title: BCG-SSI(®) vaccine-associated lymphadenitis: Incidence and management.
abstract: OBJECTIVE
  There is a high incidence of childhood tuberculosis in Latvia, including children aged less than 1 year, while BCG-associated lymphadenitis is one of the most frequent adverse events requiring surgical treatment. The aim of this study was to analyze the incidence of purulent BCG adenitis through-out the population of Latvia after the introduction of BCG-SSI(®) vaccine and to evaluate the treatment results.
  
  
  METHODS
  The study included 194 patients. All patients had received the BCG-SSI(®) vaccine during the first week of life routinely or at a later time according to the indications. The indications for surgical treatment were lymph node destruction also affecting the skin. All patients in this study received surgical treatment - the affected lymph node extirpation.
  
  
  RESULTS
  The mean age of the patients was 5.12±0.96 months. A total of 172 patients had purulent axillar lymphadenitis, 14 had purulent supraclavicular lymphadenitis, 8 patients had lymphadenitis at both localizations. During the whole study period the incidence of BCG adenitis varied from 0.02% to 0.36%, while the mean rate was 0.11%±0.08% from 184,068 vaccinated children during the study period. We observed an increasing trend in the incidence of BCG lymphadenitis during the study period. The primary and complete healing rate at the end of period was 99.5% (n=193) following an affected lymph node extirpation. The mean hospitalization time after the operation was 3.71±0.18 days.
  
  
  CONCLUSIONS
  The incidence of BCG-SSI(®) vaccine associated purulent lymphadenitis varied widely with an increasing trend, followed by the return to the product characteristic limits. Indications for the surgical treatment should not be changed. Extirpation of the purulent BCG adenitis is a safe treatment method and leads to the primary wound healing in the majority of cases.
authors: Department of Pediatric Surgery, Riga Stradins University, Riga, Latvia; Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia. Electronic address: arnis.engelis@gmail.com.
authors: Arnis
authors: A
authors: Engelis
authors: Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia.
authors: Mohit
authors: M
authors: Kakar
authors: Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia.
authors: Roberts
authors: R
authors: Meikšāns
authors: Department of Pediatric Surgery, Riga Stradins University, Riga, Latvia; Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia.
authors: Aigars
authors: A
authors: Petersons
mesh_terms: D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007844:Latvia / Q000453:epidemiology; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D014376:Tuberculosis / Q000517:prevention & control*; D014388:Tuberculosis, Lymph Node / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery
chemical_list: D001500:BCG Vaccine
keywords: BCG-SSI(®) vaccine; Complications; Lymphadenitis; Purulent BCG adenitis