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Tuberculosis (TB) can infect all age groups, even children. Three provinces in Indonesia namely West Java (14%), Papua (13%), and Bangka Belitung provinces (11%) have the highest proportion of children with TB disease. Some previous research reveals that there is a relationship between exclusive breastfeeding and BCG immunization status of children with TB disease. This current study identified the increasing trend of children (aged 0-14 years) with TB disease in Bangka Belitung province based on the coverage of exclusive breastfeeding and BCG immunization. It was observational research with a cross-sectional design. Data were retrieved from seven districts/cities in Bangka Belitung province in 2015-2017. The unit of analysis was the number of overall TB cases, the percentage of BCG immunization coverage, and exclusive breastfeeding. The data were analyzed using the Health Mapper application version 4.3.0.0 with product version 4.03. The number of children (aged 0-14 years) with TB disease increased from 2015-2017, and BCG immunization coverage and exclusive breastfeeding decreased in 2015-2016 only, but swelled in 2016-2017. The number of TB cases was still high despite the high coverage of exclusive breastfeeding and BCG immunization. Several factors such as the quality of vaccines and exclusive breastfeeding might influence the prevalence of TB in children. Future studies should employ more variables to garner more references.

This study entitled "Relationship of Individual Characteristics, Physical Environment of the House and Behavior with the incidence of pulmonary TB in Cijoro Pasir Village, Muara Ciujung Timur Village and Rangkasbitung Barat Village, Rangkasbitung District, Lebak Regency in 2019" and behavior with pulmonary TB incidence. The design of this study was cross sectional. Data was analyzed using univariate tests and bivariate tests consisting of chi-square. The total population is 123 The results showed that the incidence of pulmonary TB as many as 37 patients with positive pulmonary TB (60.7%) and 24 patients with negative AFB pulmonary TB and still found a physical environment that did not meet the requirements as many as 42 houses (68.9%), lighting as many as 38 houses (63.3%), humidity of 43 houses (70.5%), BCG immunization 35 people (57.4%), closing mouths of cough / sneezing compilation 38 people (62.3%), phlegm carelessly 32 people (52.5%) and use of eating utensils 39 people (63.9%).

The infant mortality rate caused by TB in Indonesia is 91,368 per year or 250 people everyday (Depkes RI, 2010). This study was conducted to obtain a description of the relationship history of contact with adult tuberculosis patients and history of BCG immunization with the incidence of Pulmonary TB in Children in Child Poly Room Husada Hospital. This research uses correlative descriptive method. The population in this study were all pediatric patients aged 6 months - 12 years old who went to the Husada Hospital Clinic of Central Jakarta Hospital in March 2015 - April 2015. The sample in this study were 41 people with accidental sampling sampling technique. The results showed that there was a significant correlation between contact with adult patients with the incidence of Pulmonary TB in children in Poli Anak Husada Hospital and no significant relationship between BCG immunization with the incidence of Pulmonary TB in children in Poli Anak Husada Hospital.

Background: The Indonesian Ministry of Health (2016: 01) states that in Indonesia it is estimated that 1 million new TB cases (647 per 100,000 population) with 100,000 deaths (41 per 100,000 population). Data from the Central Java Provincial Health Office (2018), said that there were 103,840 TB cases estimated, only 44.33% (48,751 sufferers) reported, so that there were still 55,089 undiscovered patients. The results of the study prove that one effective prevention for tuberculosis is BCG immunization. Research purposes: This study aims to determine the relationship of factors of knowledge, motivation and education level with adherence to BCG immunization. Subject: All mothers who have children over 1 year old at Posyandu Karang Gading Village Tanon Subdistrict are 35 people. Method: This study uses observational analytic methods with a research design correlation with a cross sectional approach to determine the relationship of knowledge, motivation and education level with adherence to implementing BCG immunization. Data obtained by questionnaire, then tabulated and analyzed using SPSS 18 for Windows. Research result: The results of the analysis with SPSS 18 for Windows used Chi Square for the dependent variable level of knowledge p value: 0.655, motivation p value: 0.109, education level p value: 0.212. Conclusion: there is no relationship between the level of knowledge, motivation and level of education towards the compliance of mothers taking BCG immunization actions on their children. Keywords: knowledge, motivation, education level, compliance with BCG immunization

