Tuberculosis is a serious health problem in developing countries. One way to overcome this is to offer immunization
to all newborns using BCG vaccine. BCG vaccine is safe but known to be associated with complications. The aim of this report
was to evaluate the safety of BCG vaccine in Eastern Province, Saudi Arabia and outline our management for BCG vaccine related
The records of infants with BCG vaccine complications were retrospectively reviewed for: age, sex, birth weight, gestation,
presentation, treatment and outcome. All were immunized (BCG vaccine SSI, Copenhagen, Denmark, 0.05 ml injected intradermally
in the left arm by a constant group of 3 trained nurses) within 48 hours after birth.
Over a 3 years period (10.3.2008 to 10.3. 2011), 26,000 newborns received BCG immunization and 81 (51 M and 30 F)
developed complications. This gives an incidence of 3.12 complications/1000 newborn. Their mean age was 4.8 months (2 months ?
12 months). Their presentations were: (L) axillary lymphadenitis (n= 62), (L) supraclavicular lymphadenitis (n= 9), local collection
at immunization site (n= 6), (L) cervical lymphadenitis (n= 1), bilateral axillary lymphadenitis (n= 1), (L) arm abscess (n= 1) and (L)
axillary lymphadenitis and local collection (n= 1). All were normal immunologically except two (SCID and HIV). These received
anti-tuberculous drugs in addition to surgery. The 6 with localized collection were aspirated only while the patient with (L) arm
abscess had incision and drainage. Those with simple lymphadenitis (n=5) were treated expectantly and resolved. The patients
with suppurative lymphadenitis were treated with total excision (n= 65) or incision and drainage (n= 3) without anti-tuberculous
Although, the use of BCG vaccine may be associated with side effects (a relatively high incidence of suppurative
lymphadenitis), the potential morbidity and mortality from tuberculosis outweighs that from BCG related complications. BCG
vaccine should be administered to all newborn where there is high prevalence of tuberculosis. BCG is contraindicated for
immuodeficient infants. Non-suppurative lymphadenitis can be treated conservatively, while suppurative lymphadenitis should be
excised. This is safe, avoids rupture and shortens the recovery period without the need for anti-tuberculous therapy.
Graduated in October 1981 from King Faisal University, College of Medicine and Medical Sciences, Dammam, Saudi Arabia. Awarded prize for
best Graduate of the Year. In January 1985, awarded prize by the Royal College of Surgeons of Ireland as the best candidate in the Primary FRCSI
Examination. In February 1987 awarded the Fellowship from The Royal College of Surgeons of Ireland. Currently working as a consultant pediatric
surgeon and consultant pediatric urologist at Maternity and Children Hospital, Dammam, Saudi Arabia. Published more than 245 papers in reputed
Journals. Reviewed more than 80 manuscripts for different Journal. Serving as an Editorial Board member of three Journals.
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