The High Council of Public Health (HCSP) recommends postponing BCG vaccination in mainland France after one month to avoid serious BCGitis, complications that remain rare.
After the shortage problems, vaccination against tuberculosis is experiencing a further upheaval. Faced with the risk of serious BCGitis, the High Council of Public Health (HCSP) recommends postponing this vaccine in metropolitan France after one month in infants to avoid this complication which is characterized in particular by inflammation of one or more lymph nodes.
In a notice published on Monday, the HCSP recalls, however, that the frequency of occurrence of severe generalized BCGitis remains very rare, of the order of 2 to 5 per million vaccinated. Between 2005-2015, 0 to 4 annual cases of generalized BCGitis were thus declared in infants following a BCG vaccination.
Pending screening
A total of 20 cases have therefore been reported to the national pharmacovigilance system, in 15 boys and 5 girls, specifies the HCPS. But for these experts, postponing vaccination beyond 1 month would be an effective strategy. This “would significantly reduce the number of BCGites in children,” they write. Especially in those with severe combined immunodeficiency (SCID), a rare condition but usually not diagnosed at this age.
While waiting for the establishment of systematic screening for this disease at birth, the HCSP has decided not to wait. “In addition, this recommendation would not significantly change current practices,” he believes. For the High Council, this vaccination would ideally be carried out during the 2nd month, before the start of other infant vaccinations.
Extremely rare cases of tuberculosis
As a reminder, before the age of 3 months, the number of declared cases of tuberculosis remains very low in France: 7 in 2013, 6 in 2014 and 4 in 2015. In 2015, the reporting regions of these cases were Picardy, Languedoc-Roussillon, Rhône-Alpes and Île-de-France. Of the 17 cases reported between 2013 and 2015, 5 had received BCG.
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