BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies

被引:175
作者
Marciano, Beatriz E. [1 ]
Huang, Chiung-Yu [2 ]
Joshi, Gyan [2 ]
Rezaei, Nima [3 ]
Carvalho, Beatriz Costa [4 ]
Allwood, Zoe [5 ]
Ikinciogullari, Aydan [6 ]
Reda, Shereen M. [7 ]
Gennery, Andrew [8 ]
Thon, Vojtech [9 ]
Espinosa-Rosales, Francisco [10 ]
Al-Herz, Waleed [11 ]
Porras, Oscar [12 ]
Shcherbina, Anna [13 ]
Szaflarska, Anna [14 ]
Kilic, Sebnem [15 ]
Franco, Jose L. [16 ]
Gomez Raccio, Andrea C. [17 ]
Roxo, Persio, Jr. [18 ]
Esteves, Isabel [19 ]
Galal, Nermeen [20 ]
Grumach, Anete Sevciovic [21 ]
Al-Tamemi, Salem [22 ]
Yildiran, Alisan [23 ]
Orellana, Julio C. [24 ]
Yamada, Masafumi [25 ]
Morio, Tomohiro [26 ]
Liberatore, Diana [27 ]
Ohtsuka, Yoshitoshi [28 ]
Lau, Yu-Lung [29 ]
Nishikomori, Ryuta [30 ]
Torres-Lozano, Carlos [31 ]
Mazzucchelli, Juliana T. L. [4 ]
Vilela, Maria M. S. [4 ]
Tavares, Fabiola S. [4 ]
Cunha, Luciana [32 ]
Pinto, Jorge A. [32 ]
Espinosa-Padilla, Sara E. [10 ]
Hernandez-Nieto, Leticia [10 ]
Elfeky, Reem A. [7 ]
Ariga, Tadashi [25 ]
Toshio, Heike [30 ]
Dogu, Figen [6 ]
Cipe, Funda [6 ]
Formankova, Renata [33 ,34 ]
Enriqueta Nunez-Nunez, M. [31 ]
Bezrodnik, Liliana [17 ]
Marques, Jose Goncalo [19 ]
Pereira, Maria I. [24 ]
Listello, Viviana [24 ]
机构
[1] NIAID, Lab Clin Infect Dis, NIH, Bethesda, MD 20892 USA
[2] NIAID, Biostat Res Branch, NIH, Bethesda, MD 20892 USA
[3] Univ Tehran Med Sci, Pediat Ctr Excellence, Childrens Med Ctr Hosp, Tehran, Iran
[4] Univ Fed Sao Paulo, Dept Pediat, Sao Paulo, Brazil
[5] Great Ormond St Hosp Sick Children, Dept Immunol, London, England
[6] Ankara Univ, Sch Med, Dept Pediat Immunol & Allergy, TR-06100 Ankara, Turkey
[7] Ain Shams Univ, Dept Pediat Allergy & Immunol, Childrens Hosp, Cairo, Egypt
[8] Great North Childrens Hosp, Paediat Immunol Dept, Newcastle Upon Tyne, Tyne & Wear, England
[9] Masaryk Univ, Dept Clin Immunol & Allergy, Fac Med, St Annes Univ Hosp, Brno, Czech Republic
[10] Natl Inst Pediat, Mexico City, DF, Mexico
[11] Kuwait Univ, Fac Med, Dept Pediat, Al Sabah Hosp, Kuwait, Kuwait
[12] Natl Childrens Hosp Dr Carlos Saenz Herrera, Dept Immunol & Rheumatol, San Jose, Costa Rica
[13] Ctr Pediat Hematol Oncol & Immunol, Dept Clin Immunol, Moscow, Russia
[14] Childrens Univ Hosp, Dept Clin Immunol & Transplantol, Krakow, Poland
[15] Uludag Univ, Fac Med, Pediat Immunol Div, Bursa, Turkey
[16] Univ Antioquia, Primary Immunodeficiency Grp, Medellin, Colombia
[17] Childrens Hosp Ricardo Gutierrez, Immunol Unit, Buenos Aires, DF, Argentina
[18] Univ Sao Paulo, Fac Med Ribeirao Preto, BR-05508 Sao Paulo, Brazil
[19] Hosp Santa Maria, Primary Immunodeficiency Ctr, Lisbon Acad Ctr, Lisbon, Portugal
[20] Cairo Univ, Santo Andre, SP, Brazil
[21] ABC, Fac Med, Sao Paulo, Brazil
[22] Sultan Qaboos Univ Hosp, Dept Child Hlth, Muscat, Oman
[23] Ondokuz Mayis Univ, Dept Pediat Immunol, Atakum, Samsun, Turkey
[24] Santisima Trinidad Childrens Hosp, Div Allergy & Clin Immunol, Cordoba, Argentina
[25] Hokkaido Univ, Dept Pediat, Grad Sch Med, Sapporo, Hokkaido, Japan
[26] Tokyo Med & Dent Univ, Tokyo, Japan
[27] Italian Hosp, Buenos Aires, DF, Argentina
