Discussions marquées : BCG

Role of BCG in attaining “END TB” by 2030

Dear viewers. We the KVG team wish a happy new year and wish to share the post on BCG vaccination. As a question of justice, world wants to end TB by 2030 – the major killer among infectious diseases often hand in glove with HIV / AIDS. India aims to achieve the same by 2025. Specific vaccination with BCG vaccine – one of the oldest vaccine is iterated as the first strategy and more and more evidences are proving the efficacy of the vaccine in preventing the infection for about 20 years, which was underestimated. Being live attenuated, can protect against other mycobacteria helping in preventing leprosy and Buruli ulcer. Nonspecifically, BCG has a role in the treatment of warts, bladder cancer. BCG vaccine is known to complement other live attenuated vaccines like OPV, Measles, in lowering the overall child mortality rate, more so on administering at birth. In view of this we wish to share the post with the viewers. Best wishes Holla n Team  

My first experience at vaccinating a child...as part of a Vaccination Outreach Programme in Rural India

Hello everyone!
This is my very first post here. I am a 3rd year Student of Medicine(M.B.B.S) studying at KVG Medical College & Hospital, Sullia, India.
Attched is a PDF file which is the original document...Please go through that as it has pictures. Whatever text that follows this is a copy from the PDF file.

Thanks for your time and have a great day!


I feel elated to have been given an awe-inspiring opportunity to be a part of a vaccination outreach programme for which I shall be ever grateful to our PSM professor Dr.V.Narayana Holla, M.D who leaves no stone unturned in inspiring us and walks that extra mile to encourage us to evolve into better doctors. If not for him, none of this would have been possible.
It all started on the morning of 7th September during our PSM department posting hours, when Dr.Holla told us about the vaccination programme and emphasised on the importance of practical knowledge in the field of medicine. Motivated by his thought-provoking words, I was filled with enthusiasm to be a part of this trip. Upon approaching him, he was more than happy to see us eagerly coming forward for it and thus began the preparation for our amazing trip.
Thrilled by this exhilarating opportunity, I brushed up on the NIS and read up on the methods of administering the different kinds of vaccines and all the necessary details and equipped myself with the much needed knowledge on vaccinating a child as per the NIS.
The next morning, I was all geared up to go, my eyes gleamed with anticipation and I was excited to experience something new. Little did Iknow what was in store for me. On an honest note, a part of me died a little seeing the vehicle in which I was to travel. But nothing could waver my excitement, not even the thought of an edgy journey. I remained undeterred by the rugged roads, still charged. And my agony paid off when I reached my destination after a long tiresome travel.
The first place I went to was an Anganwadi Centre (in Koojimale estate) that filled me with awe, looking at the cheerful kids of 2-5 years of age. The Anganwadi Centre was located amidst the green, lush hilly area of Koojimale. Also present there were mothers waiting to get their infants vaccinated. This being a remote area and the outreach being held only once every month, there was a considerably large crowd that neededvaccinations. That moment of excitement, the noble feeling of being a doctor that crept in when I looked at the kids and their mothers, is something my words fail to explain. At the Anganwadi Centre, the Anganwadi worker, helper and the Teacher were present.
Under the guidance of a proficient ANM and Dr.Sharanya, I learnt the skill of administering vaccines (I.M, Subcut, I.D, and Oral). At the Anganwadi, we administered 10 vaccines to a total of 6 children. Vaccinations given here were – bOPV + Pentavalent1 – 1 Child, bOPV + Pentavalent2 – 2 Children, , Measles1 – 2 Children, DPT 1st booster + bOPV + Measles2 – 1 Child, 1 lakh units Vit.A + Measles1 – 2 children, and 2 lakh units of Vit. A+ Measles2 – 1 Child. After administering these vaccines, every child was given a routine general examination.
After vaccinating everyone at the Anganwadi, we left for the second destination – Kadamakallu Anganwadi Centre. Here we visited the Government School and found that there was just one 10 year old child to be vaccinated (TT10). Here, I vaccinated the child. As we were about to leave, an infant was brought who needed the bOPV + Pentavalent3 + IPV. This child was vaccinated by the ANM as well as Niranjan Murthy.
I took great pride in administering the vaccine (an injection) for the very first time. The feeling was inexplicable. I look forward to being a part ofsuch programmes in the months to come. It was not just an amazing experience but also an opportunity to learn a lot of new things and most importantly I got a peek into the life of a doctor and now I think I know what it feels like to be one. My heartfelt thanks to Dr.Holla for his persistent encouragement and I also extend my gratitude to the college for its support (I hope they add such trips to the curriculum!)
Lanson Brijesh Colaco
7th Term, Phase 3, MBBS
KVG Medical College & Hospital, Sullia.


