JASON J, ARCHIBALD LK, NWANYANWU OC, KAZEMBE PN, DOBBIE H, JARVIS WR; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. G-1222.
CDC, Atlanta, GA.
BACKGROUND: WHO recommends BCG vaccine in high Mycobacterium tuberculosis (MTB) prevalence areas. BCG's clinical and immune effects are unclear and not necessarily MTB-specific. BCG vaccine scarring often is used as a surrogate marker of vaccination or effective vaccination. METHODS: In 1997-1998, as part of a cohort study of the causes and immune determinants of bloodstream infections (BSI) in hospitalized Malawians, we examined the relationships between BCG scarring and: 1) clinical findings and outcome in all 652 cohort members and 2) clinical +/- immune findings of a) patients with MTB BSI (clinical, n=32; clinical + immune, n=10) and b) infants <6 m.o. (n's=48, 19). RESULTS: In patients >6 m.o., scarring was not related to HIV status or plasma RNA levels, pulmonary symptoms (35% vs 30%), mortality, or MTB-BSI. In MTB-BSI patients, scarring was unrelated to mortality, vital signs, and clinical symptoms but those with scarring had higher proportions of memory and activated T cells and more anti-inflammatory cytokine profiles. These scarring-related immune differences were absent in those without MTB-BSI. In those <6 m.o., scarring was associated with an IL-10 dominance over IL-4. Fewer infants with either BCG scarring or BCG lesional inflammation (LI) had symptoms of sepsis than did those without BCG vaccination lesions (0/10, 0/5, and 18/33, p<.001) and more had localized infections. These infants also had lower median percents of lymphocytes spontaneously making IL-4 or TNF-a and ratios of T-cells spontaneously making IL-4 to T-cells making IL-6. CONCLUSIONS: In older patients, BCG vaccine scarring was unassociated with MTB-specific or non-specific clinical protection, although those with MTB-BSI and scarring had immune findings consistent with previous MTB antigen exposure. In infants <6 m.o., BCG vaccination was associated with non-MTB specific, anti-inflammatory, and perhaps clinically protective, immune profiles.
Publication Types:
Keywords:
- BCG Vaccine
- Cicatrix
- Cohort Studies
- Cytokines
- HIV Infections
- Health Personnel
- Humans
- Infant
- Interleukin-4
- Mycobacterium bovis
- Mycobacterium tuberculosis
- Prevalence
- T-Lymphocytes
- Vaccination
- psychology
Other ID:
UI: 102268366
From Meeting Abstracts