[28] Hyogo Coll Med, Nishinomiya, Hyogo, Japan
[29] Univ Hong Kong, Dept Pediat & Adolescent Med, LKS Fac Med, Hong Kong, Hong Kong, Peoples R China
[30] Kyoto Univ Hosp, Dept Pediat, Kyoto, Japan
[31] Western Natl Med Ctr, Dept Clin Immunol & Allergol, Guadalajara, Jalisco, Mexico
[32] Univ Fed Minas Gerais, Belo Horizonte, MG, Brazil
[33] Charles Univ Prague, Prague, Czech Republic
[34] Univ Hosp Motol, Prague, Czech Republic
[35] NIH, Serv Immunol, DLM CC, Bethesda, MD 20892 USA
[36] Hop Necker Enfants Malad, Immunol Hematol & Rheumatol Serv, Paris, France
[37] NIAID, Primary Immunodeficiency Clin, LHD, NIH, Bethesda, MD 20892 USA
[38] NIAID, Infect Dis Susceptibil Unit, NIH, Bethesda, MD 20892 USA
基金
美国国家卫生研究院; 日本科学技术振兴机构;
关键词
Primary immunodeficiency; severe combined immunodeficiency; vaccine; BCG; mycobacteria; newborn screening; hematopoietic stem cell transplant; immune reconstitution syndrome; BACILLUS-CALMETTE-GUERIN; CENTRAL-NERVOUS-SYSTEM; IMMUNOCOMPROMISED CHILDREN; TUBERCULOUS MENINGITIS; VACCINES;
D O I
10.1016/j.jaci.2014.02.028
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: Severe combined immunodeficiency (SCID) is a syndrome characterized by profound T-cell deficiency. BCG vaccine is contraindicated in patients with SCID. Because most countries encourage BCG vaccination at birth, a high percentage of patients with SCID are vaccinated before their immune defect is detected. Objectives: We sought to describe the complications and risks associated with BCG vaccination in patients with SCID. Methods: An extensive standardized questionnaire evaluating complications, therapeutics, and outcomes regarding BCG vaccination in patients given a diagnosis of SCID was widely distributed. Summary statistics and association analysis was performed. Results: Data on 349 BCG-vaccinated patients with SCID from 28 centers in 17 countries were analyzed. Fifty-one percent of the patients had BCG-associated complications, 34% disseminated and 17% localized (a 33,000- and 400-fold increase, respectively, over the general population). Patients receiving early vaccination (<= 3 1 month) showed an increased prevalence of complications (P = 5.006) and death caused by BCG-associated complications (P < .0001). The odds of experiencing complications among patients with T-cell numbers of 250/mu L or less at diagnosis was 2.1 times higher (95% CI, 1.4-3.4 times higher; P = .001) than among those with T-cell numbers of greater than 250/mL. BCG-associated complications were reported in 2 of 78 patients who received antimycobacterial therapy while asymptomatic, and no deaths caused by BCG-associated complications occurred in this group. In contrast, 46 BCG-associated deaths were reported among 160 patients treated with antimycobacterial therapy for a symptomatic BCG infection (P < .0001). Conclusions: BCG vaccine has a very high rate of complications in patients with SCID, which increase morbidity and mortality rates. Until safer and more efficient antituberculosis vaccines become available, delay in BCG vaccination should be considered to protect highly vulnerable populations from preventable complications.
