6 YEARS EXPERIENCE WITH THE DISCONTINUATION OF BCG VACCINATION .4. PROTECTIVE EFFECT OF BCG VACCINATION AGAINST THE MYCOBACTERIUM-AVIUM-INTRACELLULARE COMPLEX
6 YEARS EXPERIENCE WITH THE DISCONTINUATION OF BCG VACCINATION .4. PROTECTIVE EFFECT OF BCG VACCINATION AGAINST THE MYCOBACTERIUM-AVIUM-INTRACELLULARE COMPLEX
复制标题
DOI：
10.1016/0962-8479(94)90080-9
复制
发表时间：
1994-10-01
期刊：
影响因子：
--
通讯作者：
SVANDOVA, E
中科院分区：
文献类型：
--
作者：
TRNKA, L;DANKOVA, D;SVANDOVA, E
地点：1986年，在捷克共和国大范围的新生儿抽样调查(每年30000名婴儿)中，停止了对新生儿的大规模卡介苗接种。未接种儿童每隔两年进行一次结核菌素检测，在家庭或农场连续或反复密集接触动物的儿童，除检测结核菌素外，还进行鸟分枝杆菌复合体敏感试验。目的：在监测方案框架内，评估鸟分枝杆菌复合体(M.avium Complex)感染和疾病的发生率，分析卡介苗接种的保护效果。设计：1986~1993年，在190874名未接种疫苗的儿童中，发现36例感染复合体；结果：每年感染禽类分支杆菌复合体的风险为4.8/10万儿童，其中3.6/10万儿童发生分支杆菌病。颈淋巴结肿大24例，纵隔淋巴结肿大2例，儿童颈纵隔淋巴结肿大1例。9例患儿经细菌学确诊。大多数患儿免疫功能低下，所有感染的患儿皮肤对禽类分支杆菌复合体过敏反应明显，5例检出禽类分支杆菌复合体感染的动物来源。另有14名儿童也曾与动物有过密切接触，但未证实有禽分支杆菌复合体感染。结论：未接种卡介苗的儿童中，禽分支杆菌复合体淋巴结炎的发病率明显高于接种疫苗儿童。卡介苗细胞具有抗原决定簇，这种抗原决定簇可能对结核分枝杆菌和禽类分枝杆菌复合体感染具有保护性免疫。因此，可以认为卡介苗接种对致病结核杆菌和禽类分支杆菌复合体均有保护作用。在建议在禽类支原体感染高发地区停止新生儿大规模卡介苗接种之前，应考虑到这一点。
Setting: In 1986, mass BCG vaccination of newborns was discontinued in an extensive territorial sample of neonates in the Czech Republic (30 000 infants annually). The non-vaccinated children have since been tuberculin tested at two-year intervals; those with continual or repeated intensive contact with animals in households or on farms were also tested with Mycobacterium avium intracellulare complex sensitin in addition to tuberculin.Objective: Within the frame work of the surveillance programme the incidence of infection and disease caused by M. avium intracellulare complex (M. avium complex) was evaluated and the protective effect of BCG vaccination analysed.Design: In 1986-93, out of 190 874 non-vaccinated children, 36 were found to be infected by M. avium complex; 27 of them developed disease, i.e. mycobacteriosis other than tuberculosis (MOTT).Results: The annual risk of infection with M. avium complex was 4.8/100 000 children per year, of whom 3.6/100 000 developed mycobacteriosis. 24 patients suffered from swelling of cervical lymph nodes, 2 of mediastinal lymph nodes and one child had the disease localized both in cervical and mediastinal lymph nodes. The disease was verified bacteriologically in 9 children. Most of the diseased children had impaired immunity; a marked skin reactivity of M. avium complex sensitin was present in all infected children.Animal sources infected by M. avium complex were detected in 5 cases. Another 14 children also had close contact with animals but without proven M. avium complex infection.Conclusion: In non-BCG vaccinated children the incidence of lymphadenitis caused by M. avium complex was considerably higher than in vaccinated children. BCG cells possess antigenic determinants which confer protective immunity probably both against M. tuberculosis and against M. avium complex infections. It may thus be assumed that BCG vaccination protects both against pathogenic tubercle bacilli and M. avium complex. This should be taken into consideration before recommending discontinuation of mass BCG vaccination of newborns in areas with a high prevalence of M. avium complex infection.