Background : Immunization is an effort that deliberately provides immunity to infants/children to avoid certain diseases. Immunization is important because it affects the growth of infants and children, when administered within the stipulated time period. The facts show that many parents do not immunize on schedule and tend to postpone it. The objectives of the study analyzed the punctuality of complete basic immunization in infants aged 12 to 13 months (“Baduta”) in Semarang.Methods: This research is an observational study with cross sectional design. The population means all Baduta in Semarang, with sample of 689 Baduta from 37 Puskesmas (Society Health Center) taken randomly. Baduta immunization status is obtained from the KIA Book.Results: The results show 98.25% of Baduta have received basic immunization although not all yet complete. Immunization of measles is the most immunization which have not been received yet by Baduta (13.35%),followed by Polio-4 (8.27%) and DPT / HB / HiB-3 (7.4%). Sources of information on immunization are generally obtained from health workers and cadres.Conclusion : Immunization HB-0 is given at the most punctual (96.28%), followed by DPT / HB / HiB-3 (90.13%) and Polio-4 (85.44%), while immunization of measle s has the lowest punctuality (41.04%), followed by BCG immunization (61.5%).

Background : Tuberculosis (TB) is still a major public health problem in most developing countries and its incidence is rising in many developed countries. This study aimed to examine factors associated with tuberculosis in Deli Serdang, North Sumatera Subjects and Method : This was a cross-sectional study conducted in Deli Serdang, North Sumatera . A sample of 190 study subjects was selected for this study comprising of 95 TB patients and 95 non-TB patients. The dependent variable was tuberculosis. The independent variables were sex, education, BCG immunization, smoking, nutritional status, and dwelling density. Data on TB status were taken from medical record. The other variables were measured by questionnaire. The data were analyzed by a multiple logistic regression. Results : The risk of TB decreased with female sex (OR= 0.33; 95% CI= 0.11 to 0.98; p= 0.046). The risk of TB increased with low education (OR= 8.47; 95% CI= 3.01 to 23.80; p

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Background Although, WHO notes that there has been 'tremendous progress' towards controlling spread of Tuberculosis (TB) by 2015, situation in endemic countries like Pakistan need global attention. Pakistan currently ranks fifth among TB-high burden countries and it accounts for 61% of the TB burden in the WHO Eastern Mediterranean Region. We aim to explore the trends in relative and absolute socioeconomic inequalities in BCG vaccination coverage. Methods Data from Pakistan Demographic and Health Surveys (PDHS) 2006-7 (n = 9177 data used 8442), and 20012-13 (n = 13558, used n = 6982) were used. Information was collected from all mothers in reproductive age group, regarding BCG vaccination of their children aged < 5 years. Wealth index and education were used to assess socioeconomic position. Socioeconomic inequalities for BCG vaccination coverage were assessed by calculating Relative Index of Inequality (RII) and Absolute Index of Inequality (SII). Results Although reported frequency of not getting the child BCG vaccinated has decreased over the decade (25% in 2006, 18% in 2013). Nevertheless, socioeconomic inequalities in BCG vaccination have significantly widened over the last decade. Education related inequalities [2006-7 Urban: SII=-1.34 (-0.91, -1.76); 2012-13 Urban: SII=-1.88 (-1.43, -2.32)]; [2006-7 Rural: SII=-1.31 (-0.96, -1.65); 2012-13 Rural: SII=-1.54 (-1.13, -1.94)] have increased. Similarly, wealth related inequalities [2006-7 Urban: SII=-1.27 (-0.91, -1.62); 2012-13 Urban: SII=-1.75 (-1.37, -2.12)]; [2006-7 Rural: SII=-1.19 (-0.98, -1.39); 2012-13 Rural: SII=-1.72 (-1.43, -2.00)] have increased. Conclusions Widening absolute inequalities in BCG vaccination coverage among children over the last decade in a TB-high burden country gives rise to global concern, at a time when world aims for tuberculosis free future. The results warrant the essential public health efforts to avoid further widening in TB related socioeconomic inequalities in Pakistan. Key messages The results warrant the need to continue monitoring of TB control at population level. Study findings may help to improved TB management programs to initiate evidence-based guidelines for maternal and child health.

