Cell mediated immunity in children with scar-failure following BCG vaccination.

OBJECTIVE To find out the incidence of BCG-scar failure, in BCG vaccinated children and assess their in vitro cellular response. DESIGN Four year prospective cohort observational study. SETTING Immunization centers at: (a) State Tuberculosis Center; (b) Tuberculosis Association of Andhra Pradesh; and (c) Niloufer Hospital for Women and Children in Hyderabad. METHODS Healthy children brought to the immunization centers for BCG vaccination and were followed up till 6 months of age for scar failure. These 655 BCG vaccinated children were classified into three groups based on the age at vaccination: (i) 0 day-1 day; (ii) 2 days-30 days; and (iii) 31 days-90 days. Of these children, in vitro leukocyte migration inhibition (LMI) levels against PHA/PPD were investigated in 228 of them. RESULTS Of the 655 children, 591 (90.2%) showed presence of scar. Out of the three groups, number of children belonging to the first group in whom the scar was absent, was highest. Of 591 children with scar, LMI was performed in 34, 110 and 43 of them in the three different age groups, respectively out of whom 88.2%, 87.2% and 86% had positive response (> or = 20%) to PPD. Of 64 children who failed to develop a scar, LMI was performed in 17, 19 and 5 in three different age groups out of whom 88.2%, 94.7% and 80% had positive (> or = 20%) in vitro response to PPD. CONCLUSION Scar failure may occur in 10% of BCG vaccinated and is more common with immunization within 48 hours of life. Failure of formation of BCG-scar at the site of BCG vaccination may not necessarily imply failure of immunization because majority of them do elicit positive in vitro LMI response.