Safety of the intradermal Copenhagen 1331 BCG vaccine in neonates in Durban, South Africa

Objective To evaluate the safety of the intradermal Copenhagen BCG vaccine in neonates at different levels of delivery and neonatal units of the Durba n Functional Region and surrounding regions. Methods A prospective study was carried out over a two-year period between July 1997 and June 1999. All neonates who had been vaccinated with the intr adermal vaccine were evaluated at immunization clinics six weeks after immu nization, or earlier if adverse effects occurred. Findings In total, 9763 neonates were examined: in 95.4% the vaccination sc ar had healed and 1.5% had no visible scar. Adverse events occurred in 3.1% . The proportion of neonates with no visible vaccination scars decreased ov er the study period, as did the number with adverse events. The lowest rate of adverse events and the highest rates of healed vaccination scars were s een in the tertiary hospital and regional and district hospitals that were in close proximity to the academic centre involved in this study. Conclusions In the study sites, the transition from the percutaneous to int radermal route of administration of BCG vaccine was successful and took pla ce without incurring unacceptably high rates of adverse events. To minimize adverse events, however, it is essential to continue training health perso nnel involved in implementing intradermal BCG vaccination programmes.