Atypical mycobacteria in extrapulmonary disease among children. Incidence in Sweden from 1969 to 1990, related to changing BCG-vaccination coverage.
METHODS
In April 1975, the general BCG vaccination of newborns in Sweden was replaced by selective vaccination of groups at increased risk of tuberculosis.


OBJECTIVE
To relate the incidence of atypical mycobacterial disease in children to BCG vaccination.


METHODS
A nationwide survey in Sweden during the period 1969-90 disclosed 390 children under 15 years of age with bacteriologically confirmed atypical mycobacteria from extrapulmonary lesions.


RESULTS
The average, annual incidence of atypical mycobacterial disease per 100,000 children under 5 years of age increased from 0.06 during the period 1969-74 to a maximum level of 5.7 during 1981-85. Among the cohorts born in Sweden in the period 1975-85, the cumulative incidence rate before 5 years of age was estimated at 26.8 per 100,000 non-BCG-vaccinated children and at 4.6 among those BCG-vaccinated, ratio 5.9 (95% confidence limits 1.6, 48.5). Mycobacterium avium-intracellulare was found in 83%. Disseminated, fatal disease developed in 3 children. The remaining ones suffered from local infections, most often lymph-node or soft-tissue lesions. The observed incidence of bacteriologically confirmed diagnosis was estimated to represent approximately 40% of the 'true' number, if patients with diagnosis based on histological, clinical and epidemiological findings only were included.


CONCLUSIONS
The present study indicates that BCG vaccination plays a role in protection against localized disease caused by atypical mycobacteria in children.
Romanus
V
V
Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
Hallander
H O
HO
Wåhlén
P
P
Olinder-Nielsen
A M
AM
Magnusson
P H
PH
Juhlin
I
I
D000293:Adolescent; D017677:Age Distribution; D001500:BCG Vaccine; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000517:prevention & control; D015270:Mycobacterium avium-intracellulare Infection / Q000453:epidemiology; D011379:Prognosis; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology; D014611:Vaccination
D001500:BCG Vaccine