BCG & IPV on "Wheals"

Dear viewers
We wish to share our very short study finding with the TechNet viewers for further input and mutual sharing of experiences for the global benefit of closing the imuunization gap.
Introduction of a newer vaccine or any change in vaccination policy provides an opportunity to train / reorient the service providers to revamp the efficiency for immunizing the vaccinated.
Responses by the TechNet members and global Immunization specialists inspired us to take-up a short study in the vaccination centre in our College. Initially we experienced – intra-dermal administration of just a drop of BCG vaccine=0.05ml especially to a newborn within 24 hrs was really difficult as the skin is too thin and delicate accentuated by the unpredictable movement but now we find it ‘not so difficult’ and administer with confidence.
The skin of 1½ month infant is a little more grown but the quantity of vaccine to be administered is 0.1ml=2 drops, double the 0.05ml.
On satisfactorily administering vaccines intradermally, we ‘dreamt’ of measuring the dimensions of the wheal accurately; enough for operational purpose.
Intra-dermal administration of vaccine raises a tense blanched Peau d’orange ‘bleb/wheal’, stays for a few fractions of a second. We measured the diameter instantly on pushing the vaccine completely by pausing the video and taking print screen, edited for making slides, taking care to maintain the accuracy of measurement. Following are the pictures, 3 each for BCG and IPV.

Multi-dose vaccine in ampoules

Hello All,
In the website for WHO PQ vaccines BCG and Yellow Fever are the two vaccines which have multi dose preparations packaged in ampoules. As soon as we open a mulit-dose ampoule and administer the first dose, we are leaving the remining doses in the ampoule exposed to environment (very often the not so clean undersurface of the vaccine carrier as the opened ampoule is kept in a slit in the top sponge and the VC closed).
Grateful if someone can enlighten me about the safety of this practice and whether there is any evidence comparing relative incidence of AEFI from multi dose vaccines in an ampoule vs. a vial.
Thanks and regards,
Anindya Bose

'0'OPV and BCG to a newborn in a district hospital.

This is not a new thing. After delivery requesting for an early discharge is a common high risk practice. There is a rising awareness among the community, thanks to social mobilization by the ASHA and the Govt for introducing "ASHA" who accompanies the precious pregnant women who deliver the future citizens of this country. Parents from the lower socioeconomic group feel very very proud and honored if the service providers show a little additional interest and personal appreciation for availing the services at the facility. As usual the newborn has no name. Customarily baby of (S/O, D/O)..... will be written - most of the times. I just tried what I have been doing since 1978. I asked the name of the mother and the father, tried to jumble the spelling and suggested 'ANKUR '(taking the full advantage of my age) which the parents accepted as 'prasad' instantaneously/willingly and happily. My eyes were wet when I saw the grand mother who whispered the name and gently kissed the baby's hand. (I restrained from doing so for infection control being a field officer). While recording the above observations I saw another person inquiring the ANM for bringing a newborn which was discharged in the night.
Though this is happening in many of the places I thought of sharing this as an acknowledgment to the service providers at grass root level and work place. I wish to share the photo of ANM and ASHA if permitted.

Open Vial Use (operational guidlelines)

GoI is planning to put in place open vial policy at the facility level. In that context I would like to get comments from the members on a draft opertional guideline. This has been prepared from WHO and other resources on open vial policy. We intend to draft a pictorial guidlines covering following points. Please let us know if you have comments (please note these are India specific, so some points differ from standard guidelines e.g. keeping of reconstituted vaccines for 4 hrs etc).