Background Maternal and infant HIV status influences the decision of BCG immunization of infants at birth. The objective of this study was to determine the HIV status of HIV-exposed infants (HEIs) by the first HIV DNA PCR test and the rate of BCG uptake among the HEIs who were confirmed HIV negative. Methods This was a retrospective descriptive cross-sectional study involving the review of results of 99 dried blood samples (DBS) for the first HIV DNA PCR test of HEIs whose mothers were diagnosed HIV positive on presentation of the infants at first immunization visit at a Primary Health Centre from January 2018 to January 2019. Results Of the 99 DBS examined, 86; 86.9% (95% CI 80.1–93.6) were HIV negative, 9; 9.1% (95% CI 3.3–14.8) were positive while the results of 4 (4.0%) infants were not in the register. Only 7; 7.1% (95% CI 1.9–12.2) of the 99 HEIs returned for BCG immunization at the centre. BCG immunization status of the HEIs after first PCR results was not significantly associated with sex of the infants or availability of phone number of the guardians (p = 0.70 and 0.12, respectively). Conclusion The majority of HEIs were HIV negative at first HIV DNA PCR test. Few of these HIV negative infants returned for BCG immunization. Hence, all HEIs should be given BCG immunization according to WHO GAVCS committee recommendation on BCG immunization for settings with poor HIV diagnostic and treatment facilities for mothers and infants.

In this work we have analysed the use of two different correlation metrics and two different datasets, detecting differences in the extent and directionality of the correlation between COVID-19 infection and BCG immunization. Correlation between COVID-19 infection, death rates and BCG immunization is strongly affected by the correlation metrics and so will be their biological interpretation.

We present an updated time-adjusted dataset and conclusions at Covid-19 Time Zero + 5 month (04.06.2020). The conclusions of the original analysis reviewed and mostly maintained at this time point. With the data accumulated to date a statistical significance of the BCG immunization correlation hypothesis is evaluated with the conclusion that it has achieved the level of confidence. Several specific cases are discussed with respect to the induced immunity hypothesis.

Based on a subset of Covid-19 Wave 1 cases at a time point near TZ+3m (April, 2020), we perform an analysis of the influencing factors for the epidemics impacts with several different statistical methods. The consistent conclusion of the analysis with the available data is that apart from the policy and management quality, being the dominant factor, the most influential factors among the considered were current or recent universal BCG immunization and the prevalence of smoking.

In this work we observe a number of cases supporting the possible correlation between the administration of BCG tuberculosis vaccine and the severity of Covid-19 effects in the population proposed in the earlier works [1]. Based on the early preliminary analysis of the publicly available data we propose a number of arguments and observations providing further support for the correlation hypothesis and make an observation that the effectiveness of the protection effect of BCG immunization, if confirmed, may depend to a significant extent on the age of administration, with the early age inoculation more effective for the lasting protection.

The COVID-19 pandemic that started in China has spread within 3 months to the entire globe. We tested the hypothesis that the vaccination against tuberculosis by Bacille Calmette&ndash, Gu&eacute, rin vaccine (BCG) correlates with a better outcome for COVID-19 patients. Our analysis covers 55 countries complying with predetermined thresholds on the population size and number of deaths per million (DPM). We found a strong negative correlation between the years of BCG administration and the DPM along with the progress of the pandemic, corroborated by permutation tests. The results from multivariable regression tests with 23 economic, demographic, health-related, and pandemic restriction-related quantitative properties, substantiate the dominant contribution of BCG years to the COVID-19 outcomes. The analysis of countries according to an age-group partition reveals that the strongest correlation is attributed to the coverage in BCG vaccination of the young population (0&ndash, 24 years). Furthermore, a strong correlation and statistical significance are associated with the degree of BCG coverage for the most recent 15 years, but no association was observed in these years for other broadly used vaccination protocols for measles and rubella. We propose that BCG immunization coverage, especially among the most recently vaccinated population, contribute to attenuation of the spread and severity of the COVID-19 pandemic.

The Bacillus Calmette-Guerin vaccine (BCG vaccine) designed to prevent tuberculosis in children has been shown to induce a trained immune response in the body to fight against bacteria as well as other parasites and viruses. This knowledge has been reciprocated to generate the idea that this vaccine can also offer protection against severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). Some recent pre-print articles have highlighted that countries with mass BCG immunizations seems to have a lower incidence of coronavirus disease 2019 (COVID-19) compared to those without BCG immunization. There are yet no experimental proof of any such association and the world health organisation (WHO) is currently testing the theory with clinical trials on selected cohorts. Epidemiologists and other scientific experts has expressed both their hope and concern simultaneously regarding the success theory of BCG vaccination to prevent COVID-19. Though its still not verified in any way whether the BCG vaccination can actually prevent COVID-19 or not but we believe a thorough analytical research in this regard is indeed worth a shot.

