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Bacillus Calmette–Guérin (BCG) vaccine contains a live attenuated strain of Mycobacterium bovis, which provides 64% efficacy against tuberculous meningitis and 78% efficacy against disseminated tuberculosis.1 A number of local adverse reactions are recognised (abscess, suppurative lymphadentitis, keloid formation). An increased number of local complications were reported in the UK and Ireland since the introduction of a new BCG strain in 2002.2 ,3 It is important to distinguish between a normal vaccine response, a local complication and the very rare cases of systemic BCG infection that occur with immunodeficiency. Antibiotics and/or anti-tuberculous medication are rarely needed, except for systemic BCG infection.
Natural history of BCG site
After intradermal injection, BCG multiplies at the inoculation site, then spreads to regional nodes. A normal reaction is a red indurated area, which progresses to a local lesion that may ulcerate 2–3 weeks after vaccination. A crust is formed around this induration for 3–4 weeks. At 6–10 weeks, the crust falls off, leaving a flat 3 to 7 mm scar. Regional lymphadenopathy <1 cm (95% in the axilla) is considered a normal reaction to the vaccine.4 This ‘simple’ lymphadenitis occurs 63 days (range 16–87) after BCG vaccination5 and resolves spontaneously by 9 months.6 Lymphadenitis may be more common when BCG is given to infants <6 months old compared with older children and adults.5
Complications of BCG
Local complications occur in one in a thousand people given BCG vaccine.3 ,7
Injection site abscess
A local abscess (>1 cm in diameter) can develop at the injection site, 30 days (range 4–65) after BCG vaccination.5 Abscess formation is less common when BCG is given to infants less than 6 months old compared with older children and adults. However, abscesses are more likely in infants aged less than 6 months old immunised by …
Contributors AR devised, wrote and edited the article, TC and CB edited the article.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.