{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:07:10Z","timestamp":1784297230901,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Aim<\/jats:title>\n \n In high tuberculosis (TB) incidence countries, accelerated Bacille Calmette\u2013Gu\u00e9rin (BCG) reactions are considered markers of prior\n \n Mycobacterium tuberculosis<\/jats:italic>\n <\/jats:styled-content>\n exposure and may prompt investigation. Their significance in low\u2010incidence countries is unclear. We aimed to describe the frequency, clinical characteristics and outcomes of accelerated BCG reactions in children vaccinated in Australia.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We 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 (\u2265\u20090.5\u2009cm) within 72\u2009h, pustule formation within 5\u20137\u2009days, or healing with scar formation at 10\u201315\u2009days. Demographics, TB exposure risks, investigations and outcomes were collected.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 304 vaccinated children, 14 (5%) developed accelerated reactions. Median age was 3\u2009years (IQR 6\u201345\u2009months). Four had recently travelled to high\u2010incidence countries; none had close contact with an individual with TB. Most reactions (12\/14) occurred within 24\u201348\u2009h. Six children underwent investigation due to epidemiological risk or young age; all results were negative. No child was diagnosed with\n \n M. tuberculosis<\/jats:italic>\n <\/jats:styled-content>\n infection or disease. All reactions resolved without antimycobacterial therapy.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In this single\u2010centre cohort in a low TB incidence setting, accelerated BCG reactions occurred in one in 20 vaccinated children and were self\u2010limiting. No association with\n \n M. tuberculosis<\/jats:italic>\n <\/jats:styled-content>\n infection was identified. These findings should be interpreted with caution and warrant confirmation in larger, multicentre studies. In the interim, a risk\u2010based approach to investigation may be appropriate in low\u2010incidence settings such as Australia.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jpc.70423","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:26:56Z","timestamp":1778822816000},"page":"1186-1191","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["What Is the Significance of an Accelerated\n BCG<\/scp>\n Reaction in Children Living in Low Tuberculosis Incidence Countries?"],"prefix":"10.1111","volume":"62","author":[{"given":"Widad","family":"Al Salmi","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Sydney Children's Hospital Randwick New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2146-3253","authenticated-orcid":false,"given":"Niall","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Sydney Children's Hospital Randwick New South Wales Australia"},{"name":"Faculty of Medicine and Health, University of New South Wales Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Birrell","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Sydney Children's Hospital Randwick New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7532-9316","authenticated-orcid":false,"given":"Adam W.","family":"Bartlett","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Sydney Children's Hospital Randwick New South Wales Australia"},{"name":"The Kirby Institute, University of New South Wales Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Palasanthiran","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Sydney Children's Hospital Randwick New South Wales Australia"},{"name":"Faculty of Medicine and Health, University of New South Wales Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan J.","family":"McMullan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Sydney Children's Hospital Randwick New South Wales Australia"},{"name":"Faculty of Medicine and Health, University of New South Wales Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phoebe C. M.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Sydney Children's Hospital Randwick New South Wales Australia"},{"name":"Faculty of Medicine and Health, University of New South Wales Kensington New South Wales Australia"},{"name":"Sydney Institute for Infectious Diseases, School of Public Health, Faculty of Medicine, University of Sydney Camperdown New South Wales Australia"},{"name":"National Centre for Immunisation Research and Surveillance Westmead New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI148291"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00403-5"},{"key":"e_1_2_10_4_1","first-page":"1","article-title":"The Strategic Plan for Control of Tuberculosis in Australia, 2021\u20132025","volume":"46","author":"National Tuberculosis Advisory Committee","year":"2022","journal-title":"Communicable Diseases Intelligence"},{"key":"e_1_2_10_5_1","volume-title":"Australian Immunisation Handbook","author":"Australian Technical Advisory Group on Immunisation (ATAGI)","year":"2025"},{"issue":"8","key":"e_1_2_10_6_1","first-page":"73","article-title":"BCG Vaccines: WHO Position Paper \u2013 February 2018","volume":"93","author":"World Health Organization","year":"2018","journal-title":"Weekly Epidemiological Record"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2022-323853"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e32510"},{"key":"e_1_2_10_9_1","volume-title":"BCG Vaccination Sore","author":"Health Protection NSW","year":"2023"},{"issue":"4","key":"e_1_2_10_10_1","first-page":"1","article-title":"Use of BCG Vaccines in the Control of Tuberculosis: A Joint Statement by the ACIP and the Advisory Committee for Elimination of Tuberculosis","volume":"45","author":"Centers for Disease Control and Prevention","year":"1996","journal-title":"MMWR \u2010 Recommendations and Reports"},{"key":"e_1_2_10_11_1","volume-title":"Tuberculosis in NSW \u2013 Surveillance Report 2020","author":"NSW Tuberculosis Program, Communicable Diseases Branch","year":"2022"},{"key":"e_1_2_10_12_1","unstructured":"Therapeutic Goods Administration (TGA) \u201cBCG Vaccine SSI \u2010Mycobacterium bovisBCG (Bacillus Calmette\u2010Guerin) Danish Strain 1331 (AJ Vaccines) With Diluted Sauton SSI | 2022 \u201dhttps:\/\/www.tga.gov.au\/resources\/section\u201019a\u2010approvals\/approval\u2010lapsed\u2010bcg\u2010vaccine\u2010ssi\u2010mycobacterium\u2010bovis\u2010bcg\u2010bacillus\u2010calmette\u2010guerin\u2010danish\u2010strain\u20101331\u2010aj\u2010vaccines\u2010diluted\u2010sauton\u2010ssi."},{"key":"e_1_2_10_13_1","unstructured":"Health Protection NSW \u201cBacille Calmette\u2010Gu\u00e9rin (BCG) Vaccination for Tuberculosis (TB) \u201dhttps:\/\/www.health.nsw.gov.au:443\/Infectious\/tuberculosis\/Pages\/Language\/bcg\u2010info\u2010english.aspx."},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/44.1.40"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00196608"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60393-5"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit790"},{"key":"e_1_2_10_18_1","volume-title":"Information Sheet: Observed Rate of Vaccine Reactions \u2013 Bacille Calmette\u2010Gu\u00e9rin (BCG) Vaccine","author":"World Health Organization","year":"2012"}],"container-title":["Journal of Paediatrics and Child 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