1) Liquid DPT, TT, HepB, Hib and OPV opened in a fixed clinic may be used at more than one immunization session up to four weeks provided that
a) The expiry date has not passed.
b) The vaccines are stored under appropriate cold chain conditions.
c) The vaccine vial septum has not been submerged in water.
d) Aseptic technique has been used to withdraw all doses.
e) The vaccine vial monitor (VVM), if attached, has not reached the discard point.
f) Opened vials of measles, BCG and JE vaccine cannot be used after an initial immunization session, (even if the VVM has not reached the discard point.). BCG and Measles must be discarded within four hours of reconstitution and JE after two hours or at the end of the session, whichever comes first.
2) The revised policy applies only to OPV, DPT, TT, hepatitis B, and liquid formulations of Hib vaccines that:
a) meet WHO requirements for potency and temperature stability;
b) are packaged according to ISO standards (ISO Standard 8362-2); and
c) Contain an appropriate concentration of preservative, such as thiomersal (injectable vaccines only).
Note: Vaccines supplied via UNICEF meet these requirements.
4) Multi-dose vials from which at least one dose has been removed may be at risk of contamination of the vial septum. These vials should never, therefore, be allowed to be submerged in water (from melted ice for example) and the septum should remain clean and dry. NOTE: Well-sealed icepacks should be used in vaccine carriers and water should not be allowed to accumulate where the vials are stored.
5) Discard vaccine vial
a) discard if expired
b) VVM reached discard point (for freeze dried vaccine, before reconstitution only)
c) no label or label not legible
d) Any vial thought to be exposed to non-sterile procedure for withdrawal
e) open vials that have been under melted water
6) If multi-dose vials must be used, always pierce the septum with a sterile needle.
7) Inspect for and discard medications with visible contamination or breaches of integrity (e.g. cracks, leaks).
8) Health workers must be able to distinguish between vials that can be used in subsequent sessions and vials that must be discarded. Training and supervision materials should be revised to reflect the policy change
9) Mark with date & time opened
10) Observe correct temperature storage, store in ILR at 2-8C
11) Monitor ILR temperature regularly (twice daily)
12) Dedicated ILR section fridge for opened vials
13) Observe first in first out policy –FIFO and stock rotation.
14) Keep stock up to date, don’t overstock or understock vaccines and diluents



Follow-up on Posts 01070E
(http://listes.ulaval.ca/cgi-bin/wa?A2=i ... org&P=1144)
and 01076E
(http://listes.ulaval.ca/cgi-bin/wa?A2=i ... .org&P=406)

18 April 2007


NOTE : The link to the PATH’s evaluation of a new
refrigerator, in the previous posting didn’t
correspond exactly to the document’s name on the
site. My apologies! It is now corrected and the
document can be downloaded without any problem.


Interestingly, I found out that the reasearch
which was the topic of the news in the first
posting of this series, originated in a previous
research ten years ago at Stanford University, in
which Pr. Behr was also involved. For those
interested, you can visit the following link, for more information.

"Study Casts Doubt on Effectiveness of TB
Vaccine" by Dr. Peter Small and Dr. Marcel Behr



This posting contains two contributions. The
first is from Robert Steinglass
(mailto:Robert_Steinglass@jsi.com) from
IMMUNIZATIONbasics in the USA. The second is a
official WHO response made jointly by Diana Chang
Blanc (mailto:ChangBlancD@who.int), from
WHO/IVB/EPI and Ulli Fruth
(mailto:fruthu@who.int), from WHO/IVB/Initiative for Vaccine Research

I added some more information and links at the bottom of this posting.



It has long been known that BCG vaccines vary
greatly in their proven efficacy against
pulmonary TB from one area of the world to the
next (India, USA, elsewhere). WHO has emphasized
for a long time that BCG is primarily used
because of its proven efficacy against the more
dangerous fatal types of TB - miliary and meningeal TB in infants.
By the way, there is published data on the
efficacy of BCG against leprosy (I vaguely recall
from Malawi about 10 years ago, and perhaps elsewhere).