Tuberculosis (TB) is the leading cause of death worldwide due to an infectious disease, causing around 1.6 million deaths each year. This situation has become more complicated by the emergence of drug-resistant Mycobacterium tuberculosis (M.tb) and HIV-TB co-infection, which has significantly worsened TB prognosis and treatment. Despite years of intensive research, Bacille Calmette-Guerin (BCG) remains the only licensed vaccine and has variable efficacy. It provides protection against childhood TB but is not effective in adult pulmonary TB. As a result of intense research in understanding TB vaccinology, there are many new vaccine candidates in clinical development and many more in pre-clinical trials which aim either to replace or boost BCG vaccine. This review discusses the history of BCG vaccine development and summarizes limitations of the current vaccine strategy and recent advances in improving BCG immunization along with other new vaccines in clinical trials which are promising candidates for the future tuberculosis vaccinology program.

Miller et al. reported a correlation between BCG immunization policy with the reduced morbidity and mortality for COVID-19. Here, we adopt different data to check this correlation, but we find that the correlation is not significant in general, between countries with BCG and without BCG. It is only marginally significant among countries with BCG when median age is also considered. We argue that more investigation is needed.

Dalam upaya preventif dan promotif untuk meningkatan derajat kesehatan, setiap individu dan keluarga harus memahami konsep sakit dan sehat. Pemahaman konsep tersebut dapat membantu setiap orang dalam memelihara kesehatannya dengan bantuan medis dan sosial sekitarnya. Bantuan sosial merupakan lingkungan dimana seorang anak tumbuh dan berkembang. Dukungan sosial dalam mewujudkan kondisi rumah sehat dan dilaksanakannya imunisasi BCG merupakan kondisi yang dibutuhkan anak dalam upaya menghindarkan dari penyakit TBC Anak. Kehidupan anak akan banyak dihabiskan di rumah sehingga orang tua harus memahami bagaimana kondisi rumah yang sehat sebagai penunjang kesehatan keluarga juga status imunisasi balita yang harus dipenuhi oleh orang tua karena merupakan hak anak dalam mendapatkan status kesehatan yang layak. Rumah sehat dan imunisasi BCG merupakan upaya dalam menurunkan angka TB pada anak. Peranan dan pengetahuan orang tua akan pentingnya kedua hal tersebut menjadi kunci utama keberhasilan penanganan TB pada anak dari segi preventif dan peran promosi kesehatan sangat berar dalam meningkatkan pengetahuan orang tua pada kejadian TB anak. Dukungan kelompok sosial yang terbentuk di masyarakat melalui peran kader, tokoh agama, tokoh masyarakat dan aparat merupakan hal penting dalam menggerakan keberhasilan penanganan TBC Anak melalui kondisi rumah sehat dan imunisasi BCG. ABSTRACTIn an effort preventive and promotion to improve health degree, individuals and families must understand the concept of sick and healthy. Understanding of the concept can help everyone in maintaining their health with the help of medical and social surroundings. Social assistance is an environment which a child grows and develops. Social support in creating a healthy home conditions and the implementation of BCG immunization is necessary condition of the child in an effort to prevent child’s TB disease. Child’s life would be a lot of spent time at home, so parents need to understand how healthy housing conditions as well as the support of family health also immunization status that must be met by parents for a child's rights in obtaining proper health status. Healthy homes and BCG immunization is an effort to reduce the number of child’s TB. The role and knowledge of parents to the importance of these two things is major key to the success of child’s TB treatment in terms of preventive and health promotion role very valuable in enhancing parents knowledgeable on child TB incidence. Support for social groups that formed in the communities through the role of cadres, religious figures, community figures and officials is important things for the successful of children tuberculosis treatment through healthy housing conditions and BCG immunization.

