Effect of Bacilli Calmette-Guerin vaccine on severe combined immunodeficiency patient: a narrative review and proposed workup algorithm

Authors

  • Helly M. Joshi Grodno State Medical University, Grodno State University, Grodno, Belarus
  • Yugam R. Oza Grodno State Medical University, Grodno State University, Grodno, Belarus
  • Meirajuddin J. Tousif Khaja Bandanawaz Institute of Medical sciences, Karnataka, India
  • Anjali S. Mannava All India Institute of Medical Sciences, Chhattisgarh, India
  • Jash K. Shah Grodno State Medical University, Grodno State University, Grodno, Belarus
  • Shrinath V. Gondalia Grodno State Medical University, Grodno State University, Grodno, Belarus

DOI:

https://doi.org/10.18203/2320-6012.ijrms20232821

Keywords:

BCG vaccine, Complications, SCID, Screening, Prevention, Newborns, Algorithm

Abstract

This systematic review critically investigates the administration of the Bacillus Calmette-Guérin (BCG) vaccine in neonates with severe combined immunodeficiency (SCID). The BCG vaccine, derived from Mycobacterium bovis, is a live attenuated vaccine recognized for its significant role in mitigating the impacts of tuberculosis (TB) in endemic areas. Despite its beneficial effects in controlling TB, safety and efficacy concerns have been raised when the vaccine is administered to SCID patients, who have a severe dysfunction or absence of the immune system. The potential for the vaccine to lead to severe complications due to the immunocompromised state of SCID patients necessitates a comprehensive investigation. To better understand these issues, a thorough literature review was carried out, integrating data from clinical trials and observational studies available on the PubMed database. An extensive review and analysis of 32 relevant articles revealed substantial evidence of complications from BCG vaccination in SCID patients. These findings emphasize the urgency for a more effective pre-vaccination screening process to circumvent potential adverse effects. Given the crucial role of the BCG vaccine in controlling TB, its potential to induce severe complications in SCID patients warrants careful consideration. Therefore, this review proposes an in-depth screening algorithm for newborns before BCG vaccination administration. The goal is to prevent these adverse events, offering critical insights to health policymakers, researchers, and clinicians in the field.

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References

De Nunes-Santos CJ, Rosenzweig SD. Bacille Calmette–Guerin Complications in Newly Described Primary Immunodeficiency Diseases: 2010–2017. Front Immunol. 2018;9.

Casanova JL, Abel L. Genetic Dissection of Immunity to Mycobacteria: The Human Model. Annu Rev Immunol. 2002;20(1):581-620.

Behr MA. Comparative Genomics of BCG Vaccines by Whole-Genome DNA Microarray. Science. 1979;284(5419):1520-3.

Rodrigues LC, Diwan VK, Wheeler JG. Protective Effect of BCG against Tuberculous Meningitis and Miliary Tuberculosis: A Meta-Analysis. Int J Epidemiol. 1993;22(6):1154-8.

Zwerling A, Behr MA, Verma A, Brewer TF, Menzies D, Pai M. The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices. PLoS Med. 2011;8(3):e1001012.

Madkaikar M, Aluri J, Gupta S. Guidelines for Screening, Early Diagnosis and Management of Severe Combined Immunodeficiency (SCID) in India. Indian J Pediatr. 2016;83(5):455-62.

Bonilla FA. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015;136(5):1186-205.e78.

Buckley RH, Orange JS. Primary Immunodeficiency Diseases’, in Middleton’s Allergy, Elsevier. 2014;1144-4.

Picard C. International Union of Immunological Societies: 2017 Primary Immunodeficiency Diseases Committee Report on Inborn Errors of Immunity. J Clin Immunol. 2018;38(1):96-128.

McDonald-McGinn DM. 22q11.2 deletion syndrome’, Nat Rev Dis Primers. 2015;1(1):15071.

Boisson-Dupuis S, Bustamante J. Mycobacterial diseases in patients with inborn errors of immunity. Curr Opin Immunol. 2021;72:262-71.

Cirillo E. Severe combined immunodeficiency-an update. Ann N Y Acad Sci. 2015;1356(1):90-106.

Griffith LM. Allogeneic hematopoietic cell transplantation for primary immune deficiency diseases: Current status and critical needs. J Allergy Clin Immunol. 2008;122(6):1087-96.

