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Primary Immunodeficiency Diseases and Bacillus Calmette-Guerin (Bcg)-Vaccine–Derived Complications: A Systematic Review Publisher Pubmed



Fekrvand S1 ; Yazdani R1 ; Olbrich P2 ; Gennery A3 ; Rosenzweig SD4 ; Condinoneto A5 ; Azizi G6 ; Rafiemanesh H7 ; Hassanpour G8 ; Rezaei N1, 9 ; Abolhassani H10, 11 ; Aghamohammadi A1
Authors
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Authors Affiliations
  1. 1. Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
  2. 2. Seccion de Infectologia e Inmunopatologia, Unidad de Pediatria, Hospital Virgen del Rocio/Instituto de Biomedicina de Sevilla, Seville, Spain
  3. 3. Institute of Cellular Medicine, Newcastle University, and Paediatric Immunology and Haematopoietic Stem Cell Transplantation, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
  4. 4. Immunology Service, Department of Laboratory Medicine, National Institutes Clinical Center, National Institutes of Health, Bethesda, Md, United States
  5. 5. Department of Immunology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
  6. 6. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
  7. 7. Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  8. 8. Center for Research of Endemic Parasites of Iran, Tehran University of Medical Sciences, Tehran, Iran
  9. 9. Network for Immunology in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network, Tehran, Iran
  10. 10. Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
  11. 11. Research Center for Primary Immunodeficiencies, Iran University of Medical Sciences, Tehran, Iran

Source: Journal of Allergy and Clinical Immunology: In Practice Published:2020


Abstract

Background: Bacillus Calmette-Guerin (BCG) vaccine is a live attenuated bacterial vaccine derived from Mycobacterium bovis, which is mostly administered to neonates in regions where tuberculosis is endemic. Adverse reactions after BCG vaccination are rare; however, immunocompromised individuals and in particular patients with primary immunodeficiencies (PIDs) are prone to develop vaccine-derived complications. Objective: To systematically review demographic, clinical, immunologic, and genetic data of PIDs that present with BCG vaccine complications. Moreover, we performed a meta-analysis aiming to determine the BCG-vaccine complications rate for patients with PID. Methods: We conducted electronic searches on Embase, Web of Science, PubMed, and Scopus (1966 to September 2018) introducing terms related to PIDs, BCG vaccination, and BCG vaccine complications. Studies with human subjects with confirmed PID, BCG vaccination history, and vaccine-associated complications (VACs) were included. Results: A total of 46 PIDs associated with BCG-VAC were identified. Severe combined immunodeficiency was the most common (466 cases) and also showed the highest BCG-related mortality. Most BCG infection cases in patients with PID were reported from Iran (n = 219 [18.8%]). The overall frequency of BCG-VAC in the included 1691 PID cases was 41.5% (95% CI, 29.9-53.2; I2 = 98.3%), based on the results of the random-effect method used in this meta-analysis. Patients with Mendelian susceptibility to mycobacterial diseases had the highest frequency of BCG-VACs with a pooled frequency of 90.6% (95% CI, 79.7-1.0; I2 = 81.1%). Conclusions: Several PID entities are susceptible to BCG-VACs. Systemic neonatal PID screening programs may help to prevent a substantial amount of BCG vaccination complications. © 2020 American Academy of Allergy, Asthma & Immunology
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