BCG Vaccination

           In the pediatrics ID clinic the other day we had an interesting patient that I wanted talk about because this is something that we would not see in the US. This patient is a 3 year old girl who had a keloid around the area where she had her BCG vaccination. At first, there was inflammation around the site shortly after she had the vaccination administered. However, a keloid eventually formed that would occasionally bleed when it fell off. Of course the parents were very worried and took their daughter to the pediatrics ID clinic when they noticed that the keloid had not improved in over 2 months. At the clinic, the doctor was afraid that the inflammation would develop into an active form of TB so he had the patient started on isoniazid as prophylaxis. The doctor said the normally, isoniazid would have to be taken anywhere from 1-3 months.

            The Bacillus Calmette-Guerin (BCG) vaccination is given to babies in high risk TB areas. The vaccine is prepared from a strain of the live attenuated bovine tuberculosis bacillus, Mycobacterium bovis. Tuberculosis is the leading cause of notifiable diseases in Taiwan, with an estimated 15,000 new cases every year. In Taiwan, children are given the vaccination anywhere from the day they are born to 1 month later. When children are 12 years old, they all have to have a PPD test done at their school. In case the patient does not form an immune response, then he/she will have to get another BCG vaccination. Thus it is recommended to get a PPD test checked every 15 years because the effects of the vaccination can wear off.

            Normally the BCG vaccine is administered on the arm. However, due to cosmetic reasons (since the vaccination leaves a scar on the arm), parents have been opting to have their children vaccination in other areas of their body that are not as noticeable such as the buttocks are the bottom of their foot (this only works when the child is a baby). 

          Next week I will be giving a presentation on Extracorporeal Membrane Oxygenation (ECMO) dosing adjustments in the pediatrics population. Just as a preview, I recently had the privilege of seeing a neonate being placed on ECMO!