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Infection and Immunity, January 2004, p. 62-65, Vol. 72, No. 1
0019-9567/04/$08.00+0     DOI: 10.1128/IAI.72.1.62-65.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Mycobacterium bovis BCG Vaccination as Prophylaxis against Mycobacterium ulcerans Osteomyelitis in Buruli Ulcer Disease

F. Portaels,1* J. Aguiar,2 M. Debacker,1 A. Guédénon,3 C. Steunou,2 C. Zinsou,2 and W. M. Meyers4

Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, B-2000 Antwerp, Belgium,1 Centre Sanitaire et Nutritionnel Gbemoten, Zagnanado,2 PNLUB, Cotonou, Benin,3 Armed Forces Institute of Pathology, Washington, D.C. 203064

Received 3 June 2003/ Returned for modification 14 August 2003/ Accepted 29 September 2003

Mycobacterium ulcerans disease, or Buruli ulcer (BU), causes significant morbidity in West Africa. Clinically, the disease presents in the skin as either nonulcerative or ulcerative forms and often invades bones either subjacent to the skin lesion (contiguous osteomyelitis) or remote from the skin lesion (metastatic osteomyelitis). Osteomyelitis represents a severe form of the disease that often requires numerous surgical interventions, even amputations. Surgery is accepted as the present definitive treatment for BU. In the absence of an effective drug treatment, the need for the development of preventive and control strategies becomes paramount. No specific vaccine, however, is presently available for BU. Of 372 consecutive patients in Benin presenting with BU (confirmed by microbiological and histopathological analyses) whose Mycobacterium bovis BCG scar statuses were known, 196 children (<15 years old) and 108 adults had neonatal BCG vaccination scars. Of 196 children with BCG scars, 17 (8.7%) had osteomyelitis, while 7 of 28 children without BCG scars (25.0%) had osteomyelitis. Of 108 adults with BCG scars, 17 (15.7%) had osteomyelitis, while 14 of 40 adults without BCG scars (35.0%) had osteomyelitis. Our results show that effective BCG vaccination at birth provides significant protection against the development of M. ulcerans osteomyelitis in children and adults. Therefore, health authorities should give attention to the enhancement of neonatal BCG vaccination coverage in all countries of Africa where BU is endemic. Protection against severe forms of BU and childhood tuberculosis would likewise be improved by this intervention.

* Corresponding author. Mailing address: Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium. Phone: 32-3-247-63-17. Fax: 32-3-247-63-33. E-mail: portaels{at}itg.be.

Editor: S. H. E. Kaufmann

Infection and Immunity, January 2004, p. 62-65, Vol. 72, No. 1
0019-9567/04/$08.00+0     DOI: 10.1128/IAI.72.1.62-65.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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