Interventions for Tuberculosis Control and Elimination 2002

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Petroff’s concerns about a reversion to virulence of BCG have never been confirmed, and his observation of different colony morphology with virulent and avirulent colonies 673 have not been confirmed elsewhere. 676 The BCG strain family Until the introduction of freeze-drying in Japan in 1943, 683 the only means of maintaining a viable strain was through sub-culturing. With the distribution of the vaccine strain to multiple laboratories in the world, each using slightly different techniques for strain maintenance, it is not surprising that the BCG family shows large diversity. 660 The first freeze-dried French strain (1949) from the Pasteur Institute in Paris was strain 1173-P2 , from which the Glaxo and Danish strains descended. 684 Recent work based on molecular characterization of the various substrains points to various mutations that have occurred at different points in time (figure 57), 685-687 and indicates that the various BCG sub-strains are morphologically and genetically different from each other. Safety record of BCG vaccination A large review has shown BCG to be one of the safest vaccines. 688,689 The demarcation between a normal reaction and an adverse reaction is not always clear. 690 The normal reaction is a red indurated area measuring five to 15 mm. A crust is formed around this induration, which is soft at the center for three to four weeks. At six to ten weeks, the crust falls off, leaving a flat scar measuring three to seven millimeters. 690 Regional lymphadenopathy in the absence of erythema or vesicle formation should also be considered a normal reaction to the vaccine. 691 Complications include cutaneous lesions and regional suppurative lymphadenitis; more severe localized or multiple lesions (such as musculo-skeletal lesions); 692-694 and nonfatal and fatal complications resulting from hypersensitivity reactions or mycobacterial dissemination. 688,689,695-702 The risk of complications varies with the type of vaccine and with the age at vaccination. The risk of osteomyelitis ranged from 0.01 to 50 per 1 million vaccinations, that of multiple or generalized lesions from 0.01 to 2 and that of fatal cases from 0.01 to 1 per million vaccinated individuals. 688,689 The lowest complication rates were reported with the Tokyo strain, and the highest with the Gothenburg strain produced in Denmark. 692,703 101
Pasteur, 1921 Moreau, 1924 Tokyo, 1925 Gothenburg, 1926 Pasteur, 1927 Danish, 1931 102 Tice, 1934 Montreal, 1937 Connaught, 1948 Glaxo, 1954 Pasteur, 1961 Pasteur Merieux, 1989 Figure 57. Proposed genealogical tree of BCG vaccine substrains since isolation at the Institut Pasteur in 1921. Reproduced from686 by the permission of the publisher Churchill Livingstone.
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Tuberculosis Interventions Interven
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Editor International Union Against
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Isoniazid plus rifampicin plus pyra
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4. Preventive chemotherapy . . . .
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Acknowledgments It would not have b
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This monograph deals with the fourt
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��
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contraceptives and anti-retroviral
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is scant. However, the limited evid
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1. Chemotherapy The primary interve
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ability of the drug in the serum of
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emain elusive, 47 the general mecha
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Idiosyncratic reactions from isonia
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tis risk per 1,000 subjects was zer
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Rifampicin may rarely cause pseudom
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• opioids; 292-294 • vitamin K
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Table 4. Summary of adverse reactio
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Effect of drug potentiated by etham
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orne out by experiments which have
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longed respiratory depression follo
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quent adverse drug events are gastr
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Page 60 and 61: Table 9. Grading of activities of a
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Page 64 and 65: Effective or functional monotherapy
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Page 68 and 69: drugs with a high therapeutic margi
Page 70 and 71: Council 122 or the individual trial
Page 72 and 73: article. The experiences in Edinbur
Page 74 and 75: Per cent positive 100 80 60 40 20 0
Page 76 and 77: Based on evidence that the addition
Page 78 and 79: esented a major advance in research
Page 80 and 81: cipal consideration is the prevaili
Page 82 and 83: of six months’ duration with ison
Page 84 and 85: Treatment efficacy As enteropathy i
Page 86 and 87: Influence of isoniazid resistance o
Page 88 and 89: • Patients with sputum smear-posi
Page 90 and 91: medications were taken daily throug
Page 92 and 93: of the disease, as alternative drug
Page 94 and 95: Number of cases per 100,000 populat
Page 96 and 97: number of cases, the health care pr
Page 98 and 99: necessary). If the event occurs in
Page 100 and 101: The patient with acute renal toxici
Page 102: and no association with diarrhea. 5
Page 105 and 106: Schools Contacts of new cases Conta
Page 107 and 108: too small to allow a meaningful int
Page 109: Cases per 1,000 140 120 100 80 60 4
Page 113 and 114: mendation by WHO states that no pri
Page 115 and 116: the number of person-years of obser
Page 117 and 118: • protection afforded by vaccinat
Page 119 and 120: Saskatchewan Saskatchewan Chicago C
Page 121 and 122: Three retrospective studies among c
Page 123 and 124: Harm / protection (%) 20 0 -20 -40
Page 125 and 126: • Differences in virulence of M.
