铜陵市婴幼儿卡介菌纯蛋白衍生物试验结果分析

目的了解卡介苗（BCG）预防接种质量,分析存在的问题及其影响因素,提出改进措施,促进预防接种规范、安全、有效地开展。方法用卡介菌纯蛋白衍生物（BCG-PPD）试验方法,随机调查300名儿童接种卡介苗3个月后的阳转率。结果卡介菌纯蛋白衍生物试验总阳性率86.33%,城市儿童卡介菌纯蛋白衍生物试验阳性率高于农村儿童。卡痕大小与卡介菌纯蛋白衍生物试验阳性率呈正相关;县级及以上医院产科接种卡介苗的儿童卡介菌纯蛋白衍生物试验阳性率高于乡镇级医院产科和预防接种门诊接种卡介苗的儿童。结论加强对卡介苗接种人员,尤其要加强农村乡镇卫生院和接种门诊的接种人员的技术培训,提高接种质量。     

BCG—PPD与TB—PPD皮肤试验在大学生结核病筛查中的差异性分析

目的 比较卡介菌纯蛋白衍生物（purified protein derivative of BCG,BCG-PPD）与结核菌素纯蛋白衍生物（purified protein derivative of tuberculin,TB-PPD）在大学生结核病筛查中的差异。 方法 回顾性分析2012—2013年北京市西城区3所大学2821名学生的结核病筛查数据。根据使用的PPD试剂种类进行分组,BCG-PPD组学生1386名;TB-PPD组学生1435名。对两组观察者分别进行结核菌素试验,72 h查验硬结平均直径,对强阳性者进行胸部X线检查。采用SPSS 11.5软件进行统计分析,用秩和检验对两组硬结平均直径进行比较,用χ^2检验对组间PPD结果分布频度及结核病筛查结果进行比较,当理论值＜1时,采用Fisher确切概率法,卡痕与PPD阳性结果间相关性分析采用logistic回归,P〈0.05为差异有统计学意义。结果 中位硬结平均直径BCG-PPD组（6 mm）大于TB-PPD组（0 mm）,差异有统计学意义（Z=－10.034, P〈0.05）。BCG-PPD组的阳性率（54.8%, 759/1386）明显高于TB-PPD组（32.7%,469/1435）（χ^2=139.818,P〈0.05）;PPD强阳性率BCG-PPD组为6.6%（92/1386）,高于TB-PPD组的3.4%（49/1435）（χ^2=15.425,P〈0.05）;BCG-PPD组的异常反应发生率为1.9%（27/1386）,高于TB-PPD组的0.4%（6/1435）,差异有统计学意义（χ^2=14.274,P〈0.05）。卡痕与PPD阳性结果相关,有卡痕者更容易出现PPD阳性结果（OR=2.046,95％CI=1.630～2.569,P〈0.05）。 结论 TB-PPD和BCG-PPD皮肤试验在大学生结核病筛查中的强阳性率和异常反应发生率上存在差别,有进一步探讨的必要。     

卡介菌纯蛋白衍生物和结核菌素纯蛋白衍生物在结核病筛查中差异对比的Meta分析

为探讨卡介菌纯蛋白衍生物(BCG-PPD)和结核菌素纯蛋白衍生物(TB-PPD)在结核病筛查中的差异。笔者检索PubMed、Embase、Medline、Cochrane Library、中国知网和万方数据库从建库至2022年2月期间发表的相关文献,对符合纳入条件的文献采用Open Meta Analyst软件进行Meta分析,采用Rev Man 5.3软件Cochrane偏倚风险评估工具对文献进行质量评价。最终纳入7篇文献,共36 131例参与者,BCG-PPD组参与者18 314例,TB-PPD组参与者17 817例。采用二分类随机效应模型进行分析,合并的OR(95%CI)值为2.072(1.683～2.550),I²=78.73%,P<0.001,存在高度异质性,需要进一步分析异质性的来源。亚组分析结果显示,以学生及新生儿为研究对象的亚组OR(95%CI)值为2.393(2.132～2.686),I²=50.15%,P=0.091,I²值明显下降;以结核病患者为研究对象的亚组OR(95%CI)值为0.481(...     

