The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants

Nina Marie Birk; Thomas Nørrelykke Nissen; Monica Ladekarl; Vera Zingmark; Jesper Kjærgaard; Trine Mølbæk Jensen; Signe Kjeldgaard Jensen; Lisbeth Marianne Thøstesen; Poul-Erik Kofoed; Lone Graff Stensballe; Andreas Andersen; Ole Pryds; Susanne Dam Nielsen; Dorthe Lisbeth Jeppesen; Christine Stabell Benn

doi:10.1186/s12879-017-2641-0

The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants

Nina Marie Birk, Thomas Nørrelykke Nissen, Monica Ladekarl, Vera Zingmark, Jesper Kjærgaard, Trine Mølbæk Jensen, Signe Kjeldgaard Jensen, Lisbeth Marianne Thøstesen, Poul-Erik Kofoed, Lone Graff Stensballe, Andreas Andersen, Ole Pryds, Susanne Dam Nielsen, Dorthe Lisbeth Jeppesen, Christine Stabell Benn

Department of Clinical Medicine

6 Citations (Scopus)

111 Downloads (Pure)

Abstract

BACKGROUND: The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis is administered intradermally, and vaccination is often followed by a scar at the injection site. Among BCG-vaccinated individuals, having a scar has been associated with lower mortality. We aimed to examine the impact of vaccination technique for scarring in a high income setting, by assessing the associations between the post injection reaction, the wheal size, and the probability of developing a scar, and scar size.

METHODS: This study was nested within a clinical multicenter study randomizing 4262 infants to either BCG vaccination (BCG 1331 SSI) or no intervention. In this substudy, including 492 vaccinated infants, the immediate post BCG vaccination reaction was registered as either wheal (a raised, blanched papule at the injection site), bulge (a palpable element at the injection site), or no reaction. The presence or absence of a BCG scar and the size the scar was measured at 13 months of age.

RESULTS: Of 492 infants included, 87% had a wheal after vaccination, 11% had a bulge, and 2% had no reaction. The mean wheal size was 3.8 mm (95% confidence interval 3.7-3.9). Overall, 95% (442/466, 26 lost to follow-up) of BCG-vaccinated infants had a scar at 13 months of age. In infants with a wheal, the probability of developing a scar was 96%, declining to 87% in the case of a bulge, and to 56% in the case of no reaction (p for same probability = 0.03). Wheal size was positively correlated with the probability of getting a scar and scar size.

CONCLUSION: Scarring after BCG vaccination has been associated with lower infant mortality. In a high-income setting, we found that correct injection technique is highly important for the development of a BCG scar and that registration of the category of BCG skin reaction (as wheal, bulge, or no reaction) may be used to identify infants at risk of scar failure. Finally, the wheal size was positively associated with both the probability of getting a scar and scar size.

TRIAL REGISTRATION: The study was registered at www.ClinicalTrials.gov with trial registration number NCT01694108 .

Original language	English
Article number	540
Journal	B M C Infectious Diseases
Volume	17
Number of pages	8
ISSN	1471-2334
DOIs	https://doi.org/10.1186/s12879-017-2641-0
Publication status	Published - 3 Aug 2017

Keywords

BCG Vaccine
Bacillus
Cicatrix
Denmark
Female
Humans
Infant
Infant Mortality
Lost to Follow-Up
Male
Tuberculin Test
Vaccination
Journal Article
Multicenter Study
Randomized Controlled Trial

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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The association between Bacillus CalmetteGuérin vaccination (1331 SSI) skin reaction and subsequent scar development in infantsFinal published version, 710 KBLicence: CC BY

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Birk, N. M., Nissen, T. N., Ladekarl, M., Zingmark, V., Kjærgaard, J., Jensen, T. M., Jensen, S. K., Thøstesen, L. M., Kofoed, P-E., Stensballe, L. G., Andersen, A., Pryds, O., Nielsen, S. D., Jeppesen, D. L., & Benn, C. S. (2017). The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants. B M C Infectious Diseases, 17, [540]. https://doi.org/10.1186/s12879-017-2641-0