Page 127 and 128: infected persons may thus mask any
Page 129 and 130: If environmental mycobacteria do in
Page 131 and 132: Relative risk (log scale) 10 3 1 0.
Page 133 and 134: Because BCG vaccination is given ea
Page 135 and 136: the largest purchaser in the world)
Page 137 and 138: made here to provide a comprehensiv
Page 139 and 140: year following commencement of trea
Page 141 and 142: might be expected, therefore, that
Page 143 and 144: tionally considered to belong to gr
Page 145 and 146: Prevention of disease following ces
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Page 149 and 150: ��
Page 151 and 152: � ��
Page 153 and 154: Table 11. Preventive therapy - effe
Page 155 and 156: Logistical problems may, however, i
Page 157 and 158: In an uncontrolled study in Zambia,
Page 159 and 160: In none of the nine prospective tri
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is not usually an option, this is t
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Like other aminoglycosides, amikaci
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twice rather than once per day, red
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Quinolones Quinolones have a potent
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Rifapentine Rifapentine (cyclopenty
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published a scientific blueprint fo
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to that of isoniazid. 1162 It appea
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Appendix 3 Current vaccine developm
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this type of vaccine may not only p
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15. Goldman AL, Braman SS. Chest 19
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44. Heym B, Alzari PM, Honoré N, C
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76. McCurdy PR, Donohoe RF. Pyridox
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112. Van den Brande P, van Steenber
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147. Murray FJ. Outbreak of unexpec
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183. Acocella G, Conti R, Luisetti
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215. Prazuck T, Fisch A, Simonnet F
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248. Powell-Jackson PR, Jamieson AP
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281. LeBel M, Masson E, Guilbert E,
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310. Yeager RL, Munroe WGC, Dessau
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341. Crowle AJ, Sbarbaro JA, Judson
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376. Graham SM, Daley HM, Salanipon
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410. Paradelis AG, Triantaphyllidis
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443. Nunn P, Kibuga D, Gathua S, Br
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471. Mitchison DA. Basic mechanisms
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501. East African / British Medical
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526. East African / British Medical
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554. Medical Research Council. Five
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580. Nolan CM. Failure of therapy f
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606. Crofton J, Chaulet P, Maher D,
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631. Weis SE, Slocum PC, Blais FX,
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662. Griffith AS. A study of the BC
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695. Horwitz O, Meyer J. The safety
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723. World Health Organization. Rec
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756. Al-Kassimi FA, Al-Hajjaj MS, A
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785. Comstock GW, Webster RG. Tuber
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814. Vynnycky E, Fine PEM. The annu
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843. Talic RF, Hargreve TB, Bishop
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871. Pamra SP, Mathur GP. Effects o
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897. American Thoracic Society, Cen
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924. Elliott AM, Halwiindi B, Bagsh
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957. Escobar JA, Belsey MA, Dueñas
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989. Hoffner SE, Källenius G. Susc
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1021. Helmy B. 220-5. Side effects
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1053. Thomas L, Naumann P, Crea A.
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1083. Perumal VK, Gangadharam PRJ,
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1109. Lucchesi M. L’éthionamide
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1141. Ashtekar DR, Costa-Perira R,
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1165. Oleksijew A, Meulbroek J, Ewi
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1193. Hondalus MK, Bardarov S, Russ
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IMPRESSION, BROCHAGE IMPRIMERIE CHI
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