Regional lymphadenitis following antileprosy vaccine BCG with killed Mycobacterium leprae.

Britto, J.; Ramanathan, V.D.; Gupte, M.D.

International Journal of Leprosy; 1997; 65; 12-19.

Phase-II and extended Phase-II studies were conducted in three different sets of the population in Thiruthani taulk, Chengalpattu District, South India, involving BCG and killed Mycobacterium leprae (KML) combination vaccines to ascertain the acceptability of the vaccines. In the Phase-II study, 997 healthy volunteers were vaccinated on individual randomization with one of the vaccine arms: BCG 0.1 mg + 6 x 10 8 KML, BCG 0.1 mg + 5 x 10 7 KML, BCG 0.1 mg + 5 x 10 6 KML, BCG 0.1 mg or normal saline. Blood samples were taken and the serum was tested for antibody levels against phenolic glycolipid-I (PGL-I) and the 35-kDa protein of M. leprae . In this study, we observed regional suppurative adenitis in 6 % (6 out of 100), 3% (3 out of 100), and 3% (3 out of 100) of the vaccines in the BCG 0.1 mg + 6 x 10 8 KML, BCG 0.1 mg + 5 x 10 7 KML, BCG 0.1 mg + 5 x 10 6 KML vaccine arms, respectively, in the 13-70-year age group. Earlier BCG scar status, skin-test reactions to lepromin-A, Rees MLSA, and serum antibody levels against PGL-I and the 35-kDa protein did not help to identify the group at risk of developing suppurative adenitis. Suppurative adenitis appears to have a direct relationship between the age of the subject and the dose of the vaccine. In order to overcome the problem of regional suppurative adenitis and to know the mechanism involved, an extended Phase-II study was conducted in similar groups of the population by reducing the BCG and KML doses, i.e., with BCG 0.5 mg + 6 x 10 8 KML, BCG 0.5mg + 5 x 10 7 KML, BCG 0.1 mg + 5 x 10 7 KML. Biopsy specimens were collected from lymph nodes of the suppurative adenitis cases and were subjected for culture and histopathological examination. The observations showed that regional suppurative adenitis could be reduced to 1% in the BCG 0.5 + 6 x 10 8 KML group, 0.5% in the BCG 0.5 + 5 x 10 7 KML group and 0.5% in the BCG 0.1+ 5 x 10 6 KML group. This phenomenon of suppurative adenitis appears to be related to the total dose of mycobacterial antigens. Suppurative adenitis was seen by weeks 18 and 20 post-vaccination in the latter two lower doses; whereas it was seen by week 8 in the higher dose of the combination vaccines. No case of suppurative adenitis was observed in the BCG 0.1mg group. Culture and histopathology ruled out the possibilities of progressive BCG infection and superadded infection. Considering the above results, BCG 0.05 mg + 6 x 10 8 KML was accepted for a large-scale vaccine trial in South India.

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