ADVICE FOR PATIENTS

Tobias Brummaier, Saw Poe Yen Yen, Daydaypoe Keereecharoena, Rose McGready, Michele Vincenti-Delmas

• Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
• Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
• Faculty of Medicine, University of Basel, Basel, Switzerland
• Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom

A mother presented her 1-month-old term infant with a slowly progressive subcutaneous swelling measuring 1.2 × 1.2 cm on the left upper arm (Fig. 1a). The swelling developed at the same site where 0.1 mL Bacille Calmette-Guérin (BCG) vaccine had been administered intradermally on the day of birth.

The vaccine, manufactured by the Queen Saovabha Memorial Institute, Thai Red Cross Society, Bangkok, Thailand (Lot No. FB00817), contains approximately 2 million viable bacteria per mL of the live attenuated Mycobacterium bovis Tokyo 172 strain.

The infant was afebrile and systemically well, and no regional lymphadenitis was detected on examination.

Management and Outcome

A conservative “wait-and-see” approach was adopted. The infant was discharged home under local health-care follow-up.
A community health worker subsequently documented spontaneous resolution of the lesion with natural healing (Fig. 1b–d).

Discussion

BCG vaccines have been in use for nearly a century, are widely considered safe, and remain recommended by most countries [1].
Approximately 1–10% of recipients experience adverse reactions, the majority of which are localized (e.g., abscess, lymphadenitis). Systemic reactions such as osteomyelitis or disseminated BCG disease are rarely observed [2].

Adopting a conservative management approach for localized BCG injection-site reactions and non-suppurative lymphadenitis is generally appropriate, as these conditions are self-limiting and resolve spontaneously in most cases.

Acknowledgements

The Shoklo Malaria Research Unit is part of the Wellcome Trust Mahidol University–Oxford Tropical Medicine Research Programme, supported by the Wellcome Trust of Great Britain.

References

1. Colditz GA, Berkey CS, Mosteller F, Brewer TF, Wilson ME, Burdick E, et al.
   The efficacy of Bacillus Calmette–Guérin vaccination of newborns and infants in the prevention of tuberculosis: meta-analyses of the published literature. Pediatrics. 1995; 96(1 Pt 1): 29–35.

2. Venkataraman A, Yusuff M, Liebeschuetz S, Riddell A, Prendergast AJ.
   Management and outcome of Bacille Calmette–Guérin vaccine adverse reactions. Vaccine. 2015; 33(41): 5470–5474.