引用
收藏
页码:1134 / 1141
页数:8
相关论文
共 28 条
[1]   Primary immunodefciency diseases: an update on the classification from the International Union of Immunological Societies Expert Committee for Priary Immunodeficiency [J].
Al-Herz, Waleed ;
Bousfiha, Aziz ;
Casanova, Jean-Laurent ;
Chapel, Helen ;
Conley, Mary Ellen ;
Cunningham-Rundles, Charlotte ;
Etzioni, Amos ;
Fischer, Alain ;
Luis Franco, Jose ;
Geha, Raif S. ;
Hammarstrom, Lennart ;
Nonoyama, Shigeaki ;
Notarangelo, Luigi Daniele ;
Ochs, Hans Dieter ;
Puck, Jennifer M. ;
Roifman, Chaim M. ;
Seger, Reinhard ;
Tang, Mimi L. K. .
FRONTIERS IN IMMUNOLOGY, 2011, 2
[2]   Transplantation of hematopoietic stem cells in human severe combined immunodeficiency: longterm outcomes [J].
Buckley, Rebecca H. .
IMMUNOLOGIC RESEARCH, 2011, 49 (1-3) :25-43
[3]   Human severe combined immunodeficiency: Genetic, phenotypic, and functional diversity in one hundred eight infants [J].
Buckley, RH ;
Schiff, RI ;
Schiff, SE ;
Markert, ML ;
Williams, LW ;
Harville, TO ;
Roberts, JL ;
Puck, JM .
JOURNAL OF PEDIATRICS, 1997, 130 (03) :378-387
[4]  
Chien Y-H, J FORMOSAN MED ASS
[5]   THE INTERNATIONAL TUBERCULOSIS CAMPAIGN - A PIONEERING VENTURE IN MASS VACCINATION AND RESEARCH [J].
COMSTOCK, GW .
CLINICAL INFECTIOUS DISEASES, 1994, 19 (03) :528-540
[6]   CLINICAL AND PUBLIC-HEALTH ASPECTS OF TUBERCULOUS MENINGITIS IN CHILDREN [J].
DOERR, CA ;
STARKE, JR ;
ONG, LT .
JOURNAL OF PEDIATRICS, 1995, 127 (01) :27-33
[7]   Tuberculosis of the central nervous system in children: A 20-year survey [J].
Farinha, NJ ;
Razali, KA ;
Holzel, H ;
Morgan, G ;
Novelli, VM .
JOURNAL OF INFECTION, 2000, 41 (01) :61-68
[8]   BACILLE CALMETTE-GUERIN VACCINES - A ROUGH GUIDE [J].
FINE, PEM .
CLINICAL INFECTIOUS DISEASES, 1995, 20 (01) :11-14
[9]   Severe cutaneous bacillus Calmette-Guerin infection in immunocompromised children: the relevance of skin biopsy [J].
Gantzer, Amelie ;
Neven, Benedicte ;
Picard, Capucine ;
Brousse, Nicole ;
Lortholary, Olivier ;
Fischer, Alain ;
Bodemer, Christine ;
Fraitag, Sylvie .
JOURNAL OF CUTANEOUS PATHOLOGY, 2013, 40 (01) :30-37
[10]   Transplantation of hematopoietic stem cells and long-term survival for primary immunodeficiencies in Europe: Entering a new century, do we do better? [J].
Gennery, Andrew R. ;
Slatter, Mary A. ;
Grandin, Laure ;
Taupin, Pierre ;
Cant, Andrew J. ;
Veys, Paul ;
Amrolia, Persis J. ;
Gaspar, H. Bobby ;
Davies, E. Graham ;
Friedrich, Wilhelm ;
Hoenig, Manfred ;
Notarangelo, Luigi D. ;
Mazzolari, Evelina ;
Porta, Fulvio ;
Bredius, Robbert G. M. ;
Lankester, Arjen C. ;
Wulffraat, Nico M. ;
Seger, Reinhard ;
Guengoer, Tayfun ;
Fasth, Anders ;
Sedlacek, Petr ;
Neven, Benedicte ;
Blanche, Stephane ;
Fischer, Alain ;
Cavazzana-Calvo, Marina ;
Landais, Paul .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2010, 126 (03) :602-U342