiency (SCID), completely full of DiGeorge Zong He syndrome (cDGS), eczema and thrombocytopenia associated with immune deficiency Zeng s syndrome (WAS), high IgE Zeng s syndrome (HIES), slow of meat bud swelling disease (CGD), Meng Tak Seoul genetic transfer and easy sense of sub- branch rod bacteria disease (MSMD)
    .
    Sowing bulk of the card referred most common clinical manifestations of disease is bacteria inoculation site redness, ulceration and overflow pus, systemic multiple lymph nodes, skin and lung disease, mass formation change; also can affect the liver, spleen and bones
    .

    Disseminated BCG disease is common in children with primary immunodeficiency disease ( PID )
    .
    Common easily cause disseminated BCG disease PID include: severe disease combined immunodeficiency (SCID), completely full of DiGeorge Zong He syndrome (cDGS), eczema and thrombocytopenia associated with immune deficiency Zeng s syndrome (WAS), high IgE Zeng s syndrome (HIES), slow of meat bud swelling disease (CGD), Meng Tak Seoul genetic transfer and easy sense of sub- branch rod bacteria disease (MSMD)
    .
    Sowing bulk of the card referred most common clinical manifestations of disease is bacteria inoculation site redness, ulceration and overflow pus, systemic multiple lymph nodes, skin and lung disease, mass formation change; also can affect the liver, spleen and bones
    .

    (4) Immune Reconstitution Inflammatory Syndrome (IRIS)

    (4) Immune Reconstitution Inflammatory Syndrome (IRIS)

    IRIS , BCG ;3, ,,

    。 ,

    IRIS,BCG;3,,,

    。,

    、、

    () BCG BCG-itis ,:

    ()BCGBCG-itis,:

    1,BCG-itis :(1) BCG , (/) ;(2) ;(3)TST , T [T.SPOT-TB QuantiFERON TB-GOLD(QFT)] ;(4) , ; (5)、 ;(6) PCR RD1pncA , BCG
    。 1、2、3、41、2、3、5 ,;1、2、3、4、61、 2、3、5、6 ,
    。(,)

    1,BCG-itis:(1)BCG,(/);(2);(3)TST,T[T.SPOT-TBQuantiFERONTB-GOLD(QFT)];(4),;(5)、;(6)PCRRD1pncA,BCG
    。1、2、3、41、2、3、5,;1、2、3、4、61、2、3、5、6,
    。(,)

    2, : BCG-itis,、、, 、, ,,、 、、、、、、、 1
    。( ,)

    2,:BCG-itis,、、,、,,,、、、、、、、、1
    。(,)

    ()

    ()

    BCG-itis 、、 、、 、、
    。 、

    BCG-itis 、、、、、、
    。、

    ,,

    1,BCG : BCG , , , 1~2d ,48h,

    1,BCG:BCG,,,1~2d,48h,

    2 , the BCG vaccination unit bit is not good anti be of the treatment: (1) ground seed after intradermal blister circle about the humps disappear 30min, 2 ~ 3d after inoculation the inoculated skin irritation slight, non specific reactions, mostly without treatment , may be self-eliminate back
    .
    (2) then types the Bureau section illustrating now red swelling, hard knot, collapse case sores, blisters, scars, rashes, abscess, generally do not need treatment, note intended local clean, to prevent secondary infection, abscess or non-self mention the removal of scab before
    .

    2 , the BCG vaccination unit bit is not good anti be of the treatment: (1) ground seed after intradermal blister circle about the humps disappear 30min, 2 ~ 3d after inoculation the inoculated skin irritation slight, non specific reactions, mostly without treatment , may be self-eliminate back
    .
    (2) then types the Bureau section illustrating now red swelling, hard knot, collapse case sores, blisters, scars, rashes, abscess, generally do not need treatment, note intended local clean, to prevent secondary infection, abscess or non-self mention the removal of scab before
    .

