EVALUATION OF THE EFFECT OF VACCINATION TECHNIQUE ON BCG VACCINE REACTION

Objective: To evaluate the effect of BCG vaccination technique to post BCG reactions and scarring. Material and Methods: Eighty four children were enrolled in this descriptive, observational study. All of them received 0.05 ml of BCG of Serum Institute of India Ltd at 2 months of age, in the upper left deltoid region. A detailed questionnaire was completed. The vaccines were implemented by 9 different pediatricians who were trained for intradermal injection and working consecutively at the Unit between December 2011 and Mai 2012. The vaccination technique was monitored by direct observation of post-vaccination wheal and route of administration. One investigator evaluated the BCG reaction by measuring immediately the longest diameter of wheal after injection. The technique was classified as Technique 1(intradermal) if the diameter is 5-6 mm, Technique 2 if the diameter is less then 5 mm. BCG reaction was evaluated at 3 months of age and scar formation was evaluated at 12 months of age. A scar formation with a diameter more than 2 mm was accepted as present. During this follow-up period, the local reaction is noted as exaggerated if the longest diameter of the reaction was more than 6 mm. Results: Technique 1 (Intradermal) was applied on 44 (52,4%) infants. . The white wheal was not formed in 10% of the infants. All infants had vaccination reaction during the follow-up but BCG reaction at 3 months of age was earlier in Technique 1 (intradermal) group. During the follow-up period we observed exaggerated local reaction in 22 (27.2 %) infants. Exaggerated local reactions were less in the intradermal technique. 0f the 81 infants assessed for scar formation only one patient had no scar at 12 months of age and his reaction was abortive. Conclusions: This study showed that the vaccination technique had no impact on scar formation but exaggerated local reactions occur less with intradermal vaccination. Further randomized studies relating vaccination technique to vaccine effectiveness are needed. Key words: BCG vaccine; vaccination technique; intradermal; scar