Latar belakang. Tuberkulosis adalah penyakit yang masih menjadi masalah kesehatan di dunia. Pada tahun 2014 terjadi peningkatan insidens, prevalens bahkan kematian karena TB di Indonesia. Tujuan. Mengetahui besar risiko tidak diimunisasi BCG terhadap kejadian TB Paru pada anak di Kota Sukabumi tahun 2015-2016 setelah dikontrol oleh variabel umur, jenis kelamin, berat badan lahir, pemberian ASI Eksklusif, kunjungan Neonatal, pemberian Vitamin A, pendidikan Ibu dan Pekerjaan Ibu. Sedangkan tujuan sekunder dari studi ini adalah mengidentifikasi status imunisasi BCG dan kejadian TB Paru pada anak serta variable covariatnya dan mengetahui besar risiko anak yang tidak diimunisasi serta mengetahui besar Efektivitas vaksin BCG. Metode. Penelitian ini menggunakan desain case control. Kasus dan kontrol adalah anak kota Sukabumi usia 0-5 tahun yang diperoleh dari laporan rutin program TB, imunisasi, KIA dan Gizi di Dinas Kesehatan Kota Sukabumi. Hasil. Analisis multivariat menunjukkan bahwa risiko anak yang tidak diimunisasi BCG dan KN sebanyak 3 kali adalah 1,13 kali lebih besar untuk terkena TB paru dibandingkan kelompok rujukan dan anak yang diimunisasi BCG. Dari hasil tersebut diketahui bahwa efektivitas vaksin BCG tanpa interaksi 67%, sedangkan dengan interaksi 82%. Kesimpulan. Imunisasi di Kota Sukabumi masih merupakan salah satu upaya yang efektif untuk mencegah terjadinya TB paru pada anak.

A healthy 4-month-old girl presented with widespread scaly papules and a nodule over the site of BCG immunization. A diagnosis of disseminated cutaneous tuberculosis in an immunocompetent child was confirmed with biopsy. The child was treated with antituberculosis therapy without recurrence.

Growing evidence suggests the outcome of Mycobacterium tuberculosis (Mtb) infection is established rapidly after exposure, but how the current tuberculosis vaccine, BCG, impacts early immunity is poorly understood. Here we found that murine BCG immunization promotes a dramatic shift in infected cell types. While alveolar macrophages (AM) are the major infected cell for the first two weeks in unimmunized animals, BCG promotes the accelerated recruitment and infection of lung infiltrating phagocytes. Interestingly, this shift is dependent on CD4 T cells, yet does not require intrinsic recognition of antigen presented by infected AM. Mtb-specific T cells are first activated in lung regions devoid of infected cells, and these events precede vaccine-induced reduction of the bacterial burden, which occurs only after the co-localization of T cells and infected cells. Understanding how BCG alters early immune responses to Mtb provides new avenues to improve upon the immunity it confers.

The bacille Calmette–Guerin (BCG) vaccine is one of the oldest and most widely used vaccines. The demonstration of its protective efficacy against tuberculosis (TB) in historical British Medical Research Council trials led to routine BCG vaccination in many parts of the world. Today, BCG vaccination policies vary across countries. BCG given once only at birth is the vaccination schedule currently practiced in most countries. In response to declining TB incidence rates, a number of countries have shifted from universal to selective BCG vaccination. Many countries have stopped BCG revaccination as evidence accumulates over its failure to confer additional protection. BCG vaccination of the HIV-infected is contraindicated, although neonatal BCG vaccination in TB-endemic countries may be continued until vaccination in HIV-exposed infants can be selectively deferred. Although BCG has demonstrated substantial protection against serious forms of TB, its protective effect against pulmonary TB is partial and variable. Without better vaccines and improved diagnostic and treatment tools, it may be difficult to meet the TB-related Millennium Development Goals. Concerted efforts are required to integrate scientific advancement and political mobilization in vaccine development, clinical trials, and field implementation.