Bacillus Calmette-Guerin vaccination in preterm infants.

OBJECTIVE: To evaluate the tuberculin response after bacille Calmette-Guérin (BCG) vaccination in preterm infants. METHODS: Thirty-five infants born at <35 weeks gestation were included in the study. An intradermal injection of 0.05 ml BCG vaccine was given to each infant at postnatal months 2-3. Tuberculin skin tests (TSTs) were done 8-12 weeks after vaccination using 0.1 ml of 5 TU purified protein derivative (PPD). The diameter of induration was measured 72 h later and > or =5 mm induration was taken as a positive response. RESULTS: The babies had a mean birth weight (SD) of 1650 (424) g, and a gestational age of 32.4 (2.1) weeks. The TST was positive in 20 (57%) of the infants. The mean body weight of the tuberculin-positive babies was significantly higher than the others at both vaccination and TST. No difference was found between groups concerning sex, birth weight, gestational age, intrauterine growth and postnatal age at BCG vaccination and TST. CONCLUSION: BCG vaccination in preterm infants at months 2-3 of postnatal life results in a high percentage of BCG scarring and 57% TST conversion. A positive tuberculin response was significantly related to the postnatal weight gain of the preterm infants.     

北京城郊学生卡介苗瘢痕与哮喘等过敏性疾病关系的调查

目的　了解卡介苗瘢痕 (卡瘢 )的大小在哮喘过敏学生与正常学生间有否差异 ,比较北京城郊学生间卡瘢直径以及喘息过敏症状的差异。方法　应用“国际间儿童哮喘及其它过敏性疾病对比研究”的统一方案 ,采取整群抽样的方法 ,对北京城区 819名学生及北京郊区 10 4 4名学生进行问卷调查、皮肤变应原点刺试验 (SPT)及卡瘢直径的检测。结果　 (1)对于问卷回答既往有喘息史、近12个月有喘息症状、既往哮喘史、花粉症史、过敏性皮炎史、湿疹史、变应性鼻炎史、SPT有特应性及高敏感性、序列试验确诊哮喘以上 10项指标的阳性组学生卡瘢平均直径为 (7 0± 2 1)mm～ (8 8± 2 8)mm ,阴性组学生卡瘢平均直径为 (7 2± 2 7)mm～ (8 2± 2 2 )mm ,每项指标阳性组与阴性组卡瘢直径间的比较差异均无显著性 (P >0 0 5 ) ;(2 )郊区学生卡瘢平均直径为 (8 2± 2 3)mm ,城区学生为(7 3± 2 9)mm ,城市与郊区比较差异有显著性 (P <0 0 1) ;对于问卷回答既往有喘息史、近 12个月有喘息症状、既往哮喘史、花粉症史、过敏性皮炎史、湿疹史、变应性鼻炎史、SPT有特应性 8项指标 ,郊区学生的阳性率为 0 6 %～ 11 4 % ,城区学生的阳性率为 3 1%～ 35 7% ,城市与郊区比较差异均有显著性 (P <0 0 1)。结论　在相同生活环境     

