BACKGROUND—BCGvaccination using the multipuncture device (the Heaf gun) isrecommended in the UK for infants and very small children only. The aimof this study was to investigate the rate of conversion of thetuberculin test, the safety and acceptability of BCG vaccination usingthe multipuncture device and to compare it with the conventional intradermal method in schoolchildren. METHODS—Schoolchildrenattending schools in Tower Hamlets who were eligible for BCGvaccination were tuberculin tested using the Heaf gun. Those with grade0-1 reaction were randomised to receive BCG vaccination using eitherthe multipuncture or the intradermal method. The site of BCGvaccination was inspected after eight weeks for inflammatory changesand scarring. A questionnaire about pain and inflammation at the siteof vaccination was completed. The Heaf test was repeated at eight weeksand its results were assessed by an examiner unaware of the results ofthe previous Heaf test and the method of BCG administration. The Heaftest conversion was deemed to have occurred if there was a change of atleast one grade in the response. RESULTS—One hundredand sixty nine children (83 girls) of mean age 11.8 years completed thestudy, of which 81 received BCG by the multipuncture method. The Heaftest did not convert in 22 of 81(27.2%) receiving BCG by themultipuncture device compared with six of 88 (6.8%) who received thevaccine by the intradermal method (odds ratio 0.2, 95% confidenceinterval 0.07 to 0.55). The BCG scar was visible in all children whohad intradermal BCG compared with 67 of 81 (81.8%) of themultipuncture group. The multipuncture method was less painful andcaused fewer inflammatory changes than the intradermal method. CONCLUSIONS—Inschoolchildren the multi- puncture device for administering BCGcaused a lower rate of tuberculin conversion as measured by the Heaftest and less of an inflammatory response than the intradermal method.The method needs to be modified before it is applied on a wider scaleto schoolchildren.
展开▼
