BCG vaccination in patients with severe combined immunodeficiency: complications, risks, and vaccination policies.
BCG vaccination in patients with severe combined immunodeficiency: complications, risks, and vaccination policies.
复制标题
DOI：
10.1016/j.jaci.2014.02.028
复制
发表时间：
2014-04
影响因子：
14.2
通讯作者：
Rosenzweig, Sergio D.
中科院分区：
文献类型：
--
作者：
Marciano, Beatriz E.;Huang, Chiung-Yu;Joshi, Gyan;Rezaei, Nima;Carvalho, Beatriz Costa;Allwood, Zoe;Ikinciogullari, Aydan;Reda, Shereen M.;Gennery, Andrew;Thon, Vojtech;Espinosa-Rosales, Francisco;Al-Herz, Waleed;Porras, Oscar;Shcherbina, Anna;Szaflarska, Anna;Kilic, Sebnem;Franco, Jose L.;Gomez Raccio, Andrea C.;Roxo, Persio, Jr.;Esteves, Isabel;Galal, Nermeen;Grumach, Anete Sevciovic;Al-Tamemi, Salem;Yildiran, Alisan;Orellana, Julio C.;Yamada, Masafumi;Morio, Tomohiro;Liberatore, Diana;Ohtsuka, Yoshitoshi;Lau, Yu-Lung;Nishikomori, Ryuta;Torres-Lozano, Carlos;Mazzucchelli, Juliana T. L.;Vilela, Maria M. S.;Tavares, Fabiola S.;Cunha, Luciana;Pinto, Jorge A.;Espinosa-Padilla, Sara E.;Hernandez-Nieto, Leticia;Elfeky, Reem A.;Ariga, Tadashi;Toshio, Heike;Dogu, Figen;Cipe, Funda;Formankova, Renata;Enriqueta Nunez-Nunez, M.;Bezrodnik, Liliana;Marques, Jose Goncalo;Pereira, Maria I.;Listello, Viviana;Slatter, Mary A.;Nademi, Zohreh;Kowalczyk, Danuta;Fleisher, Thomas A.;Davies, Graham;Neven, Benedicte;Rosenzweig, Sergio D.
关键词：
SCID是一种以T细胞严重缺乏为特征的综合征。卡介苗是SCID患者的禁忌症。由于大多数国家鼓励在出生时接种卡介苗，因此在发现免疫缺陷之前，高比例的SCID患者接种了卡介苗。描述SCID患者接种卡介苗的并发症和相关风险。广泛分发了一份评估诊断为SCID的患者中卡介苗并发症、治疗方法和结果的广泛标准化问卷。进行汇总统计和关联分析。分析了来自17个国家28个中心的349名接种卡介苗的SCID患者的数据。51%的患者出现卡介苗并发症，34%为播散性，17%为局限性（分别比一般人群增加33,000和400倍）。早期接种疫苗（≤1个月）的患者出现卡介苗并发症（p=0.006）和卡介苗并发症死亡（p<0.0001）的发生率增加。诊断时T细胞≤250/uL的患者出现并发症的几率比T细胞≤250/uL的患者高2.1倍（95% CI, 1.4-3.4; p = 0.001）。78例接受抗分枝杆菌治疗的患者中有2例报告卡介苗并发症，该组无卡介苗并发症，未发生死亡。相比之下，在160例因症状性卡介苗感染接受抗分枝杆菌治疗的患者中，报告了46例卡介苗相关死亡（p<0.0001）。卡介苗在SCID患者中有很高的并发症发生率，增加了发病率和死亡率。在获得更安全和更有效的抗结核疫苗之前，应考虑推迟卡介苗接种，以保护高度脆弱人群免受可预防的并发症的侵害。
SCID is a syndrome characterized by profound T cell deficiency. BCG vaccine is contraindicated in SCID patients. Because most countries encourage BCG vaccination at birth, a high percent of SCID patients are vaccinated before their immune defect is detected. To describe the complications and risks associated with BCG vaccination in SCID patients. An extensive standardized questionnaire evaluating complications, therapeutics, and outcome regarding BCG in patients diagnosed with SCID was widely distributed. Summary statistics and association analysis was performed. Data on 349 BCG vaccinated SCID patients from 28 centers in 17 countries was analyzed. Fifty-one percent of the patients developed BCG complications, 34% disseminated and 17% localized (a 33,000 and 400 fold increase, respectively, over the general population). Patients receiving early vaccination (≤ 1 month) showed an increased prevalence of complications (p=0.006) and death due to BCG complications (p<0.0001). The odds of experiencing complications among patients with T cells ≤ 250/uL at diagnosis was 2.1 times higher (95% CI, 1.4-3.4; p = 0.001) than among those with T cells > 250/uL. BCG complications were reported in 2/78 patients who received anti-mycobacterial therapy while asymptomatic and no deaths due to BCG complications occurred in this group. In contrast 46 BCG-associated deaths were reported among 160 patients treated with anti-mycobacterial therapy for a symptomatic BCG infection (p<0.0001). BCG vaccine has a very high rate of complications in SCID patients, which increase morbidity and mortality rates. Until safer and more efficient anti-tuberculosis vaccines become available, delay in BCG vaccination should be considered to protect highly vulnerable populations from preventable complications.
登录
查看更多内容
影响因子：
14.2
作者：
Gennery, Andrew R.;Slatter, Mary A.;Landais, Paul
通讯作者：
Landais, Paul
影响因子：
11.8
作者：
Talbot, EA;Perkins, MD;Frothingham, R
通讯作者：
Frothingham, R
影响因子：
4.4
作者：
Buckley, Rebecca H.
通讯作者：
Buckley, Rebecca H.
影响因子：
8.8
作者：
Grohskopf, Lisa;Uyeki, Timothy;Bridges, Carolyn
通讯作者：
Bridges, Carolyn
影响因子：
3.8
作者：
ROMANUS, V;FASTH, A;WIHOLM, BE
通讯作者：
WIHOLM, BE