不同毒力结核杆菌的纯化蛋白质衍生物对人巨噬细胞凋亡的诱导及其与Toll样受体-2的相关性

目的 了解两种不同毒力结核杆菌的纯化蛋白衍生物刺激下人单核-巨噬细胞(THP-1)凋亡的差异及其与Toll样受体-2(TLR-2)的相关性.方法 分别用等浓度的高毒力结核杆菌衍生蛋白(H37Rv-PPD)和低毒力结核杆菌衍生蛋白(BCG-PPD)在3、8、15和24 h刺激分化成熟的THP-1细胞;Hochest染色后观察细胞凋亡及坏死情况.流式细胞仪检测细胞Annexin V蛋白以判定凋亡及TLR-2表达情况;加入TLR-2阻断剂后,再用流式细胞仪测定细胞表面TLR-2的阻断效果及凋亡情况.结果 BCG-PPD刺激下细胞以凋亡多见,而H37Rv-PPD刺激下细胞核则多呈坏死状.凋亡率随时间升高,第24小时凋亡比例高达30.2%,而同时间点TLR-2的比例为8.8%;应用TLR-2阻断剂后,每个时间点TLR-2表达比例均在3%以下,对应时间点凋亡比例下降,第24小时凋亡比例仅为10.5%.H37Rv-PPD可引起TLR-2高表达,第24小时TLR-2表达率为17.2%,该时间点凋亡率仅为7.7%;TLR-2阻断后,其表达率在对照波动范围内,但凋亡率与TLR-2未阻断前相比变化不大.结论 BCG-PPD主要诱导THP-1的凋亡,且与TLR-2有一定的相关性;而H37Rv-PPD主要诱导THP-1的坏死.

Abstract：

Objective To study the cell death in macrophages (THP-1) stimulated with different agonists (H37Rv-PPD or BCG-PPD) and to investigate the relationship between Toll like receptor (TLR)-2 and THP-1 apoptosis. Methods H37Rv-PPD and BCG-PPD were used to stimulate THP-1 cells for 3 h, 8 h, 15 h and 24 h, respectively with or without TLR-2 blockade. Cells were analyzed by flow cytometry to detect the TLR-2 expression. Annexin V staining and Hochest staining were performed to evaluate apoptosis. Results The apoptosis cells were increased when stimulated with BCG-PPD and the percentage was 30.2% at 24 h, which were confirmed by Hochest staining.However, the expression of TLR-2 did not increase simultaneously with percentage of 8.8% at 24 h.Nevertheless, most cells presented with necrosis form when stimulated with H37Rv-PPD and the expression of TLR-2 remained at high level with the percentage of 17.2% at 24 h, while the percent of apoptosis rate was only 7.7%. Under treatment of TLR-2 antibodies, the percentage of apoptosis decreased to 10.5% at 24 h of BCG-PPD stimulation and TLR-2 expressions were down-regulated to less than 3% at all time points; but after H37Rv-PPD stimulation, the percentage of apoptosis and TLR-2 expression did not changed obviously. Conclusions The attenuated BCG-PPD induces THP-1 apoptosis predominately, which is partially correlated with TLR-2 expression. While virulent H37Rv-PPD induces THP-1 necrosis predominately.     

Bacillus Calmette-Guérin immunization in infants born to HIV-1-seropositive mothers

During the prospective follow-up of 64 babies at risk for perinatal HIV-1 infection because their mothers were seropositive, and of 130 control babies whose mothers were seronegative, we studied the occurrence of complications of bacillus Calmette-Guérin (BCG) immunization and its ability to induce cutaneous reactivity to tuberculin. Babies born both to HIV-1-positive and HIV-1-negative mothers received BCG immunization during their first month of life according to the Expanded Programme on Immunization (EPI) recommendations. Local and regional complications of BCG vaccine were looked for at 3, 6 and 9 months after inoculation. A tuberculin skin test was performed at 6 or 9 months of age. Most babies born to HIV-1-positive mothers were later classified as infected or uninfected according to their clinical condition and/or serological status at 18 months of age. The mean duration of the follow-up was 36 months (range 30-40 months). No chronic or deep ulcerations at the site of injection or disseminated forms of BCG infection were observed. The frequency of BCG-related lymphadenitis in the group of HIV-1-infected children (24%) did not differ significantly from the group of uninfected children (19%; Fisher test: P = 0.73). In contrast, the tuberculin skin test responses were positive less often in the group of HIV-1-infected children (33%) than in the uninfected group (83%; Fisher test: P = 0.007). Because BCG vaccine appears to be safe--even when given to perinatally infected babies--continuation of the BCG immunization policies of the EPI is justified, especially in view of the growing incidence of tuberculosis as a complication of HIV infection.     

