BCG Case Study Lisa Chen, MD Neha Shah, MPH Ending TB in the Last Frontier November 10, 2018 1 LTBI CASE STUDIES Curry Tuberculosis Center International Bacille Calmette-Guérin (BCG) ▪ Live, attenuated vaccine derived from M. bovis ▪ Efficacy is conflicting: ▪ Meta-analysis: 51% efficacy (range 0-80%) in preventing any TB disease ▪ Greatest efficacy in newborns: 70-80% protective against meningeal, disseminated TB, mortality ▪ Duration of protection unknown, possibly 10-15 yrs • Colditz, et al. JAMA. 1994;271(9):698. • Michelsen, et al. Thorax. 2014 Sep;69(9):851-6. • Roy, et al. BMJ. 2014;349:g4643.
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BCG Case Study
Lisa Chen, MDNeha Shah, MPH
Ending TB in the Last FrontierNovember 10, 2018 1
LTBI CASE
STUDIES
Curry Tuberculosis Center International
Bacille Calmette-Guérin (BCG)
▪ Live, attenuated vaccine derived from M. bovis
▪ Efficacy is conflicting:
▪ Meta-analysis: 51% efficacy (range 0-80%) in preventing any TB disease
▪ Greatest efficacy in newborns: 70-80% protective against meningeal, disseminated TB, mortality
▪ Duration of protection unknown, possibly 10-15 yrs
• Colditz, et al. JAMA. 1994;271(9):698.
• Michelsen, et al. Thorax. 2014 Sep;69(9):851-6.
• Roy, et al. BMJ. 2014;349:g4643.
BCG Case Study
Lisa Chen, MDNeha Shah, MPH
Ending TB in the Last FrontierNovember 10, 2018 2
TST interpretation with BCG
▪ Reaction dependent on years since vaccination and age at time of vaccination
• Colditz, et al. JAMA. 1994;271(9):698.
• Michelsen, et al. Thorax. 2014 Sep;69(9):851-6.
• Roy, et al. BMJ. 2014;349:g4643.
Age Vaccination TST reaction
0-1 yrs <10mm after 10 years of age
1 – 5 years 10-15% may have positive TST even 20-25 years later
> 5 years 40% will have persistent positive TST
BCG World Atlas (www.bcgatlas.org)
▪ Provides info on current/past BCG policies for >180 countries
▪Assists clinicians to determine if TST or IGRA would be valid tools to use and help to interpret TST.
BCG Case Study
Lisa Chen, MDNeha Shah, MPH
Ending TB in the Last FrontierNovember 10, 2018 3
Case
A 9‐year‐old boy had a TST that showed 12 mm of induration. He was born in Switzerland in 2006 and moved to the US at age 4. Then moved to Morocco 3 years ago to live with his maternal family members and just returned to the US.
▪What would you do? Is LTBI treatment indicated? If so, what regimen?
• Switzerland stopped giving BCG in 1980s
• Since he was born in 2006, likely did not receive BCG in Switzerland
BCG Case Study
Lisa Chen, MDNeha Shah, MPH
Ending TB in the Last FrontierNovember 10, 2018 4
• Morocco still gives BCG, however at birth only.
• Since he lived in Morocco many years after his birth, it is unlikely that he received BCG in Morocco
• Thus, 12 mm PPD likely true (+).
• LTBI treatment is recommended
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