<i>Mycobacterium bovis</i>BCG–Associated Osteomyelitis/Osteitis, Taiwan

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To the Editor: Thirty-eight patients with Mycobacterium bovis BCG–associated osteomyelitis/osteitis, including 8 who were previously reported (1), were identified during Taiwan’s vaccine injury compensation program during 1989–2012; a total of 30 (79%) patients applied for compensation during 2009–2012 (Figure). In Taiwan, a laboratory program to differentiate BCG from other species of the M. tuberculosis complex, using a kit for the Tokyo-172 vaccine strain spoligotyping, was established in 2004 (1). Since 2008, the isolated extrapulmonary tuberculosis strains and pathologic specimens collected from children <5 years of age have been sent to the national reference mycobacterial laboratory for BCG detection (2). The detected incidence of BCG osteitis/osteomyelitis increased from 3.68 cases per million vaccinations during 2002–2006 to 30.1 per million during 2008–2012.

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