Incidence of lymphadenitis following Bacillus Calmette-Guérin (BCG) vaccination in north Indian children

IntroductionBacillus Calmette-Guerin (BCG) vaccination is given as a part of the national immunization schedule in India and its most common complication is BCG lymphadenitis. The reported incidence of BCG lymphadenitis ranges from 0.1 to 9.9% in various studies. In our country, though most babies get BCG vaccination during the neonatal period, the incidence of BCG lymphadenitis is not studied well.AimsTo study the incidence of lymphadenitis following BCG vaccination at tertiary care hospital in North India.MethodsIt was a prospective longitudinal observational study. All newborns weighing ≥1.5 kg at birth without any significant illness who received BCG vaccination at our institute were enrolled and followed up for 16 weeks after vaccination. Babies were examined at 6, 10 and 14 weeks for the development of lymphadenopathy. Meta-analysis of studies evaluating incidence of BCG adenitis in children was also performed.ResultsOut of 817 babies vaccinated during the enrolment period, 605 babies could be followed up till 16.2 ± 0.9 weeks post BCG vaccination. One case of BCG lymphadenitis was detected at 14 weeks. Thus, the observed incidence of BCG lymphadenitis was 0.16% (95% CI of 0.004%–0.92%). Meta-analysis of 21 studies showed mean incidence estimate of 0.336% (95% CI: 0.315%–0.358%) using fixed effect model whereas random effect model showed mean incidence of 4.45% (95% CI: 3.02%–6.15%).ConclusionThe lower incidence of lymphadenitis in our study can probably be attributed to a less immunogenic vaccine (Danish 1331), proper technique, experience of the vaccinator and good storage facilities available at our institute.     

Tuberculosis screening results made at primary schools in Cizre

Tuberculosis (Tbc) gained importance as a public health problem in the recent years. The course of the disease is more severe in childhood. Tbc screening was made by The Tuberculosis Control 11th Group Presidency on the primary school students in Cizre, in November 2005. A total of 2242 children have been taken to this study. Of the children, 1130 (50.4%) were boys and 1112 (49.6%) were girls. The mean age of the children was 6.9+/-0.8 (range, 4-14) years. Concerning Bacillus Calmette-Guerin (BCG) vaccine scar, 1676 (74.7%) children had no scar, 536 children (23.9%) had single scar, and 32 children (1.4%) had double scar. The mean diameter of the tuberculin skin test (TST) was 2.1+/-2.7 mm. Regarding sexuality and TST mean diameter, statistically significant relation was not detected between girls and boys (p=0.3). The mean diameter of TST were 1.5+/-1.4 mm, 3.5+/-4.0 mm and 11.2+/-3.3 mm in the children with no BCG scar, in those with single BCG scar, and in those with double BCG scar, respectively. Of the TST results of all children, 2065 (92.1%) were negative, 101 (4.5%) were attributed to BCG, and 76 (3.4%) were positive, respectively. The rate of positiveness of TST was 1.2% in the children with no BCG scar, 8.9% in the children with single BCG scar, and 50% in the children with double BCG scar, respectively. A statistically significant correlation between the increase in the BCG scar number and the increase in the TST mean diameter was detected (p<0.05). Of the children who were likely to have Tbc, 139 (6.2%) were advised to apply at the dispensary. Single BCG vaccination was inadequate in the children. We suggest encouraging the families about postpartal single BCG vaccination. Furthermore, school screenings should be paid greater attention.     

300例BCG接种后淋巴结及接种局部异常反应和处理

目的 探讨婴幼儿卡介苗（BCG）接种后淋巴结肿大不同情况的处理方法.方法 对南京市1 891 640名接种BCG的婴幼儿中发生的300例淋巴结肿大异常反应及处理方法进行回顾性分析.结果 300例婴幼儿BCG接种后回流区淋巴结有不同程度的肿大,淋巴结肿大主要分布于注射侧腋下,占54.7%,次为接种局部皮下深部脓肿,占38.0%.对于淋巴结肿大早期采用简单易行的微波治疗和热敷治疗,治愈率在55.0%以上,脓肿形成者进行切开引流,其治愈率达100.0%.结论 根据淋巴结肿大不同的情况,可采取不同的治疗方法.     

