What is BCG reaction? What can parents expect at site of the BCG vaccine?
One common concern that parents have is related to the slight swelling and blistering that happens at the site of the BCG vaccine, usually given in the left upper arm (Deltoid region). Most reactions are minor and heal with a small scar, which serves as a confirmation of the vaccine. Very rarely, we get an exaggerated reaction, abscess formation or local lymph node enlargement under the armpit which may need further review. Please share.
For more detailed information on the BCG vaccine, do review • BCG vaccine. Why should we give BCG v...
The BCG vaccine or Bacillus Calmette Guerin is the vaccine for tuberculosis (live inactivated vaccine), It is usually given in the newborn period in the left deltoid region in the upper part of your arm. The BCG vaccine protects against the severe childhood forms of Tuberculosis (Tuberculous meningitis and Miliary TB, both of which are severe infections in young children under 5 years of age).
It's a convention to give it there as the studies which look at the benefits of the BCG vaccine have looked at the immune response based on the skin thickness and other characteristics at this site (one reason why it is not recommended by WHO to give it over the thigh or other sites). It's an intradermal injection given into the skin layers-it's a special technique (tricky to get the needle exactly into the skin layer) and an initial wheal comes up after the injection, but after that, there is no reaction seen for a few weeks.
After three to four weeks, you start seeing a bump in that region. This bump often worries parents because they are not clear about what it is. Be aware that it is an expected reaction to the BCG vaccine. It's actually a good thing to have it because you know that your baby is responding to the BCG vaccine in the right way.
So, what happens to this bump? It becomes a blister, the fluid may break out and sometimes the fluid reaccumulates once the scab covering it sloughs off. This process might repeat (cycle) three or four times like this. It's a sterile fluid, there is no infection and it's not pus-you don't need antibiotic creams over it but keep the area clean. You can clean the area with wet cotton and continue to monitor. Usually after three or four cycles like this over a month or so it scabs and leaves a very thin scar.
As the baby grows, this scar is usually taken as an indication that the baby has had the BCG vaccine and has reacted. Sometimes a BCG mark doesn't come up-the intradermal injection technique is difficult, sometimes the injection is not successful as mentioned above. If there is a high risk of tuberculosis contact, we would suggest doing a Mantoux test after three months of age or a PPD (Mantoux) test which is given in the forearm of the baby to see if the baby has reacted. If there is no reaction, the vaccine can be given a second time. This is optional however. We do see some babies who react more with the BCG vaccine when it is given to older kids, and so you have to discuss the possibility. If you do the Mantoux test, do not delay the BCG vaccine subsequent to that as it may cause an exaggerated reaction-as the Mantoux test itself sensitizes the baby to the tuberculosis antigen.
Some babies develop BCG adenitis (swelling of lymph node in the armpit area) or BCG abscess, which is a large abscess formation at the injection site. Thankfully, both these severe reactions are very uncommon, and they can be managed by referral to pediatric surgeon, and consideration for antituberculous medicine based on severity and referring to local guidelines (not all of them need medication).
I hope this information is helpful, do review the videos linked here and do share as well.
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