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vaccination question

  • 31-01-2008 12:43pm
    #1
    metrovelvet
    Closed Accounts Posts: 9,376 ✭✭✭


    I've noticed that Irish people have vaccination marks on their arms but Americans don't. Why is that?


Comments

  • #2
    DrIndy
    Registered Users, Registered Users 2 Posts: 3,461 ✭✭✭DrIndy


    its the BCG vaccination - to protect from TB. There is controversy regarding this vaccination as it does not always protect you from primary lung TB but most evidence is it provides excellent protection from disseminated TB (TB that gets out of the lungs and runs riot through you).

    The trials for the BCG seem to offer 60-80% protection from TB in the northern hemispheres but this is not replicated in other countries.

    The US in particular does not have a universal TB vaccination regime and never did and so most people there don't have the triangle scars as they do here. In the USA, instead, people are checked with a mantoux test and treated if positive.

    Look in older people on the other side of their arms - that single scar is the smallpox vaccination.


  • #3
    Dr Galen
    Registered Users, Registered Users 2 Posts: 7,373 ✭✭✭Dr Galen


    i've a deadly scar, isn;t that the one that swells up and gets all manky? i constantly used to pick the scab off mine and squeeze all the yuck out.....ah memories


  • #4
    Alun
    Registered Users, Registered Users 2 Posts: 21,499 ✭✭✭✭Alun


    DrIndy wrote: »
    In the USA, instead, people are checked with a mantoux test and treated if positive.
    That's the way it was done in the schools in the UK as well way back when I had mine done (70's). Don't know what the situation is now though.


  • #5
    N8
    Registered Users, Registered Users 2 Posts: 458 ✭✭N8


    DrIndy wrote: »
    its the BCG vaccination - to protect from TB. There is controversy regarding this vaccination as it does not always protect you from primary lung TB but most evidence is it provides excellent protection from disseminated TB (TB that gets out of the lungs and runs riot through you).

    The trials for the BCG seem to offer 60-80% protection from TB in the northern hemispheres but this is not replicated in other countries.


    so are those vaccinated here in Ireland protected against other strains of TB disemminating from immigrants to Ireland (say from Russia where TB is rife) or whilst travelling worldwide and then coming home?


  • #6
    Chunky Monkey
    Closed Accounts Posts: 923 ✭✭✭Chunky Monkey


    Only one girl in our class got that vaccination. The rest of us scratched the test mark on our arm. The doc said I was okay for it but I pleaded and he let me go. So no awesome scar for me :)


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  • #7
    ZorbaTehZ
    Registered Users, Registered Users 2 Posts: 2,149 ✭✭✭ZorbaTehZ


    I got it done when I was younger, and I've got no scar...


  • #8
    DrIndy
    Registered Users, Registered Users 2 Posts: 3,461 ✭✭✭DrIndy


    N8 wrote: »
    so are those vaccinated here in Ireland protected against other strains of TB disemminating from immigrants to Ireland (say from Russia where TB is rife) or whilst travelling worldwide and then coming home?
    Not definitively. That is the problem. The BCG relies of a vigorous reaction in an immunoligcally naive host. In the equator it is theorised that the BCG frequently fails because there are less virulent mycobacteria (cousins to TB) present all around in the environment which desensitises the host to the BCG.

    Thus if vaccinated here then you should have equal protection - but there are many, many host factors involved as well. Deficiency of interferon-gamma will result in untreatable TB as the drugs that kill it rely on the immune response to clear it out and those with this deficiency cannot do so.

    They did a trial of giving interferon-gamma to patients who were non-responders to therapy and it did clear out the infection by selectively activating the important T-cell mediated response. however when they stopped the treatment the residual bug just multiplied and reappeared in the lungs again. Remember TB takes up to 6 weeks to grow in a lab - most bacteria take a few days. TB infects very slowly and this is why you need such long treatment to kill it.

    There are also different virulencies in the strains of TB. The TB that is coming over to ireland from eastern europe - notably the former USSR is not only much more likely to be multidrug resistant but also to be more virulent.

    The crux is to not assume someone is always immune to TB and also if in doubt, treat as TB as it is also notoriously difficult to catch sometimes. I had a patient who was getting fevers and weight loss - nothing grew on culture, nothing on smear, everything to exclude everything else was negative. We treated him experimentally on TB meds and found that his fevers settled completely within 2 weeks and then 6 weeks later we got a bug growing from the lab. This is sometimes the only way to find out.


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