ArticleJournal of paediatrics and child health2026
What Is the Significance of an Accelerated BCG Reaction in Children Living in Low Tuberculosis Incidence Countries?
Article in Journal of paediatrics and child health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
aimIn high tuberculosis (TB) incidence countries, accelerated Bacille Calmette-Guérin (BCG) reactions are considered markers of prior Mycobacterium tuberculosis exposure and may prompt investigation. Their significance in low-incidence countries is unclear. We aimed to describe the frequency, clinical characteristics and outcomes of accelerated BCG reactions in children vaccinated in Australia.
methodsWe conducted a retrospective case series at a quaternary hospital in Sydney, NSW. All children receiving intradermal Danish strain 1331 BCG between December 2023 and December 2024 were included. Accelerated reaction was defined as induration (≥ 0.5 cm) within 72 h, pustule formation within 5-7 days, or healing with scar formation at 10-15 days. Demographics, TB exposure risks, investigations and outcomes were collected.
resultsAmong 304 vaccinated children, 14 (5%) developed accelerated reactions. Median age was 3 years (IQR 6-45 months). Four had recently travelled to high-incidence countries; none had close contact with an individual with TB. Most reactions (12/14) occurred within 24-48 h. Six children underwent investigation due to epidemiological risk or young age; all results were negative. No child was diagnosed with M. tuberculosis infection or disease. All reactions resolved without antimycobacterial therapy.
conclusionsIn this single-centre cohort in a low TB incidence setting, accelerated BCG reactions occurred in one in 20 vaccinated children and were self-limiting. No association with M. tuberculosis infection was identified. These findings should be interpreted with caution and warrant confirmation in larger, multicentre studies. In the interim, a risk-based approach to investigation may be appropriate in low-incidence settings such as Australia.
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