300例BCG接种后淋巴结及接种局部异常反应和处理

目的探讨婴幼儿卡介苗(BCG)接种后淋巴结肿大不同情况的处理方法。方法对南京市1 891 640名接种BCG的婴幼儿中发生的300例淋巴结肿大异常反应及处理方法进行回顾性分析。结果300例婴幼儿BCG接种后回流区淋巴结有不同程度的肿大,淋巴结肿大主要分布于注射侧腋下,占54．7％,次为接种局部皮下深部脓肿,占38．0％。对于淋巴结肿大早期采用简单易行的微波治疗和热敷治疗,治愈率在55．0％以上,脓肿形成者进行切开引流,其治愈率达100．0％。结论根据淋巴结肿大不同的情况,可采取不同的治疗方法。     

北京市新生儿卡介苗接种质量的监测

目的　了解近10年来北京市新生儿卡介苗接种工作的质量情况。方法 对1991～2000年本市各年新生儿卡介苗接种工作记录和质量监控结果记录进行统计,逐年分析。结果 近10年全市新生儿卡介苗接种率(简称接种率)、接种及时率、接种后12周结素试验阳转率(简称阳转率)和卡痕率以及结素反应平均直径、卡痕平均直径等6项指标均比较稳定。城区、近郊区和远郊区的接种率无明显差别,均在97%以上;农村的阳转率和结素反应平均直径两项指标也非常接近城区(包括近郊区)。结论 北京市新生儿卡介苗接种工作质量较高并在近10年中保持了各项监测指标的稳定。     

BCG vaccination in the world

BCG vaccination programme and BCG vaccination coverage in the world were summarized mainly based on the published informations from official organizations, such as World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Centers for Disease Control and Prevention (CDC). From this review, we can see how widely BCG has been used for the prevention of tuberculosis in the world. In most of the developing countries, especially in Africa, the Americas, and Pacific Region, BCG vaccination is carried out to newborn babies soon after birth by intradermal injection according to the recommendations from WHO, but some of the developing countries in Asia and Europe have their own modified BCG vaccination programmes. In economically developed countries, BCG vaccination programme has been established according to the tuberculosis status of each countries. Some countries have general vaccination policy, and other countries have selected vaccination policy, but there is no country where BCG vaccination is not carried out at all. Among G8 contries, as representatives of the economically developed countries, Japan, United Kingdom, France and Russian Federation have BCG general vaccination policy for the specified age group. In these 4 countries revaccination (s) of BCG are still carried out. In Germany, some provinces have general vaccination policy and some others have selected vaccination policy. In the United States of America, BCG vaccination is recommended to selected high risk infants and health care workers by CDC. There are many debates as for the efficacy and safety of BCG vaccination, and the development of new vaccine better than BCG has been actively discussed and some encouraging results in animal models have been reported from several laboratories. But, there is almost no possibility to be able to use a new vaccine in the routine practice within a couple of years. From the practical point of view, therefore, the operational researches for the better and more appropriate usage of BCG are equally important and more practical than the researches for the development of new vaccines.     

停止卡介苗复种后儿童青少年结核感染及发病的研究

目的　观察停止卡介苗 (BCG)复种后,儿童青少年结核感染及发病情况。方法 1998年分别对北京市房山区12岁学生 (停止BCG复种组)和北京市通州区12岁学生 (未停BCG复种组)行结核菌素 (PPD)试验,72小时测量PPD反应——凡硬结平均直径≥6mm者行胸部X线检查,发现肺部阴影者查痰抗酸菌等。然后,依据PPD反应强度及活动性肺结核病人检出情况测算结核感染率及患病率。结果 停止BCG复种组与未停BCG复种组活动性肺结核病患病率分别为14.8/10万和18.6/10万 (P＞0.05)。结核感染率：以直径≥15mm为结核感染标准,分别为7.9%和19.6% (P＜0.05);以直径≥20mm为标准,分别为3.9%和4.2% (P＞0.05)。由此可见,用于反映停止BCG复种组结核感染与发病的两项主要指标均不高于甚至低于未停BCG复种组。结论 停止BCG复种后不会引起儿童青少年结核感染及发病的增加。同时可节省大量人力、物力和财力,更好实施其它有效的结核病控制措施。     