My concern is that, with web chatter,
anti-vaccination groups can seize on information
such as the low efficacy of BCG against pulmonary
TB. This is why a communications strategy is
important at global and country level to
anticipate mischief and provide tools/messages to
health workers at various levels to deal with it.
I hope the authors clearly distinguish between
BCG and other vaccines when they broadly say that
"Vaccines administered to infants today have
never been tested, it is not the same product
anymore, says Professor Behr. All these vaccines
are thus of unknown effectiveness."

WHO has an excellent web site on vaccine safety
(Immunization safety :
http://www.who.int/immunization_safety/en). I am
not sure what their policies are regarding
responding to every serious (or frivolous) report
concerning unsafe vaccines. As of early April, I
did not see any posting related to this recent
article on BCG. Perhaps WHO would be able to
inform TECHNET readers in countries about
suitable responses to this particular claim against BCG.



WHO deems the currently available BCG vaccine
safe and continues to recommend that a single
dose of BCG be given to neonates as soon as
possible after birth in countries with a high
prevalence of TB, as well as to infants and
children in countries with low endemicity of
tuberculosis if they are at increased risk of
exposure. While numerous efficacy studies
demonstrate that the current vaccine does not
have a significant impact against pulmonary
disease (the most common manifestation of the
disease), it offers considerable protection
against life-threatening TB meningitis and
disseminated TB disease among infants and young children.

The vast majority of BCG vaccinations given
worldwide are derived from the French Pasteur
strain 1173 P2, the Danish strain 1331, the Glaxo
strain 1077 and the Tokyo strain 172. In terms
of efficacy, there is not overwhelming evidence
that one strain is demonstrably better than
another and there is currently no global
consensus on which BCG strain is most
optimal. While a recent case-control study
conducted in South Africa (Mahomed H, Kibel M et
al, Pediatr. Infect Dis J. 2006; 25 (12):1166-72)
demonstrated that intradermal immunization with
the Danish 1331 strain resulted in slightly lower
rates of disseminated TB (meningitis and/or
miliary spread) than percutaneous immunization of
children with the Tokyo strain 172, both strains
proved equally effective in preventing against
all manifestations of TB in children. Moreover,
the observed protective efficacy against
disseminated TB in the combined BCG vaccinated
cohorts exceeded 75%, as compared to the non-vaccinated cohort.

Furthermore, with increased understanding of the
immunological deficiencies of BCG vaccine and
advances in mycobacterial genome analysis,
promising new products may be forthcoming. In
fact, several approaches to develop new TB
vaccines are underway, with 5 candidate vaccines
currently in early clinical trials. These are
either live mycobacteria ("improved" BCG or
rationally attenuated M.tuberculosis) or subunit
vaccines containing one or several TB antigens.
If any of these first generation vaccines prove
efficacious, licensure can be expected around 2015.

In 2004, WHO published a BCG vaccine position
paper in the Weekly Epidemiological Record which
provides a detailed summary of key information on the disease and the vaccine.
BCG Vaccine : Position paper (January 2004)
Original English and French versions [pdf 468kb]
at : http://www.who.int/immunization/wer7904 ... _paper.pdf

For further information, the link also provides a
partial list of references upon which the
position is based. (http://www.who.int/immunization/Refs_BCG_May_1_2006.pdf)

Diana Chang Blanc, IVB/EPI
Ulli Fruth, IVB/Initiative for Vaccine Research


NOTE : I didn’t find any material on protection
by BCG against leprosy in Malawi but in India.

"Effectiveness of bacillus Calmette-Guerin (BCG)
vaccination in the prevention of leprosy; a
case-finding control study in Nagpur, India", by
Zodpey, Sanjay P, Shrikhande, Sunanda
N, Salodkar, Atul D, Maldhure, Bhagirath
R, Kulkarni, Shyam W. ; International Journal of
Leprosy and Other Mycobacterial Diseases, Sep 1998.


Maybe some members can share other articles they are aware of.

Another article may also interest members. This
is : "BCG vaccine effectiveness in preventing
tuberculosis and its interaction with human
immunodeficiency virus infection", by María
Patricia Arbeláez, Kenrad E Nelson and Alvaro
Muñoz ; International Journal of Epidemiology 2000;29:1085-1091.


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