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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.
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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.
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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
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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