Comparison of tuberculin skin testing and QuantiFERON-TB Gold-In Tube test in health care workers

The purpose of this prospective, cross-sectional observational study was to compare the tuberculin skin testing (TST) with QuantiFERON-TB Gold-In Tube (QTF-GIT) for the detection of latent tuberculosis infection in healthcare workers (HCWs). The study included 78 volunteers who are HCWs at the same tertiary care teaching hospital for chest diseases and tuberculosis. Participants with active tuberculosis, immunodefficiency or malnutrition were not included. The TST was administered by the Mantoux method. Peptides representing ESAT-6, CFP-10 and TB7-7 were used as TB-specific antigens in the whole-blood Interferon-gamma (IFN-g) assay (QTF-GIT). There was a statistically significant relation between the number of Bacillus Calmette-Guerin (BCG) scars and the diameter of TST (p< 0.01). QTF results according to previous BCG vaccinations did not significantly differ (p> 0.05). There was an intermediate concordance between two tests (k: 0.346). QTF-GIT has a sensitivity of 56.14% (both TST and QTF-GIT are positive), specificity of 90.48% (both TST and QTF-GIT are negative); positive predictive value of 94.12% and negative predictive value of 43.18% and accuracy is 65.38%. There was a statistically significant relation between TST diameter and QTF result (p< 0.01). Latent tuberculosis infection prevalance of our study population was 43% according to QTF-GIT test, 73% according to TST and BCG vaccination rate was 87%. In conclusion, TST is affected by previous BCG vaccinations, QTF-GIT is not. We can recommend QTF-GIT test for the detection of latent tuberculosis infection as an alternative to TST in populations with routine BCG vaccination programme.     

Dactilitis and oligoarthritis after BCG immunotherapy in a patient affected by bladder cancer

The treatment of bladder cancer with Bacillus of Calmette-Guerin (BCG) immunotherapy can induce the appearance of a reactive disorder. The Authors describe a 55-year-old male patient with bladder cancer treated with endovesical instillation of BCG immunotherapy, followed after the fifth application by asymmetric oligoarthritis and dactilitis. The observed positivity of both HLA-B27 and HLA-B51 antigens reinforces the hypothesis of a reactive form, possibly through "molecular mimicry" mechanism. The discontinuation of BCG instillation along which a therapeutic attempt with NSAD failed to improve the rheumatic manifestation, which completely remitted after a four-month course of oral steroids. No relapses of joint and tendon involvement was observed during the following five-month period. The clinico-pathogenetic implications suggested by this case are discussed.     

Immunogenicity of hydrolysate formulas in children (Part 2): 41 case reports.

Hydrolysate formulas (HF) have been developed with the purpose of reducing the allergenicity of cow's milk proteins, thus providing a suitable formula for feeding babies with cow's milk (CM) allergy (CMA). More recently, used for the treatment of CMA HFs have provoked 211 reactions in babies at high risk of atopy . In this paper we report 81 babies, who attended the Allergy and Clinical Immunology Division of the Pediatric Department of Rome University "La Sapienza" (study children) between June 1997 and October 1998, 41 of whom were tested with Nidina HA (a whey partial HF) and 40 with whole CM. Ninety-seven healthy children with no history of atopy of comparable age and sex formed the control group. All study children reacted to Nidina HA and to CM with similar symptoms. All the control babies tested negative. With these 41 case reports the number of reactions to HFs totals 252. These data strongly indicate that partial HFs may be allergenic not only in an already sensitized individual, but also immunogenic in a predisposed baby.     

