Objective: We aim to describe Bacille Calmette Guerin (BCG) complications in Gaza using two studies: one during an outbreak and the other after control of the possible contributing factors to this outbreak.
Methodology: The first study was conducted on 6145 newborn infants vaccinated in 21 primary care centres in Gaza with BCG vaccine, Pasteur Paris, batch number 5122 from July to October 2001. The study was repeated after changing the BCG vaccine and training 63 nurses from November to December 2001. The training program included theoretical lectures on BCG and tuberculosis and practical training in strict intradermal injection. The second study included 6877 newborn infants vaccinated with BCG vaccine, batch number 101023, Denmark, from January to April 2002.
Results: During the outbreak, BCG complications occurred in 225 infants with a complication rate of 36.61 per 1000 vaccinations. The mean age at presentation was 4 months. The commonest complications were regional lymphadenitis in 138 (61.33%) infants, local abscess in 48 (21.33%) infants, local ulcer in 26 (11.56%) infants, keloid scar in 12 (5.33%) infants and one (0.44%) infant who died from disseminated disease had severe combined immunodeficiency. In the follow-up study, BCG complications occurred in 43 infants with a complication rate of 6.25 per 1000 vaccinations, which is significantly lower (P < 0.001) than that during the initial outbreak.
Conclusion: The study supports the use of a less virulent vaccine and proper vaccination techniques to minimize the incidence of BCG complications. The training of nurses in strict intradermal injection should be maintained and the proper selection of those receiving the vaccines should be considered to avoid the vaccination of any infant with immunodeficiency.