FMGE 2025 — Pediatrics

Question 51: A mother brings her 9-month-old baby, concerned that no BCG scar has appeared, although the baby received the BCG vaccine at birth. What is the next best step?

• A. Do the Mantoux test & wait for the result
• B. Refer the baby for a chest X-ray & further evaluation
• C. Give the BCG vaccine immediately
• D. Reassure the mother (Correct Answer)

Explanation: ***Reassure the mother*** - The absence of a characteristic **BCG scar** up to 9 months later is common and does not indicate **vaccination failure** if the vaccine was properly administered and documented. - Standard vaccination protocols generally recommend **no re-vaccination** or immediate investigation solely based on the lack of a scar in an otherwise healthy infant. *Give the BCG vaccine immediately* - **Re-vaccination** without evidence of non-conversion (which is not routinely assessed) is not standard practice and carries the risk of increased **local adverse reactions**. - Current public health policies consider a single documented BCG dose adequate protection, regardless of the subsequent **cutaneous reaction**. *Do the Mantoux test & wait for the result* - The **Mantoux test (TST)** is not recommended solely for assessing BCG efficacy or scar absence in asymptomatic children due to difficulties in defining a protective threshold. - Finding a negative TST result does not currently mandate **re-vaccination**, as international guidelines prioritize coverage reliability over scar/TST status. *Refer the baby for a chest X-ray & further evaluation* - Extensive investigations, including a **chest X-ray**, are reserved for children presenting with signs or symptoms highly suggestive of **active tuberculosis disease**. - Performing aggressive workups on an asymptomatic child solely for an absent scar constitutes an excessive response and is not supported by clinical guidelines.