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

5

• 37 years old

• Black• Female• Born in

Rwanda in 1965

• Left deltoid

BCG

Smallpox

6

• 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

7

• 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

9

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

Philippines in 1970

• Left deltoid BCG

10

• 13 years old

• Male

• Born in Iraq in 1990

• Left deltoid

BCG

11

• 13 years old• Male• Born in Iraq in

1990• Left deltoid

BCG

12

• 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

14

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

Philippines in 1984

• Left deltoidBCG

BCG

15

• 60 years old

• Asian

• Male

• Born in the Philippines in 1943

• Left deltoidBCG

16

• 60 years old

• Asian

• Male

• Born in the Philippines in 1943

• Left deltoid

BCG

17

• 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

19

• 38 years old

• Male

• Born in Kerala State, India in 1965

• Left arm

Smallpox

20

• 38 years old• Caucasian• Female• Born in

Winnipeg, Manitoba

• Health care worker

• Received BCG vaccine in 1983

• Left deltoid

BCG

Smallpox

21

• 55 years old• Caucasian• Female• Born in

Hungary in 1947

• Left deltoid

Smallpox

22

• 26 years old

• Black

• Male

• Born in Sierra Leone in 1976

• Right arm

SMALLPOX

BCG

BCG

23

• 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