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EFETIVIDADE DO BCG-ID EM COMUNICANTES DE PACIENTES COM AS FORMAS MULTIBACILARES DA HANSENÍASE
Duppre, Nadia Cristina | Date Issued:
1998
Alternative title
Effectiveness of BCG-ID in communicants of patients with the multibacillary forms of leprosyAuthor
Advisor
Affilliation
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Abstract in Portuguese
O presente estudo foi realizado com a finalidade de avaliar o papel protetor
do BCG-ID, recebido nos primeiros anos de vida na proteção contra a
hansenseníase. Foram incluídos 620 comunicantes de pacientes com as formas
multibacilares da hanseníase e acompanhados por um período de 5 anos. Os
comunicantes foram recrutados no período de junho de 1987 a dezembro de
1992. Desses, 468 apresentavam cicatriz de BCG e 152 não apresentavam
cicatriz de BCG. A faixa etária variou de 0 a 28 anos e 72 (11,6%) dos contatos
estavam doentes ou adoeceram em algum momento do acompanhamento. O
percentual de adoecimento foi de 8,33% (39) com cicatriz de BCG e 21,7% (33)
sem cicatriz vacinal. Entre aqueles com cicatriz de BCG, 35 (7,5%) foram
classificados como PB e 4 (0,85%) foram classificados MB. Para aqueles sem
cicatriz de BCG, 24 (15,8%) foram PB e 9 (5,9%) foram MB. A proteção conferida
pelo BCG para as formas multibacilares (BB/BL/LL) foi de 86% e de 53% para as
formas paucibacilares (TT/BT/HI/NI). Entre as 59 contatos que adoeceram
apresentando a forma paucibacilar 12 (20%) tinham idade entre 0 a 9 anos e
desenvolveram a forma Nodular Infantil (NI) e desses 10 (83,3%) apresentaram
cura espontânea, sugerindo que o BCG pode polarizar para a forma tuberculóide,
crianças submetidas precocemente à infecção pelo M.leprae. A taxa de
adoecimento considerando-se somente os casos co-prevalentes, foi 2 vezes
maior nos pacientes sem cicatriz de BCG enquanto que, entre os casos incidentes
esta taxa foi 7 vezes maior nos contatos sem cicatriz de BCG. Considerando
todos os 72 contatos que adoeceram, a taxa de adoecimento foi 3 vezes maior
para aqueles sem cicatriz de BCG quando comparados àqueles com cicatriz
vacinal. Os casos incidentes se concentraram no primeiro ano após o diagnóstico
do caso índice, sendo praticamente ausente após o quarto ano de seguimento. O
risco de adoecer variou com a carga bacilar do caso índice, número de pessoas
por cômodo da casa, mais de um doente multibacilar na família e tipo de
convivência intradomiciliar com o caso índice. A proteção conferida pelo BCG
variou de acordo com a faixa etária do contato, sendo de 55% para aqueles com
idade de 0 a 9 anos, de 91% para 10 a 18 anos e nenhuma para aqueles com 19
a 28 anos, sugerindo um decréscimo no efeito protetor do BCG-ID e provável
influência da idade em que o contato recebeu a vacina.
Abstract
The present study aimed to assess the role of the BCG-ID as a protector,
received in the first years of life as a protection against leprosy. A total of 620
contacts of patients with the multibacillary forms of leprosy have been included
and followed for period of five years. Such contacts were recruited from June 1987
to December 1992. These, 468 presented BCG scars and 152 did not present
BCG scars. The age group varied from 0 to 28 years old and 72 (11.6%) of the
contacts were sick or got sick sometime during the follow-up. The percentage of
sickening was of 8.33% (39) with BCG scars and 21.7% (33) without vaccinal
scars. Among those with BCG scars 35 (7.5%) were classified as PB and 4
(0.85%) were classified as MB. For those without BCG scars, 24 (15.8%) were PB
and 9 (5.9%) were MB. Thus, the protection given by the BCG to the multibacillary
forms (BB/BL/LL) was of 86% and of 53% to the paucibacillary forms
(TT/BT/HI/INL). It was observed that among the 59 contacts who got sick
presenting the paucibacillary form 12 (20%) were between 0 and 9 years old and
developed the Infantum Nodular Leprosy (INL) form and out of these 10 (83.3%)
presented spontaneous healing, suggesting that the BCG may polarize to the
tuberculoid form, children that were early submitted to infection by the M.leprae.
The sickening rate considering only the co-prevailing cases, was twice higher in
those patient who did not present the BCG scar whereas, among the incident
cases this rate was 7 times higher in the contacts without BCG scars. Considering
all the 72 contacts who got sick, the sickening rate was 3 times higher for those
without the BCG scars than when compared to those with the vaccinal scar.
Another finding of this study was that the incident cases concentrated themselves
in a meaningful way in the first year after the diagnosis of the rate case, being
practically absent after the fourth year of follow-up, suggesting that the main
source of infection in these contacts concentrated itself in the family environment.
The risk of getting sick varied with the bacillus load of the rate case, number of
people per room in the house, more than one multibacillary patient in the family
and the kind of introdomicile living with the rate case. The protection given by the
BCG varied according to the age group of the contact, being 55% for those with
age from 0 to 9 years old, of 91% for 10 to 18 years old and none for those of 19
to 28 years old, suggesting a decrease in the protector effect of the BCG-ID and a
probable influence of the age in which the contact received the vaccine.
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