BCG AŞI TEKNİĞİNİN BCG AŞI REAKSİYONUNA OLAN ETKİSİNİN DEĞERLENDİRİLMESİ

Öz

Amaç: BCG aşısı yapılmış olan çocuklarda aşı tekniğinin skar oluşumuna etkisinin değerlendirilmesi amaçlanmaktadır.

Gereç ve Yöntem: Aralık 2011- Mayıs 2012 yılları arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi Sosyal Pediatri Poliklinik’ne BCG aşısını olmak için başvurmuş 2 aylık bebeklere bu süreçte poliklinikte çalışan 9 tane farklı hekim tarafından sol üst deltoid bölgeye yapılan 0.05 ml BCG aşısının tekniği incelenmiş ve aşının nasıl yapıldığı bu dönemde kaydedilmiştir. Aynı araştırıcı tarafından yapılan aşı sonrası oluşan beyaz makül 5 mm ve daha büyük ise Teknik 1(intradermal), 5 mm’den küçük ise Teknik 2 olarak tanımlanmıştır. BCG reaksiyonu 3.ayda ve skar formasyonu 12. ayda değerlendirilmiştir. Skar oluşumu ≥ 2 mm ise pozitif olarak kabul edilmiştir. İzlem süresinde en uzun çapı 6 mm’den fazla olan reaksiyonlar abartılı reaksiyon olarak tanımlanmıştır.

Bulgular: Çalışmaya alınan 84 hastanın 52,3%’ü Teknik 1 ile aşılanırken, diğerleri Teknik 2 ile aşılanmıştır. Hastaların 10%’nunda aşı sonrası beyaz iz oluşmamıştır. 1 ay sonrasında BCG aşısına bağlı reaksiyon Teknik 1 grubunda Teknik 2 grubuna göre daha erken oluşmuştur. İzlem sırasında 22 hastada abartılı reaksiyon gelişmiş olup, teknik 2 ile aşılananlarda daha fazla görülmüştür. 12. ayda BCG skarı açısından değerlendirilen 81 hastanın bir tanesi hariç hepsinde BCG skarı oluşmuştur.

Sonuç: Çalışmamızda BCG aşı tekniğinin BCG skarı üzerine etkisi gösterilememiş olup abartılı reaksiyon Teknik 2’de daha fazla görülmüştür. BCG aşı tekniğini ve aşının koruyuculuğuna olan etkisini inceleyen daha fazla sayıda çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

• BCG aşısı
• aşı tekniği
• intradermal
• skar

EVALUATION OF THE EFFECT OF VACCINATION TECHNIQUE ON BCG VACCINE REACTION

Öz

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.

Anahtar Kelimeler

• BCG vaccine
• vaccination technique
• intradermal
• scar

Kaynakça

1. Dommergues MA, de La Rocque F, Guy C, Lécuyer A, Jacquet A, Guérin N, et al. Local and regional adverse reactions to BCG-SSI vaccination: a 12- month 2009;27:6967-73. study. Vaccine
2. Faridi MM, Krishnamurthy S. Abortive reaction and time of scar formation after BCG vaccination. Vaccine 2008;26:289-90.
3. Hawkridge A, Hatherill M, Little F, Goetz MA, Barker L, Mahomed H et al. Efficacy of percutaneous versus intradermal BCG in the prevention of tuberculosis in South African infants: randomised trial. BMJ 2008;337:2052.
4. Jeena PM, Chhagan MK, Topley J, Coovadia HM. Safety of the intradermal Copenhagen 1331 BCG vaccine in neonates in Durban, South Africa. Bull World Health Organ 2001;79:337-43.
5. Kemp EB, Belshe RB, Hoft DF. Immune responses stimulated by percutaneous and intradermal bacille Calmette-Guérin. J Infect Dis 1996;174:113-9.
6. Kheir AE1, Alhaj AA, Ibrahim SA. The sensitivity of BCG scar as an indicator of previous vaccination among Sudanese infants. Vaccine 2011;29:8189-91.
7. Negrete-Esqueda L, Vargas-Origel A. Response to Bacillus Calmette-Guérin vaccine in full-term and preterm infants. Am J Perinatol 2007;24:183-189.
8. Roth A, Sodemann M, Jensen H, Poulsen A, Gustafson P, Gomes J et al. Vaccination technique, PPD reaction and BCG scarring in a cohort of children Vaccine 2005;23:3991-8. 2000-2002.

9. Santiago EM, Lawson E, Gillenwater K, Kalangi S, Lescano AG, Du Quella G,et al. A prospective study of bacillus Calmette-Guérin scar formation and tuberculin skin test reactivity in infants in Lima, Peru. Pediatrics. 2003;112:298
10. Smith CK, M.Orme I, Stark JR. In: Plotkin SA,Orenstein EA,Offit PA eds. Vaccines. 6nd ed. Philadelphia:WB Saunders, 2013:789-811.
11. WHO. Global Advisory Committee on Vaccine Safety, 29-30 November 2006. Wkly Epidemiol Rec 2007;82:18-24.