Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Lymphadenitis following intradermal BCG vaccination

피내용 BCG 접종 후 발생한 국소 림프절염

  • Baek, Hey Sung (Department of Pediatrics, College of Medicine, Hanyang University) ;
  • Chang, Ji Young (Department of Pediatrics, College of Medicine, Hanyang University) ;
  • Moon, Su Ji (Department of Pediatrics, College of Medicine, Hanyang University) ;
  • Oh, Sung Hee (Department of Pediatrics, College of Medicine, Hanyang University)
  • 백혜성 (한양대학교 의과대학 소아과학교실) ;
  • 장지영 (한양대학교 의과대학 소아과학교실) ;
  • 문수지 (한양대학교 의과대학 소아과학교실) ;
  • 오성희 (한양대학교 의과대학 소아과학교실)
  • Received : 2005.07.12
  • Accepted : 2005.10.05
  • Published : 2006.01.15
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Abstract

Purpose : Intradermal BCG vaccine has not well been accepted by pediatric practitioners due to BCG lymphadenitis. Therefore, this study was undertaken to find out the incidence of lymphadenitis following intradermal BCG vaccination and its clinical outcome. Methods : One thousand and fifty infants, who received intradermal BCG(French 1173 P2, Korea Tuberculosis Association) vaccination in the Well Baby Clinic of Hanyang University Hospital from July 2001 to January 2004, were included in the study. Severe local reactions at the injection site and any mass noted on surrounding areas were reported to, and evaluated by, pediatricians. Surgical procedures, either surgical resection or needle aspiration, were recommended when lymph nodes progressed to suppurate without regression. Results : Twenty infants(1.9 percent) developed lymphadenitis 2 to 8 months following vaccination. The incidence of BCG lymphadenitis was significantly higher in infants born with intrauterine period of <38 weeks and birth weight of <2,700 g. The lymph nodes became suppurative in 7/17 infants (41.2 percent) and four infants required surgical procedures with which the rate for the requirement of surgical procedures among intradermal BCG vaccinnes approximated to be 0.45 percent. There was no correlation between the size of lymph nodes and suppuration, however surgical procedures were required significantly more often for lymph nodes of greater than 3 cm in diameter. Conclusion : The incidence of BCG lymphadenitis following intradermal BCG(French 1173 P2, Korea Tuberculosis Association) vaccinations would be more than 1.9 percent, when considering cases of lymphadenits not reported. More efforts need to be paid to decrease the incidence of BCG lymphadenitis in order to promote intradermal BCG vaccination in Korea.

목 적 : 지금까지 일부 일선 의료진들이 피부로 느끼는 국내 소아들에서의 피내 BCG 접종 후 림프절염의 발생률이 일부 보고되고 있는 빈도보다 높다는 견해가 적지 않아 왔다. 이에 저자들은 1개월 소아에서 BCG 피내접종 후 발생하는 국소 림프절염의 발생빈도 및 경과 관찰에 대해 알아보고자 하였다. 방 법 : 2001년 7월부터 2004년 1월까지 한양대학교병원 육아지도실에서 생후 1개월경에 BCG 백신(French 1173 P2, 대한결핵협회)을 피내접종 받은 영아 1,050명을 대상으로 하였다. 접종후 림프절비대 등의 이상반응이 발생하는 경우 다시 내원하도록 지도하였으며, 림프절비대가 확인된 경우 소아과에서 정기적인 진료를 받도록 하였다. 림프절비대가 심화 화농되어 파열될 가능성이 높다고 판단되는 경우에는 외과적 적출을 받거나 주사침흡인술을 받도록 하였다. 결 과 : BCG 접종을 받은 1,050명 중 이상반응이 있어 내원한 경우 림프절염이 확인된 환아는 20명(1.9%)이었고 BCG 림프절염은 접종 후 2개월에서 8개월에 발생하였다. BCG 림프절염의 발생빈도는 재태연령 38주 미만아 및 출생체중 2,700 g 미만아에서 높았다. BCG 림프절염이 발생한 17례 중 7례(41.2%)가 화농화되었으며 그중 4례에서 외과적 시술을 받았으며 피내 BCG 접종 후 외과적 시술을 받는 확률은 0.45%로 추정된다. BCG 림프절염의 최대 크기와 화농화와는 연관이 없었으나 3cm 이상 커진 경우는 그렇지 않은 경우보다 외과적 시술을 받은 비율이 의미 있게 높았다. 결 론 : 국내에서의 피내 BCG 접종 후 림프절종대 및 화농성 림프절염의 빈도는 BCG 접종 후 림프절비대가 발생되었는데도 보고되지 않아 조사에서 누락되었을 경우를 감안한다면, 1.9%를 상회할 것으로 추정된다. 앞으로 BCG 림프절염의 발생빈도를 줄이기 위한 노력을 지속하여 안전하고 효과적인 BCG 피내접종이 이루어질 수 있도록 하여야겠다.

Keywords

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