Shearer WT. Establishing diagnostic criteria for severe combined immunodeficiency disease (SCID), leaky SCID, and Omenn syndrome: The Primary Immune Deficiency Treatment Consortium experience. J Allergy Clin Immunol. 2014;133(4):1092-8.

Devonshire AL, Makhija M. Approach to primary immunodeficiency. Allergy Asthma Proc. 2019;40(6):465-9.

Marciano BE. BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies. J Allergy Clin Immunol. 2014;133(4):1134-41.

Sarmiento JD, Villada F, Orrego JC, Franco JL, Trujillo-Vargas CM. Adverse events following immunization in patients with primary immunodeficiencies. Vaccine. 2016;34(13):1611-6.

Sharifi PA, Aghamohammadi A, Mahmoudi S, Pourakbari B, Saboui F, Mamishi S. Clinical, laboratory and imaging findings of the patients with disseminated Bacilli Calmette–Guerin disease. Allergol Immunopathol (Madr). 2015;43(3):254-8.

Arbeláez MP, Nelson KE, Muñoz A. BCG vaccine effectiveness in preventing tuberculosis and its interaction with human immunodeficiency virus infection. Int J Epidemiol. 2000;29(6):1085-91.

Norouzi S, Aghamohammadi A, Mamishi S, Rosenzweig SD, Rezaei N. Bacillus Calmette-Guérin (BCG) complications associated with primary immunodeficiency diseases. J Infect. 2012;64(6):543-54.

Sadeghi-Shanbestari M. Immunologic aspects of patients with disseminated bacille Calmette-Guerin disease in north-west of Iran. Ital J Pediatr. 2009;35(1):42.

Ying W. Clinical Characteristics and Immunogenetics of BCGosis/BCGitis in Chinese Children: A 6 Year Follow-Up Study. PLoS One. 2014;9(4):e94485.

Buckley RH. Human severe combined immunodeficiency: Genetic, phenotypic, and functional diversity in one hundred eight infants. J Pediatr. 1997;130(3):378-87.

El-Sayed S. Neonatal screening for absolute lymphopenia. Egyp J Pediatr Allergy Immunol. 2013;11(2).

Chan K, Puck JM. Development of population-based newborn screening for severe combined immunodeficiency. J Allergy Clin Immunol. 2005;115(2):391-8.

Douek DC. Changes in thymic function with age and during the treatment of HIV infection. Nature. 1998;396(6712):690-95.

Puck JM. Laboratory technology for population-based screening for severe combined immunodeficiency in neonates: The winner is T-cell receptor excision circles. J Allergy Clin Immunol. 2012;129(3):607-16.

Schembri HJ, Pace K, Sciberras J, Scicluna W. Systemic BCGosis following intra-renal instillation of BCG: a case report. J Surg Case Rep. 2021;12.

Lukacs S, Tschobotko B, Szabo NA, Symes A. Systemic BCG-Osis as a Rare Side Effect of Intravesical BCG Treatment for Superficial Bladder Cancer. Case Rep Urol. 2013;1-3.

Venkataraman A, Yusuff M, Liebeschuetz S, Riddell A, Prendergast AJ, Management and outcome of Bacille Calmette-Guérin vaccine adverse reactions. Vaccine. 2015;33(41):5470-4.

Lin LC. BCG Vaccine Induced Tuberculous Osteomyelitis of Left Distal Femur in a Young Child: Case Report and Literature Review. Austin J Clin Case Rep. 2021;8(6):1217.

Tsai YL, Chen YJ, Lai YC. Long-term follow-up of osteomyelitis caused by Bacille Calmette-Guérin vaccination in immunocompetent children. Sci Rep. 2020;10(1):4072.

Pancharatnam D, Yong SM, Tan Sc. Osteomyelitis: An Uncommon Complication of BCG Vaccination. Malays Orthop J. 2021;15(1):144-5.

Gharehdaghi M. Bacille Calmette-Guérin Osteomyelitis. Arch Bone J Surg. 2015;3(4):291-5.

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Published

2023-08-31

How to Cite

Joshi, H. M., Oza, Y. R., Tousif, M. J., Mannava, A. S., Shah, J. K., & Gondalia, S. V. (2023). Effect of Bacilli Calmette-Guerin vaccine on severe combined immunodeficiency patient: a narrative review and proposed workup algorithm. International Journal of Research in Medical Sciences, 11(9), 3556–3561. https://doi.org/10.18203/2320-6012.ijrms20232821

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Section

Review Articles