Recognition of BCG Scars Dr. Earl Hershfield Ms. Barbara Roche Tuberculosis Research Unit University of Manitoba, 2004.

Recognition of BCG Scars

Dr. Earl HershfieldMs. Barbara Roche

Tuberculosis Research UnitUniversity of Manitoba, 2004

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• International (current): http://www.who.int/immunization_monitoring/en/globalsummary/timeseries/tscoveragebcg.htm

• Canada (current and historical): http://www.phac-aspc.gc.ca/tbpc-latb/index.html

BCG Vaccine Usage

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Distinguishing a BCG scarfrom a Smallpox scar

BCG Scar Classic Features

• Raised centre

• Left upper arm or, much less commonly, on thigh or forearm

Smallpox Scar Classic Features

• Depressed with radiating lines to edges

• Routine use stopped in the late 1970’s

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• 37 years old

• Black

• Female

• Born in Rwanda in 1965

• Left deltoid

BCG

Smallpox

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• 37 years old

• Black• Female• Born in

Rwanda in 1965

• Left deltoid

BCG

Smallpox

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• 44 years old• Caucasian• Female• Born in

Montreal in 1958

• Lived in Spain 1962-66 and

1976-81• Graduated as a

nurse in Manitoba, 1983

BCG

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• 44 years old• Caucasian• Female• Born in Montreal

in 1958• Lived in Spain

1962-66 and 1976-81

• Graduated as a nurse in Manitoba, 1983

BCG

8

• 32 years old• Asian• Female• Born in the

Philippines in 1970

• Left deltoid

BCGBCG

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• 32 years old• Asian• Female• Born in the

Philippines in 1970

• Left deltoid BCG

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• 13 years old

• Male

• Born in Iraq in 1990

• Left deltoid

BCG

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• 13 years old• Male• Born in Iraq in

1990• Left deltoid

BCG

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• 46 years old• Female• Born in

Trinidad in 1956

• Left upper arm and shoulder

BCG

Smallpox

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• 46 years old

• Female

• Born in Trinidad in 1956

• Left upper arm and shoulder

BCG

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• 18 years old• Asian• Female• Born in the

Philippines in 1984

• Left deltoidBCG

BCG

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• 60 years old

• Asian

• Male

• Born in the Philippines in 1943

• Left deltoidBCG

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• 60 years old

• Asian

• Male

• Born in the Philippines in 1943

• Left deltoid

BCG

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• 38 years old

• Male• Born in

Kerala State, India in 1965

• Left arm

BCG

Smallpox

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• 38 years old

• Male

• Born in Kerala State, India in 1965

• Left arm

BCG

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• 38 years old

• Male

• Born in Kerala State, India in 1965

• Left arm

Smallpox

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• 38 years old• Caucasian• Female• Born in

Winnipeg, Manitoba

• Health care worker

• Received BCG vaccine in 1983

• Left deltoid

BCG

Smallpox

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• 55 years old• Caucasian• Female• Born in

Hungary in 1947

• Left deltoid

Smallpox

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• 26 years old

• Black

• Male

• Born in Sierra Leone in 1976

• Right arm

SMALLPOX

BCG

BCG

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• 26 years old• Black• Male• Born in

Sierra Leone in 1976

• Right armSmallpox

BCG

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And once again…Distinguishing a BCG scar

from a Smallpox scar

BCG Scar Classic Features

• Raised centre

• Left upper arm or, much less commonly, on thigh or forearm

Smallpox Scar Classic Features

• Depressed with radiating lines to edges

• Routine use stopped in the late 1970’s