Complications related to Bacillus Calmette-Guérin vaccine and management approaches: A review

Abstract

Tuberculosis (TB) is an infectious disease, particularly preventable in children using the Bacillus Calmette-Guérin (BCG) attenuated vaccine. Individuals with strong immune systems can safely receive the BCG vaccine; however, certain factors such as age, immune system problems, vaccine dose, and injection route can cause side effects. Mild local reactions and ulceration at the intradermal injection site are common after BCG vaccination. However, in individuals with weakened immune systems, serious complications such as suppurative lymphadenitis, osteitis, or disseminated BCG disease (BCGosis) may develop. Therefore, the BCG vaccine should be carefully considered in individuals infected with human immunodeficiency virus (HIV) and patients with primary immunodeficiency disorder (PID). Treatment methods depend on the severity of the condition. In cases of uncomplicated injection site ulceration and minor, non-suppurative lymphadenopathy, local wound care and observation are conservative treatments. However, management approaches for deep or disseminated disease include surgical interventions and antimycobacterial therapy in addition to immunological evaluation. Furthermore, while hematopoietic stem cell transplantation may be considered in some PID patients, urgent enzyme replacement therapy using polyethylene glycol–modified adenosine deaminase (ADA) is necessary in patients with ADA deficiency. In conclusion, the BCG vaccine is a powerful tool in preventing TB, especially in childhood, and is safe in people with healthy immune systems. However, in individuals with any immune system–related disease, the administration of this attenuated vaccine should be evaluated by specialist physicians, and immediate intervention should be sought in case of serious side effects.

Keywords

adverse event / BCG / BCGosis / vaccination

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