Birk, NM, Nissen, TN, Ladekarl, M, Zingmark, V, Kjærgaard, J, Jensen, TM, Jensen, SK, Thøstesen, LM, Kofoed, P-E, Stensballe, LG, Andersen, A, Pryds, O, Nielsen, SD, Jeppesen, DL & Benn, CS 2017, 'The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants', B M C Infectious Diseases, vol. 17, 540. https://doi.org/10.1186/s12879-017-2641-0

@article{7ea2e193059843cca8b08bf6b378cd8d,

title = "The association between Bacillus Calmette-Gu{\'e}rin vaccination (1331 SSI) skin reaction and subsequent scar development in infants",

abstract = "BACKGROUND: The Bacillus Calmette-Gu{\'e}rin vaccine (BCG) against tuberculosis is administered intradermally, and vaccination is often followed by a scar at the injection site. Among BCG-vaccinated individuals, having a scar has been associated with lower mortality. We aimed to examine the impact of vaccination technique for scarring in a high income setting, by assessing the associations between the post injection reaction, the wheal size, and the probability of developing a scar, and scar size.METHODS: This study was nested within a clinical multicenter study randomizing 4262 infants to either BCG vaccination (BCG 1331 SSI) or no intervention. In this substudy, including 492 vaccinated infants, the immediate post BCG vaccination reaction was registered as either wheal (a raised, blanched papule at the injection site), bulge (a palpable element at the injection site), or no reaction. The presence or absence of a BCG scar and the size the scar was measured at 13 months of age.RESULTS: Of 492 infants included, 87% had a wheal after vaccination, 11% had a bulge, and 2% had no reaction. The mean wheal size was 3.8 mm (95% confidence interval 3.7-3.9). Overall, 95% (442/466, 26 lost to follow-up) of BCG-vaccinated infants had a scar at 13 months of age. In infants with a wheal, the probability of developing a scar was 96%, declining to 87% in the case of a bulge, and to 56% in the case of no reaction (p for same probability = 0.03). Wheal size was positively correlated with the probability of getting a scar and scar size.CONCLUSION: Scarring after BCG vaccination has been associated with lower infant mortality. In a high-income setting, we found that correct injection technique is highly important for the development of a BCG scar and that registration of the category of BCG skin reaction (as wheal, bulge, or no reaction) may be used to identify infants at risk of scar failure. Finally, the wheal size was positively associated with both the probability of getting a scar and scar size.TRIAL REGISTRATION: The study was registered at www.ClinicalTrials.gov with trial registration number NCT01694108 .",

keywords = "BCG Vaccine, Bacillus, Cicatrix, Denmark, Female, Humans, Infant, Infant Mortality, Lost to Follow-Up, Male, Tuberculin Test, Vaccination, Journal Article, Multicenter Study, Randomized Controlled Trial",

author = "Birk, {Nina Marie} and Nissen, {Thomas N{\o}rrelykke} and Monica Ladekarl and Vera Zingmark and Jesper Kj{\ae}rgaard and Jensen, {Trine M{\o}lb{\ae}k} and Jensen, {Signe Kjeldgaard} and Th{\o}stesen, {Lisbeth Marianne} and Poul-Erik Kofoed and Stensballe, {Lone Graff} and Andreas Andersen and Ole Pryds and Nielsen, {Susanne Dam} and Jeppesen, {Dorthe Lisbeth} and Benn, {Christine Stabell}",

year = "2017",

month = aug,

day = "3",

doi = "10.1186/s12879-017-2641-0",

language = "English",

volume = "17",

journal = "B M C Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central Ltd.",

