Journal tackles pros and cons of BCG
Journal tackles pros and cons of BCG
With more cases of tuberculosis in the United States resulting from primary infection than previously believed, two TB researchers argue that bacillus of Calmette and Guerin (BCG) should be used more liberally in this country. Others, however, argue that the vaccine's effectiveness remains questionable and its benefit among health care workers is still ambiguous.
The renewed debate over BCG was published in the March issue of Infection Control and Epidem iology. The Centers for Disease Control and Pre ven tion recommends BCG only for health care workers who work in high-risk situations where drug-resistant TB is prevalent.
Two researchers from Australia explain their reasons for increasing the use of BCG in health care workers who come into regular contact with TB patients, arguing that BCG is a more practical alternative to 12 months of isoniazid prophylaxis for skin-test positive health care workers.
Although TB rates have declined in the United States in recent years, health care workers continue to be exposed. Recent reports also have shown that as many as two-thirds of drug-resistant TB cases result from recent infection rather than reactivation, they point out.
In an editorial reviewing the most recent thinking about BCG, David Henderson, MD, director of clinical care at the National Institutes of Health's Clinical Center, concludes that current information on the use of BCG in health care workers is conflicting and may never be cleared up. The most recent meta-analysis found BCG to be 50% effective at best.
"In my own view, it is clear that the questions of efficacy and the appropriateness of BCG immunization of health care workers in low-prevalence area remains unanswered," he writes.
The Australian researchers note that a large prospective trial of BCG could answer those questions and the United States is one of few countries in which a BCG trial could be carried out because so many health care workers have not been vaccinated.
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