02618nas a2200337   4500000000100000008004100001260001300042653001200055653001600067653001100083653002100094653001100115653002600126653002800152653002300180653002000203653002800223653002600251653002800277653001600305100001400321700001400335700001600349245007700365856009100442300001100533490000700544050001700551520169800568022001402266       2006                            d  c2006 Jul10aAnimals10aBCG Vaccine10aBrazil10aHealth Personnel10aHumans10aImmunization Programs10aImmunization, Secondary10aProgram evaluation10aTuberculin Test10aTuberculosis, Meningeal10aTuberculosis, Miliary10aTuberculosis, Pulmonary10aVaccination1 aBarreto M1 aPereira S1 aFerreira AA00aBCG vaccine: efficacy and indications for vaccination and revaccination.  uhttp://www.scielo.br/scielo.php?pid=S0021-75572006000400006&script=sci_arttext&tlng=en  aS45-540 v82  aBARRETO 20063 a<p><b>OBJECTIVES: </b>To review the protective efficacy of the first and second doses of BCG vaccine and to assess its major indications and contraindications.</p><p><b>SOURCES OF DATA: </b>A systematic review of the literature was made by searching PubMed and selecting studies carried out in the last 50 years. The studies were grouped according to their design (clinical trials, case-control studies, and meta-analyses) and the results were presented separately for each type of study. Other relevant topics such as BCG and HIV/AIDS, use of tuberculin skin test, issues related to vaccine scars and to the development of new vaccines were also reviewed.</p><p><b>SUMMARY OF THE FINDINGS: </b>BCG vaccine has been used since 1921. However, the data concerning its use are variable and inconsistent. The protective efficacy of the first dose of BCG vaccine against miliary tuberculosis or tuberculous meningitis is remarkably important. Nevertheless, results regarding pulmonary tuberculosis have been inconsistent, either showing no efficacy or a protective efficacy rate around 80%. There is some evidence that a second dose of BCG vaccine does not increase its protective efficacy. Studies have shown that BCG vaccine protects against leprosy. The development of new vaccines to replace BCG in the future has been investigated.</p><p><b>CONCLUSIONS: </b>Despite the hope that a new vaccine against tuberculosis will be available in the future, BCG vaccine, in spite of its deficiencies, is today and will be for many years to come an important tool in controlling the harmful effects of tuberculosis, especially in countries where this disease has moderate to high levels of incidence.</p>  a0021-7557