Intradermal BCG: partial protection against tuberculosis in children: unproven efficacy of multipuncture administration.

(1) In France the annual incidence of tuberculosis is currently about 11 cases per 100 000 population; fewer than two of the 11 cases are children under 15. (2) The incidence of tuberculosis is higher among sub-Saharan African immigrants living in France, and also among their children. (3) The protection afforded by bacillus Calmette Guerin (BCG) must be evaluated clinically. A positive tuberculin test after BCG vaccination does not necessarily indicate protection against tuberculosis. (4) Intradermal BCG vaccination protects about 80% of young children from extrapulmonary tuberculosis (especially tuberculosis meningitis). It seems far less effective against pulmonary tuberculosis, the most frequent and most contagious form. (5) Efficacy of BCG vaccination in adults is uncertain. Protection is moderate at best. (6) Multipuncture BCG vaccination has not been assessed using clinical outcomes, and may be less effective than intradermal injection. Yet it remains the most frequent mode of BCG delivery in France. (7) In some European countries, interruption of BCG mass vaccination was followed by a few extra cases of tuberculous meningitis per year. (8) In countries with low endemicity there are no reliable clinical evaluation or epidemiological data to support revaccination after a negative postvaccination tuberculin skin-test.