    .
    3 , the BCG - ITIS of the treatment: (1) BCG-itis not the main sheet Bureau unit used anti-TB drugs, anti-TB drugs are not recommended systemic use, the discretion situation using Mycobacterium vaccae other immunoregulatory agents
    .
    (2) If the lymph node abscesses after 6 to 9 months to heal not observed, and the diameter of ≥ 3cm, or the development of simple suppurative lymphadenitis, needle aspiration can pus, bacteriological inspection check
    .
    Avoid free -cut opening lead flow
    .
    (3) If the lymph bar junction abscess 2 to 3 times by needle aspiration, no significant improvement or sinus formation, or simple lymphadenitis after 6 to 9 months to heal not observed, and the linear diameter ≥ 3cm, or lesions progress rapidly within two months, should be considered for external surgical excision
    .
    (The above three categories are low-quality level of evidence, in equal strength recommended)

    .
    3 , the BCG - ITIS of the treatment: (1) BCG-itis not the main sheet Bureau unit used anti-TB drugs, anti-TB drugs are not recommended systemic use, the discretion situation using Mycobacterium vaccae other immunoregulatory agents
    .
    (2) If the lymph node abscesses after 6 to 9 months to heal not observed, and the diameter of ≥ 3cm, or the development of simple suppurative lymphadenitis, needle aspiration can pus, bacteriological inspection check
    .
    Avoid free -cut opening lead flow
    .
    (3) If the lymph bar junction abscess 2 to 3 times by needle aspiration, no significant improvement or sinus formation, or simple lymphadenitis after 6 to 9 months to heal not observed, and the linear diameter ≥ 3cm, or lesions progress rapidly within two months, should be considered for external surgical excision
    .
    (The above three categories are low-quality level of evidence, in equal strength recommended)

    4 , treatment of disseminated BCG disease: disseminated BCG disease often and send the PID
    .
    Needle for sowing dispersion of card via bacterial disease of treatment therapy, should be anti- BCG therapy, drug selection and treatment depends immunodeficiency type interactions between, clinical effects, adverse drug reactions and drug used to typically experience of election 3 to select four kinds of drug products
    .

    4 , treatment of disseminated BCG disease: disseminated BCG disease often and send the PID
    .
    Needle for sowing dispersion of card via bacterial disease of treatment therapy, should be anti- BCG therapy, drug selection and treatment depends immunodeficiency type interactions between, clinical effects, adverse drug reactions and drug used to typically experience of election 3 to select four kinds of drug products
    .

    In summary, BCG safe full of tall, not good anti should be less, is Yi Zhong wide pan should be used for the prevention of tuberculosis and non-muscle invasive bladder cancer treatment vaccines
    .
    BCG for tuberculosis vaccination time, common adverse reactions to the injection site of the ulcer or local lymphadenitis, for minor local reactions, build proposed " wait observation " , without any intervention regression in most cases
    .

    In summary, BCG safe full of tall, not good anti should be less, is Yi Zhong wide pan should be used for the prevention of tuberculosis and non-muscle invasive bladder cancer treatment vaccines
    .
    BCG for tuberculosis vaccination time, common adverse reactions to the injection site of the ulcer or local lymphadenitis, for minor local reactions, build proposed " wait observation " , without any intervention regression in most cases
    .

    Original source

    Original source

    Chinese Medical Association Tuberculosis Branch, Chinese National Tuberculosis Association School and Child Tuberculosis Prevention and Treatment Professional Branch .
    Guidelines for the clinical management of BCG adverse reactions .
    Chinese Journal of National Tuberculosis June 21, Vol.
    43, No.
    6 , ChinJantituberc, June 2020, Vol.
    43, No.
    6

    Chinese Medical Association Tuberculosis Branch, Chinese National Tuberculosis Association School and Child Tuberculosis Prevention and Treatment Professional Branch .
    Guidelines for the clinical management of BCG adverse reactions .
    Chinese Journal of National Tuberculosis June 21, Vol.
    43, No.
    6 , ChinJantituberc, June 2020, Vol.
    43, No.
    6

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