It stimulates macrophages, T- and B-lymphocytes, natural killer cell function.
It activates CD4 T cells and an increases cytokines such as interleukin (IL)‐1, IL‐2, and tumor necrosis factor alpha (TNF‐α). IL‐1 and TNF‐α have antiviral effects on HPV by downregulating its gene transcription.
Side effects of IL‐BCG
BCG-induced reactions : local, regional, distant, or disseminated pattern.
BCGitis refers to local and regional patterns.
BCGosis refers to the distant and disseminated pattern.
Pain.
Edema.
Ulceration.
Scarring.
Influenza‐like symptoms such as fever, chills and draining sinuses, which could be efficiently managed by isoniazid.
Regional lymphadenitis, local abscesses and occasional systemic infections with associated granulomatous hepatitis.
Pityriasis rosea‐like eruption, urticaria and erythema multiforme.
Generalized maculopapular or purpuric eruptions associated with arthralgia and abdominal pain or myalgia, usually after repeated vaccination.
Extensive ulceration.
Lupus vulgaris may develop at the vaccination site, usually a few months after vaccination.
Scrofuloderma.
BCC in a BCG scar.
SCC in a BCG induced lupus vulgaris.
Sweet’s syndrome.
Severe hypotension and signs of disseminated intravascular coagulation were observed ( rare).
Multiple tuberculoid granulomas.
Licensed BCG vaccines differ markedly in their content of viable mycobacteria possibly contributing to formulation-dependent activation of innate and adaptive immunity and distinct protective effects.*
New strategies in BCG immunotherapy may involve use of vitamin D analogs that might reduce the exacerbated inflammatory process and untoward side effect of BCG in vaccinated population in high TB endemic setting.*
Contraindications
Anaphylaxis or a severe hypersensitivity ( absolute contraindication )
HIV‐infected infants should not receive BCG vaccination due to the high rates of BCG‐associated disease.
Impaired immunity (HIV infection, known or suspected congenital immunodeficiency, leukaemia, lymphoma or generalized malignant disease.
Patients under immunosupressive treatment.
BCG vaccines should not be given 1 year prior to, during, or 1 year following treatment with ustekinumab.
BCG vaccination should not be given during pregnancy.
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