To the Editor: BCG (Mycobacte-rium bovis BCG) is a vaccine for pre-venting childhood tuberculosis (TB), especially military and meningeal TB. Because Taiwan has an annual TB incidence rate of ≈70 cases/100,000 persons, the National Immunization Program has included neonatal BCG vaccination since 1965. The coverage rate has remained at 97% since 2001. According to the Taiwan Tuberculosis Registry, the median rate of TB infec-tions diagnosed in patients <10 years of age during 2005–2007 was 0.39% (60 cases) (1). The risk of developing childhood extrapulmonary TB without lung involvement is highest among children <5 years of age.In 1965, the World Health Or-ganization registered freeze-dried Tokyo-172 seed lot as an international reference vaccine strain (2). Tokyo-172 BCG is currently used in Taiwan, Japan, and South Korea. The vaccine is recommended as less reactogenic. Because intradermal injection is rec-ognized as a more effective BCG ad-ministration route (3), it is practiced in Taiwan, while a multiple puncture method is used in Japan and South Korea. In addition, 10% BCG (Danish strain) vaccinations for infants are ad-ministrated intracutaneously in South Korea (4). Although BCG is effective in preventing progressive primary TB, adverse reactions to the vaccine do occur. A systemic review of adverse reactions has been established in Ja-pan (5) but not in South Korea (4) and Taiwan (6).
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