铜陵市新生儿卡介苗接种质量监测结果分析

目的　探讨提高和确保新生儿BCG接种工作质量的方法和途径。方法 采取完善全市组织管理体系、全员培训、设常年新生儿BCG监测门诊、扩大监测面等措施。结果 1999— 2 0 0 1年 ,新生儿BCG接种率、接种后 12周末PPD阳转率、卡痕率、PPD反应平均直径、卡痕平均直径等监测指标均稳定达标 ,及时发现消除不利因素 ,对接种无效的 10 2名进行了补种。结论 强化组织管理体系 ,全员培训 ,连续、动态、全覆盖监测有利于BCG接种质量的恒定提高。     

The frequency profile of tuberculin skin testing among students in nursing school]

The frequency profile of tuberculin skin testing (TST) among students in nursing school was studied. Students received a TST upon matriculation. The TST was done by the method of Mantoux, in which 0.1 ml of PPDs was administered intradermally, and the diameters of skin rash and induration were read by the medical doctor at 48 hours. When TST results are negative--that is, the diameter of skin rash is below 10 mm (in Japan, the TST results are judged by skin rash diameter rather than that of induration)-BCG vaccination is given. Those receiving the BCG vaccination are retested with a TST one year later. When the second TST was also negative both the BCG vaccination and TST were followed for two more years. Those students testing TST-negative are not permitted to take clinical training in the tuberculosis ward. Student's mean age on entrance was 18.6 +/- 2.1 years old, and all but three were female. About 70% of students entering in 1996 to 1998 had a history of previous BCG vaccination. In 14% their positive TSTs could be attributed to probable infection with tuberculosis in childhood. In the remaining 16%, details as to TST and BCG vaccination status are unknown. The frequency distribution of TST results was bimodal, showing one peak at 6 mm and another at 12 mm (skin rash diameter). The percentage of negative and positive reactors are 47.1% and 52.9%, respectively. The TST-negative students entering in 1994 to 1996 were given the BCG vaccination. Twenty-four of 134 students (17.9%) remained negative at the second TST, and 6 students (4.5%) at the third year, even after two repeated BCG vaccinations. The TST results were chronologically observed in the above 6 students after BCG vaccination. The TST results of two students showed positive in September, 1996 and June, 1997. While four students showed positive in September, 1996, all ultimately reverted to negative when retested in June, 1997. Those students had negative results for TST at the initial test in 1998 had the two step-tuberculin skin testing. All eight students with negative TST had the history of BCG vaccination. The second TST showed positive except one student whose scar after BCG vaccination was not observed on the arm. The TST is currently recommended in hospital tuberculosis-control programs. If TST-negative, medical staff and students may not work in the tuberculosis ward. However, after BCG vaccinations is given, and subsequent TST conversion is confirmed, they are then able to work or to have training in the ward. From our results, there is 4.5% non-convertors even after 2 years of repeated BCG vaccinations. However, these non-converters turned positive four months after BCG vaccination, only to revert to negative nine months later. These students are considered to have delayed hypersensitivity to PPD after BCG vaccination. However, their reactivity waned in the short period of nine months after the conversion of their TST's. Therefore, it is concluded that non converters after repeated BCG vaccinations are able to have clinical training in the tuberculosis ward as long as their BCG vaccinations are correctly administered and any immunological deficiencies are ruled out.     

新生儿接种卡介苗后引起腋下淋巴结炎的原因及对策

笔者对30例新生儿接种卡介苗后引起腋下淋巴结炎的原因进行分析。认为新生儿接种卡介苗引起腋下淋巴结炎主要与疫苗未充分摇匀、注射过深或注入皮下、超量接种、被接种者的身体状况与年龄等有关。提出了要做好宣教工作,接种前应该向家长讲解卡介苗相关知识,接种后除了告诉家长要关注接种部位是否有化脓等情况,还要高度关注是否发生淋巴结肿大的现象;同时也应提高卡介苗接种人员的接种技术,疫苗要充分摇匀,严格控制接种剂量,正确掌握接种方法接种部位,避免卡介苗注射过量或注入皮下。如果发现异常反应,要及时采取有效的治疗及护理措施,缩短疗程,以便减轻患儿的痛苦,确保儿童身心健康。