BCG VACCINE, FREEZE-DRIED (Live)
VACCINUM TUBERCULOSIS (BCG) CRYODESSICATUM
 
Composition:

Each single 0.1 ml human dose contains:
Approximately 0,05 mg moist weight of BCG and between 1,5-6,0 x 105 viable units.
Each ampoule contains 3 mg Sodium L-glutamate monohydrate.

Description:
Freeze-Dried BCG Vaccine is a dried preparation containing live bacteria derived from a culture of the Bacillus of Calmette and Guerin, known as BCG, intended for intradermal injection, 1, 2, 3. The vaccine meets the requirements of WHO for dried BCG vaccine (Requirements for Biological Substances No 11, formulated by WHO Expert Committee of Biological Standardization Technical Report Series, No 745, 1987; 771, 1988).


Indications:

For the primary immunization of infants and immunization or reimmunization of children and adults who have reacted negatively to the usual tuberculin tests. It may be given at the same time with DPT, DT, TT, Measles, Polio vaccines (OPV and IPV), Hepatitis B and Yellow fever.


Administration:
For infants under one year of age, 0,05 ml of the reconstituted vaccine should be given intradermally. For others, the dose is 0,1 ml, again given intradermally. The use of a special tuberculin syringe and a sterile 26-gauge needle is recommended for each injection, so that exact dose can be administrated. The skin may not be cleaned with antiseptic. Jet injections do not generally provide a reliable dose and should not be used. Prior to use, the bacterial mass should be shaken so that it falls to the bottom of the ampoule. Special care is needed in opening the ampoule and reconstituting the vaccine gently with the sterile diluent provided, so that the vaccine is not blown out of the ampoule. A site frequently used for vaccination is the region over the distal insertion of the deltoid muscle, about one third down the left upper arm. The needle should be introduces with its aperture upwards.

Because of sensitivity to daylight, the vaccine must be kept in the dark. When withdrawals are made from the ampoule, the vaccine may only be exposed to the light for the minimum period of time. If not used immediately after reconstitution, the vaccine should be kept on ice and protected from light. Any opened ampoule should be kept on ice and protected from light, any opened ampoule remaining at the end of the immunizing session (maximum 6 hours) MUST BE DISCARDED.

Skin testing with tuberculin is not generally carried out before giving BCG, but when performed, those who are found to be positive reactors need not be immunized.

Reactions and side effects:
The papule caused by the intradermal injection persist 15-30 minutes. Two or three weeks later a red nodule is observed and its dimensions increase for a further one or two weeks. In some cases a small abscess is formed which later develops into a small ulcer. The latter heals spontaneously without treatment in a few weeks. Three to six months after vaccination the ulcer heals completely and a small scar is formed. Enlargement of the axillary lymph-nodes may occasionally develop after vaccination but spontaneous regression usually occurs after a few months. In rare cases perforation and persistent suppuration can accompany the lymph-node enlargement and anti- tuberculous chemoprophylaxis may be indicated. Surgical excision is not recommended. Inadvertent subcutaneous injection produces abscess formation and may lead to ugly retracted scars.

Contraindications and warnings:
The vaccine is contraindicated in those individuals with cell-mediated immune deficiency including treatment with immuno-suppressive drugs. Keloid and lupoid reactions may occur at the site of injection and such infants or children should not be re-vaccinated. HIV infected, non symptomatic persons should be immunized with BCG vaccine according to standard schedules. Persons with clinical AIDS should not receive BCG vaccine (but should receive other EPI vaccines).

Storage of the vaccine:
The vaccine should be stored in a dry, dark place at a temperature between 2°C and 8°C. Transportation should also be at 2°C-8°C. The vaccine should be protected from the light. Once an ampoule has been opened, its contents should be used immediately. The diluent should not be frozen. During storage in refrigerator (2°C-8°C) the product is stable until indicated date of expiration.

Shelf – life:
Not more than 24 months after the date of issue, provided that this is not more than 36 months from date of last satisfactory test for culturable particles, if stored in the dark at 2°C-8°C.


Presentation:

10-doses Ampoule plus diluent.
20-doses Ampoule plus diluent.


Bibliography:
1. Las Souches BCG. Lyophisation et activine biologique. (1970) Rodopska, S. Int. Symp. on BCG Vaccine. Symp. Series lmmunobiol. Stand. 17, pp. 169-174.
2. Studies on the quality control of BCG: Laboratory examinations and postvaccination control in the field. (1983) Engibarov, A. Chouchkova, M. and Koychev C. Int, Symp. on BCG Vaccines and Tuberculins. Develop. biol. Stand. 58, pp. 163-171.
3. A quarter of a century in the field of BCG. (1983) Rodopska, S. let, Symp. on BCG Vaccines and Tuberculins. Develop. biol. Stand. 58, pp. 257-272.


Name and address of manufacturer:

BB- NCIPD Ltd. BULGARIA
1504 Sofia, 26 Yanko Sakazov Blvd.,
Tel.: **359 2 944 69 99 / 281
Fax: **359 2 943 30 75
E-mail: bulbio@bulbio.com

Last Revision: October 2001


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