}

TY - JOUR

T1 - The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants

AU - Birk, Nina Marie

AU - Nissen, Thomas Nørrelykke

AU - Ladekarl, Monica

AU - Zingmark, Vera

AU - Kjærgaard, Jesper

AU - Jensen, Trine Mølbæk

AU - Jensen, Signe Kjeldgaard

AU - Thøstesen, Lisbeth Marianne

AU - Kofoed, Poul-Erik

AU - Stensballe, Lone Graff

AU - Andersen, Andreas

AU - Pryds, Ole

AU - Nielsen, Susanne Dam

AU - Jeppesen, Dorthe Lisbeth

AU - Benn, Christine Stabell

PY - 2017/8/3

Y1 - 2017/8/3

N2 - BACKGROUND: The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis is administered intradermally, and vaccination is often followed by a scar at the injection site. Among BCG-vaccinated individuals, having a scar has been associated with lower mortality. We aimed to examine the impact of vaccination technique for scarring in a high income setting, by assessing the associations between the post injection reaction, the wheal size, and the probability of developing a scar, and scar size.METHODS: This study was nested within a clinical multicenter study randomizing 4262 infants to either BCG vaccination (BCG 1331 SSI) or no intervention. In this substudy, including 492 vaccinated infants, the immediate post BCG vaccination reaction was registered as either wheal (a raised, blanched papule at the injection site), bulge (a palpable element at the injection site), or no reaction. The presence or absence of a BCG scar and the size the scar was measured at 13 months of age.RESULTS: Of 492 infants included, 87% had a wheal after vaccination, 11% had a bulge, and 2% had no reaction. The mean wheal size was 3.8 mm (95% confidence interval 3.7-3.9). Overall, 95% (442/466, 26 lost to follow-up) of BCG-vaccinated infants had a scar at 13 months of age. In infants with a wheal, the probability of developing a scar was 96%, declining to 87% in the case of a bulge, and to 56% in the case of no reaction (p for same probability = 0.03). Wheal size was positively correlated with the probability of getting a scar and scar size.CONCLUSION: Scarring after BCG vaccination has been associated with lower infant mortality. In a high-income setting, we found that correct injection technique is highly important for the development of a BCG scar and that registration of the category of BCG skin reaction (as wheal, bulge, or no reaction) may be used to identify infants at risk of scar failure. Finally, the wheal size was positively associated with both the probability of getting a scar and scar size.TRIAL REGISTRATION: The study was registered at www.ClinicalTrials.gov with trial registration number NCT01694108 .

AB - BACKGROUND: The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis is administered intradermally, and vaccination is often followed by a scar at the injection site. Among BCG-vaccinated individuals, having a scar has been associated with lower mortality. We aimed to examine the impact of vaccination technique for scarring in a high income setting, by assessing the associations between the post injection reaction, the wheal size, and the probability of developing a scar, and scar size.METHODS: This study was nested within a clinical multicenter study randomizing 4262 infants to either BCG vaccination (BCG 1331 SSI) or no intervention. In this substudy, including 492 vaccinated infants, the immediate post BCG vaccination reaction was registered as either wheal (a raised, blanched papule at the injection site), bulge (a palpable element at the injection site), or no reaction. The presence or absence of a BCG scar and the size the scar was measured at 13 months of age.RESULTS: Of 492 infants included, 87% had a wheal after vaccination, 11% had a bulge, and 2% had no reaction. The mean wheal size was 3.8 mm (95% confidence interval 3.7-3.9). Overall, 95% (442/466, 26 lost to follow-up) of BCG-vaccinated infants had a scar at 13 months of age. In infants with a wheal, the probability of developing a scar was 96%, declining to 87% in the case of a bulge, and to 56% in the case of no reaction (p for same probability = 0.03). Wheal size was positively correlated with the probability of getting a scar and scar size.CONCLUSION: Scarring after BCG vaccination has been associated with lower infant mortality. In a high-income setting, we found that correct injection technique is highly important for the development of a BCG scar and that registration of the category of BCG skin reaction (as wheal, bulge, or no reaction) may be used to identify infants at risk of scar failure. Finally, the wheal size was positively associated with both the probability of getting a scar and scar size.TRIAL REGISTRATION: The study was registered at www.ClinicalTrials.gov with trial registration number NCT01694108 .

KW - BCG Vaccine

KW - Bacillus

KW - Cicatrix

KW - Denmark

KW - Female

KW - Humans

KW - Infant

KW - Infant Mortality

KW - Lost to Follow-Up

KW - Male

KW - Tuberculin Test

KW - Vaccination

KW - Journal Article

KW - Multicenter Study

KW - Randomized Controlled Trial

U2 - 10.1186/s12879-017-2641-0

DO - 10.1186/s12879-017-2641-0

M3 - Journal article

C2 - 28774269

SN - 1471-2334

VL - 17

JO - B M C Infectious Diseases

JF - B M C Infectious Diseases

M1 - 540

ER -

The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants

Abstract

Keywords

UN SDGs

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