Interventions for Tuberculosis Control and Elimination 2002

mendation by WHO states that no principal changes in BCG vaccine policy
are warranted unless children present with symptomatic HIV infection, 721
a statement that has not been challenged. 722,723
Management of adverse reactions due to BCG vaccination
Children with lymphadenitis due to BCG were randomly allocated to receive
either isoniazid or no treatment. 724 There was no difference in the duration
of lymphadenitis between the two groups, nor did isoniazid prevent
the occurrence of suppuration. Similarly, children with abscess formation
were randomly assigned to receive either isoniazid or erythromycin (serving
as placebo). 725 The response in each treatment group was the same.
In another study, comparing excision, excision plus isoniazid, and isoniazid
alone compared to a control group without intervention, no significant differences
were observed between the various interventions, and in particular,
isoniazid offered no advantage. 726 Non-suppurative lymphadenitis is a
normal reaction, and is best left without antibiotic treatment. 690,727
Patients with suppurative lymphadenitis following BCG vaccination
were randomly assigned to treatment with simple needle aspiration, introducing
the needle subcutaneously two to three centimeters distant from the
node, versus no treatment. 728 Regression was significantly faster in the
treated than in the non-treated group, and spontaneous drainage was less
frequent.
For osteoarticular mycobacteriosis due to BCG, combination therapy
is indicated, but results were not always favorable (both in terms of sequelae
and relapses) in a case series from Sweden. 729
A standard course of treatment (as for clinically manifest tuberculosis)
is also indicated in disseminated mycobacteriosis due to BCG. As this
is a rare complication, however, treatment regimens have not been amenable
to formal study. In treatment, it should be kept in mind that BCG is, like
its parent organism, M. bovis, naturally resistant to pyrazinamide.
Efficacy and effectiveness of BCG vaccination
Efficacy is the extent to which an intervention produces a beneficial result
under ideal conditions. The best setting to address efficacy is thus prospectively,
in a controlled clinical trial. In contrast, effectiveness takes the various
constraints that are found in the field into account in the actual routine
delivery of the intervention. 730 Effectiveness is often ascertained
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