PMID- 25701674
OWN - NLM
STAT- MEDLINE
DCOM- 20160317
LR  - 20150316
IS  - 1873-2518 (Electronic)
IS  - 0264-410X (Linking)
VI  - 33
IP  - 13
DP  - 2015 Mar 24
TI  - Clinical manifestations of leprosy after BCG vaccination: an observational study 
      in Bangladesh.
PG  - 1562-7
LID - S0264-410X(15)00183-8 [pii]
LID - 10.1016/j.vaccine.2015.02.017 [doi]
AB  - BACKGROUND: Although BCG is used as a vaccine against tuberculosis, it also 
      protects against leprosy. Previous evaluation over 18 years of an intervention of 
      two doses BCG for 3536 household contacts of leprosy patients showed that 28 
      (23%) out of 122 contacts diagnosed with leprosy, developed symptoms 2-10 months 
      after vaccination. This study describes contacts of leprosy patients in 
      Bangladesh who developed leprosy within 12 weeks after receiving a single BCG 
      dose. METHODS: A cluster RCT in Bangladesh aims to study the effectiveness of the 
      BCG vaccine versus BCG in combination with single dose rifampicin (SDR) given 2 
      to 3 months after BCG, in the prevention of leprosy among contacts of newly 
      diagnosed leprosy patients. During the first 1,5 years of this ongoing trial we 
      identified contacts who developed leprosy within the first 12 weeks after 
      receiving BCG vaccination, the timeframe before SDR is given. RESULTS: We 
      identified 21 contacts who developed leprosy within 12 weeks after BCG 
      vaccination among 5196 vaccinated contacts (0.40%). All 21 cases presented with 
      paucibacillary (PB) leprosy, including children and adults. About half of these 
      cases had previously received BCG vaccination as indicated by the presence of a 
      BCG scar; 43% presented with signs of nerve function impairment and/or Type 1 
      (reversal) reaction, and 56% of the index patients had multibacillary (MB) 
      leprosy. CONCLUSION: An unexpectedly high proportion of healthy contacts of 
      leprosy patients presented with PB leprosy within 12 weeks after receiving BCG 
      vaccination, possibly as a result of boosted cell-mediated immunity by homologues 
      of Mycobacterium leprae antigens in BCG. Various immunological mechanisms could 
      underlie this phenomenon, including an immune reconstitution inflammatory 
      syndrome (IRIS). Further studies are required to determine whether BCG 
      vaccination merely altered the incubation period or actually changed the course 
      of the infection from self-limiting, subclinical infection to manifest disease.
CI  - Copyright (c) 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Richardus, Renate A
AU  - Richardus RA
AD  - Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 
      Rotterdam, The Netherlands.
FAU - Butlin, C Ruth
AU  - Butlin CR
AD  - Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, 
      Bangladesh.
FAU - Alam, Khorshed
AU  - Alam K
AD  - Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, 
      Bangladesh.
FAU - Kundu, Kallyan
AU  - Kundu K
AD  - Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, 
      Bangladesh.
FAU - Geluk, Annemieke
AU  - Geluk A
AD  - Department of Infectious Diseases, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - Richardus, Jan Hendrik
AU  - Richardus JH
AD  - Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 
      Rotterdam, The Netherlands. Electronic address: j.richardus@erasmusmc.nl.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20150218
PL  - Netherlands
TA  - Vaccine
JT  - Vaccine
JID - 8406899
RN  - 0 (Antigens, Bacterial)
RN  - 0 (BCG Vaccine)
RN  - 0 (Leprostatic Agents)
RN  - VJT6J7R4TR (Rifampin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Antigens, Bacterial/*immunology
MH  - BCG Vaccine/*adverse effects/*immunology/therapeutic use
MH  - Bangladesh
MH  - Child
MH  - Drug Therapy, Combination
MH  - Family Characteristics
MH  - Female
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/etiology
MH  - Immunity, Cellular
MH  - Leprostatic Agents/administration & dosage
MH  - Leprosy, Paucibacillary/*etiology/immunology/*prevention & control
MH  - Male
MH  - Middle Aged
MH  - Mycobacterium leprae/*immunology
MH  - Rifampin/*administration & dosage
MH  - Vaccination
MH  - Young Adult
OTO - NOTNLM
OT  - BCG
OT  - Contacts
OT  - Leprosy
OT  - M. leprae
OT  - Prevention
OT  - Prophylaxis
EDAT- 2015/02/24 06:00
MHDA- 2016/03/18 06:00
CRDT- 2015/02/22 06:00
PHST- 2014/12/06 00:00 [received]
PHST- 2015/01/16 00:00 [revised]
PHST- 2015/02/05 00:00 [accepted]
PHST- 2015/02/22 06:00 [entrez]
PHST- 2015/02/24 06:00 [pubmed]
PHST- 2016/03/18 06:00 [medline]
AID - S0264-410X(15)00183-8 [pii]
AID - 10.1016/j.vaccine.2015.02.017 [doi]
PST - ppublish
SO  - Vaccine. 2015 Mar 24;33(13):1562-7. doi: 10.1016/j.vaccine.2015.02.017. Epub 2015 
      Feb 18.