PURPOSE The BCG immunization has long been performed in Japan. Although the BCG immunization service is the responsibility of the municipality, the manner in which the BCG immunization is delivered differs from municipality to municipality. The purpose of this study was to clarify how the different manner of the BCG immunization delivery systems influenced the BCG immunization coverage. METHODS The study of BCG immunization coverage was conducted in the Tama area located in the western suburbs of Tokyo in 2004. The birth data and the immunization history by the age of 3 years were collected in the three-year-old health check-up from a total of 2,341 children residing in the Tama area. Based on the age at immunization for each child, the BCG immunization coverage was calculated according to the types of the BCG immunization delivery system. The immunization types were defined as follows; the BCG immunization given on the occasion of the mass health check-up (Group 1); the exclusive mass BCG immunization in a monthly service (Group 2); the exclusive mass BCG immunization in a bimonthly service (Group 3); the exclusive mass BCG immunization in services of fewer than every two months (Group 4); and the immunization given on an individual basis by a general practitioner (Group 5). A univariate analysis was performed to examine the relationship between the BCG immunization coverage by the age of 6 months and the difference among the BCG immunization delivery systems, followed by a multivariate regression analysis to adjust for the factors related to the demography, health care services and the socio-economic status of the municipalities. RESULTS Unadjusted odds ratios and adjusted odds ratios for BCG unimmunized children under the age of 6 months by the BCG immunization delivery manner groups were OR 1 reference, adj. OR 1 reference in Group 1; OR 1.42 CI 0.87-2.29, adj. OR 4.01 CI 2.24-7.11 in Group 2; OR 4.96 CI 3.66-6.82, adj. OR 15.59 CI 10.10-24.49 in Group 3;OR 18.60 CI 13.77-25.49, adj. OR 48.17 CI 29.62-79.75 in Group 4; and OR 4.24 CI 2.86-6.31, adj. OR 15.61 CI 9.05-27.26 in Group 5. The univariate analysis and multivariate regression analysis revealed an influence of the BCG immunization delivery manner on the BCG immunization coverage. CONCLUSION The choice of BCG immunization delivery manner is very important to raise the BCG immunization coverage. The BCG immunization given on the occasion of the mass health check-up and the high-frequent immunization service are thought to improve the BCG immunization coverage.

Background: Pulmonary tuberculosis (TB) sufferers in Indonesia have dramatically increased from 1997 to 2014. The cases of pediatric pulmonary TB in Indonesia was firstly discovered in 2013, namely at the age of

BCG immunization schedules for the demonstration of resistance to listeriosis in C3H mice were re-evaluated in a series of experiments. A two-step procedure was found to be superior to a one-step vaccination schedule. Reactivation with BCG five days before challenge caused a significant depression of the multiplication of Listeria monocytogenes in the spleen. A saline extract of tubercle bacilli was able to reactivate the BCG immunization in the “same way, even though a transient non-immunogenic effect of the same extract was also demonstrated. In the two-step procedure the vaccination dose was found to play a minor role, whereas the reactivation was dose-dependent.

BCG immunization, utilizing whole-body coordination, is a highly cost-effective means of health intervention for preventing miliary tuberculosis (TB) and TB meningitis. In this study, we investigated the appropriate age by which a child should have completed his or her BCG immunization and discuss the current BCG immunization rate in Akita Prefecture, Japan. BCG immunization rates in urban and rural areas were 90.1% and 80.7%, respectively. Our immunization data were lower than the World Health Organization's (WHO) recommended rate. Immunization coverage rates in urban settings were higher than those in rural areas among infants four months to fifteen months of age, except for those six months old. We recommend : (1) completing BCG immunization by the age of twelve months, (2) preparing and educating parents for BCG immunization by means of a health policy, and (3) changing BCG immunization methods from group to individual inoculation. Immunization coverage rates may be increased or maintained to prevent miliary TB and TB meningitis., Journal of physiological anthropology. 2007, 26(5), p.547-551

BCG immunization at birth is an evidence-based intervention for the reduction of tuberculosis transmission. While performance of BCG immunization is commonly measured by coverage, ensuring that every child is immunized immediately after birth is an important public health goal. This study was aimed at assessing the coverage and factors influencing BCG immunization delays in Hayin Mallam, Zango Zaria, Kaduna Nigeria. A cross-sectional study was conducted among 210 mothers of under-fives who were enrolled into the survey. A pre-tested semi-structured interviewer-administered questionnaire was used to collect data from these mothers. Data was analyzed using IBM SPSS 20. Majorities (76.7%) of the children were immunized with BCG, but only 44.7% of them received the vaccine in the first 7 days of life. Majority of the mothers (42.9%) had post-secondary education; this did not translate to being aware of the correct timing of BCG vaccination. The major determinants of delay in a child receiving BCG were mothers’ educational status, whether she attended ANC and whether she delivered in a health facility. Even though most of the under-fives were immunized with BCG, a significant number received it later than the recommended time. Efforts to improve female education must be intensified, and antenatal care attendance and hospital delivery improved so that these could serve as avenues for educating mothers on the usefulness of immunization, particularly if done according to schedule.

