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The BCG Controversy-Reply FREE

John D. Clemens, MD; Jackie J. H. Chuong, MD; Alvan R. Feinstein, MD
JAMA. 1983;250(21):2929-2929. doi:10.1001/jama.1983.03340210026015
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In Reply.—  We agree with Dr Pust that our methodological and statistical analysis does not exclude the possibility that some of the variation in the results of the eight BCG trials may have been caused by biologic differences among the trials. However, when the animal data published by Palmer and Long1 were evaluated quantitatively by Hart,2 differing prevalence rates of atypical mycobacteria were regarded as an unlikely source for much of the variation in the results. Similarly, other proposed biologic explanations, such as the hypothesis that the trials differed because of the differing nutritional status of the trial populations3 or the more recent hypothesis that frequent infections with Mycobacterium tuberculosis of low virulence vitiate apparent BCG efficacy,4 lack convincing empiric demonstrations in human populations. Consequently, we do not believe that BCG should be discounted in developing countries simply because several possible—and, as yet, unknown—biologic factors may be

REFERENCES

Palmer C, Long M:  Effects of infection with atypical mycobacteria on BCG vaccination and tuberculosis . Am Rev Respir Dis 1966;;94:553-568.
Hart PD'A:  Efficacy and applicability of mass BCG vaccination in tuberculosis control . Br J Med 1967;; 1:587-592.
Dubos R:  Acquired immunity to tuberculosis . Am Rev Respir Dis 1964;;90:505-515.
Vaccination against tuberculosis: Report of an ICMR/WHO scientific group. WHO Tech Rep Ser, 1980, pp 1-21.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Palmer C, Long M:  Effects of infection with atypical mycobacteria on BCG vaccination and tuberculosis . Am Rev Respir Dis 1966;;94:553-568.
Hart PD'A:  Efficacy and applicability of mass BCG vaccination in tuberculosis control . Br J Med 1967;; 1:587-592.
Dubos R:  Acquired immunity to tuberculosis . Am Rev Respir Dis 1964;;90:505-515.
Vaccination against tuberculosis: Report of an ICMR/WHO scientific group. WHO Tech Rep Ser, 1980, pp 1-21.
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