In each arm children's BCG vaccination status was assessed by BCG scar reading and baseline information was collected. Our study describes the BCG scar reactivation after exantema subitum and influenza vaccine, suggesting that other non-specific stimuli might trigger the BCG reactivation 31. Declaration of transparency: IA affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Our results also suggest that models of BCG impact should be revised to include an effect against infection and consequently latent M tuberculosis infection and reactivation as without this the effect of BCG would be underestimated. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Where results of both assays were available from a study we chose the QuantiFERON result as this was most used among the selected studies. Five articles provided information on degree of exposure to infectious cases.11 12 13 27 29 Three articles reported that BCG vaccination was given at birth,13 26 27 while the remaining articles did not provide time of vaccination. RJH was responsible for the statistical analysis. Kawasaki disease presenting with reactivation of BCG scar M N Lucas 1, R Ajanthan 2 Sri Lanka Journal of Child Health, 2008; 37: 100 (Key words: Kawasaki Disease, reactivation of BCG scar) A 2½ month old baby boy presented to ward 1 Lady Ridgeway Hospital on 2/7/2008 with fever of 4 days duration. Eight of the 10 Quantiferon studies used Quantiferon In Tube Gold, which includes a further antigen (TB7.7). In the appropriate setting a skin biopsy may serve to establish the diagnosis of sarcoidosis and avoid more invasive attempts at obtaining tissue. Countries with a policy of vaccination at birth tend to be those countries with a higher incidence of tuberculosis (cut off >20/100 000 according to European Centre for Disease Prevention (ECDC)) than those countries without such vaccination policy (<20/100 000). We defined studies of high quality as those that scored ≥66.6%, moderate for 33.3-66.6%, and low for those <33.3%. Our results should be treated with caution for several reasons. Based on a modified Newcastle-Ottawa scale, we considered three studies to be of high quality, eight of moderate quality, and three of low quality (table⇑ and see appendix 2 for details). Trial registration PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/). IA is supported by the UK National Institute for Health Research and the UK MRC. Understanding RSV, a major cause of respiratory illness in infants. This was achieved by examining, in this subset, the number of children with active disease (regardless of assay status) in those who received BCG versus those who did not. All authors contributed to planning, interpretation and writing of the manuscript and critically revised the manuscript for intellectual content. A small number of additional cases might have been included as some outbreak investigations were undertaken over a period of several weeks. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77). Vaccine efficacy was higher in Salvador (19%, 3 to 33%) than in Manaus (1%, −27 to 27%) with the highest vaccine efficacy in children from Salvador aged <11 years at revaccination (33%, 3 to 54%). Infection was defined as any positive results of interferon γ release assays in contacts irrespective of whether they had evidence of active tuberculosis or not. We found evidence of progression to active tuberculosis as identified at point of screening of index cases. The purpose of this study was to evaluate the frequency of reactivation of the BCG in Mexican children diagnosed with KD. SH and LS contributed to the literature search and quality assessment. This test cannot distinguish a positive response caused by M tuberculosis infection from that caused by BCG vaccination or non-tuberculous mycobacterial infection.9 The recently developed T cell based interferon γ release assays (IGRA) can detect M tuberculosis infection and discriminate this from previous BCG vaccination and most non-tuberculous mycobacterial infections,10 allowing investigation of whether BCG protects against M tuberculosis infection.11 12 13 If BCG is found to protect against infection, it will have key implications for its use in current immunisation programmes14 as well as in the future development of new improved tuberculosis vaccines. We use cookies to help provide and enhance our service and tailor content and ads. Our results provide evidence that BCG protects against tuberculosis infection from multiple epidemiologically different settings and independent of the type of interferon γ release assay used to detect infection. Where assessed, the main differences in the subgroup analyses were for rating on the Newcastle-Ottawa scale, the P value for which was similar under the permutation test recommended by Higgins and Thompson.17 Similarly, the small number of studies limited the power to explore whether the variation in protection by BCG against tuberculosis is mostly through variation in protection against infection. Design Systematic review and meta-analysis. D+L=DerSimonian and Laird method; M-H=Mantel-Haenszel method. We searched Embase (1980 until November 2013), Medline (1950 until November 2013), and the Cochrane Library as well as reference lists of retrieved articles and conference abstracts. Further stratification by ELISpot, Quantiferon, and Quantiferon In Tube showed no evidence of inconsistency (data not shown). IA is guarantor. In addition, transparent reporting from outbreak and contact studies of individual ages and time of vaccination and exposure to tuberculosis of participants should allow future meta-analysis to investigate protection against infection. The main use of BCG is for vaccination against tuberculosis.BCG vaccine can be administered after birth intradermally. Data were not always complete, and we could not control for, or explore interaction with, all variables. We also reviewed the personal libraries of the research team. The authors describe an infant presenting at 2 weeks of age with congenital acute lymphoblastic leukemia who had previously received routine bacille Calmette-Guérin (BCG) vaccination at birth. The scarcity of evidence on whether the vaccine is effective against Mycobacterium tuberculosis infection was because of limitations of the tuberculin skin test. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Objectives To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children. All studies included non-immunocompromised populations, with low probability that specific cut off values are required. A further potential source of bias relates to the greater likelihood that private paediatricians who care for children from medium and high socioeconomic levels might recommend against BCG vaccination if they consider these children to be at a lower risk of infection. Discrepancy in quality assessment was discussed and resolved by the two reviewers. With the extended follow-up (9 years) and the additional cases accrued we now have enough power to report vaccine efficacy separately for the two cities (with different distances from Equator and presumably different prevalence of non-tuberculosis mycobacteria), and by age at vaccination and clinical form. We also looked at factors that could alter the measured protective effect of BCG: latitude, the recommended age of vaccination in the area where the study was conducted, type of assay, and study quality. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Analysis was performed with the DerSimonian and Laird random effects model, which incorporates variation between studies in the weighting.

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