THE PREVALENCE OF WASTINGOF CHILDREN AGE 24-59 MONTHS IN NANGGROE ACEH DARUSSALAM Surkesda NAD 2006 as post tsunami household health survey and covering all 21 districts/cities had assessed child nutritional status (wasting), with cut-off point

Setting: Tuberculin testing is an accepted method for screening pregnant women for tuberculosis. The interpretation of tuberculin reactivity in bacillus Calmette-Guerin (BCG)-immunized pregnant women is still in debate. Objective: Four related issues were addressed: (1) The effect of pregnancy on tuberculin reactivity; (2) the effect of age differential on tuberculin reactivity; (3) the effect of repeated immunization with BCG; and (4) the risk of developing tuberculosis during pregnancy or a 3-year post-partum period. Design: We performed tuberculin testing in 840 healthy Chilean women in the 32nd to 34th week of pregnancy; 807 had been immunized with 1 or more doses of BCG. There were 3 age groups: 177 were ≥ 19 years old, 534 were 20–29 years old, and 129 were ≥ 30 years old. All women in the study were followed at least 3 years post-partum. Results: Women ≤ 19 years old and non-pregnant women of similar age studied in the same geographical area had a similar distribution of the size of tuberculin reactions. Over 50% of all BCG-immunized women in each group had tuberculin reactions ≥ 10 mm. A differential effect of different doses of BCG was significant only in 20- to 29-year-old women. None of the women in this study developed tuberculosis during pregnancy or a 3-year post-partum observation period. Conclusions: Healthy, BCG-immunized pregnant women may have positive tuberculin reactions without having an increased risk for tuberculosis. The incidence of tuberculosis and the BCG immunization status need to be considered in the development of policy recommendations for diagnosis and treatment of Mycobacterium tuberculosis infection in pregnant women.

Setting: Some infants immunized with BCG in the newborn period fail to develop any measurable tuberculin reactivity despite a local reaction at the site of immunization. Objective: We wished to determine the possibility of a genetic regulation of this phenomenon by comparing the tuberculin reactivity of BCG-immunized parents and siblings of infants who failed to respond to BCG, and of infants who developed tuberculin reactivity after immunization. Design: We studied 65 parents and siblings of 33 nonresponder infants, and 35 parents and siblings of 14 infants who had developed tuberculin reactivity. Tuberculin reactivity was analyzed by multiple regression analysis considering the BCG immunization status of each individual, and the 2 groups were compared by analysis of covariance. Results: 96 of these family members had one or more BCG scars. The percentages of tuberculin reactors and non-reactors among BCG-immunized family members of both index infant groups were not significantly different. Conclusion: These observations suggest that maturational differences among newborns, rather than genetic regulation, account for the lack of development of cellular immunity against tuberculin after BCG immunization in some infants.

Effective prophylactic and/or therapeutic vaccination is a key strategy for controlling the global TB epidemic. The partial effectiveness of the existing TB vaccine, bacille Calmette-Guerin (BCG), suggests effective vaccination is possible and highlights the need for an improved vaccination strategy. Clinical trials are evaluating both modifications to the existing BCG immunization methods and also novel TB vaccines, designed to replace or boost BCG. Candidate vaccines in clinical development include live mycobacterial vaccines designed to replace BCG, subunit vaccines designed to boost BCG and therapeutic vaccines designed as an adjunct to chemotherapy. There is a great need for validated animal models, identification of immunological biomarkers of protection and field sites with the capacity for large-scale efficacy testing in order to develop and license a novel TB vaccine or regimen.

SummaryThis paper describes a matched case-control study to determine the efficacy of BCG vaccine in preventing the occurrence of leprosy in southern Malaŵi, a previously unstudied area. The BCG immunization rate amongst 145 individuals with leprosy was 44.8%, compared to 62.5% in 290 matched controls. The protective efficacy of BCG vaccine against leprosy in this region was estimated to be 63.6%; smallpox immunization had no effect. These findings support the view that BCG vaccine should be considered as a control measure in areas where leprosy is endemic.