BCG VACCINATION STATUS OF CHILDREN WITH TUBERCULOUS MENINGITIS AND THE USE OF UNSUPERVISED ISONIAZID PROPHYLAXIS

From 1985 to 1992, 193 children with tuberculous meningitis (TBM) with a median age of 26 months were admitted to the Department of Paediatr ics and Child Health, Tygerberg Hospital. Of these children 143 (74%) were documented to have received BCG, either by reference to 'Road to Health' cards or by contact with local authority clinic staff. In a fu rther 18 children a BCG scar was visible. Therefore at least 161 of th e children (83%) had received BCG vaccination. As the Western Gape has also been shown to have the highest incidence of TBM in South Africa, there is concern that BCG as currently used does not have a significa nt protective effect against disseminated tuberculosis. Seventy-seven children (40%) were also reported to have a close household contact wh o had been treated for pulmonary tuberculosis within the previous 24 m onths. Only 17 of these children (22%), however, were prescribed proph ylactic isoniazid and only 7 of these completed 3 months or more proph ylaxis.