1. Recognition of BCG Scars Dr. Earl Hershfield Ms. Barbara Roche Tuberculosis Research Unit University of Manitoba, 2004

2. 2 International (current): http://www.who.int/immunization_monit oring/en/globalsummary/timeseries/tscov eragebcg.htm Canada (current and historical): http://www.phac-aspc.gc.ca/tbpc- latb/index.html BCG Vaccine Usage

3. 3 Distinguishing a BCG scar from a Smallpox scar BCG Scar Classic Features Raised centre Left upper arm or, much less commonly, on thigh or forearm Smallpox Scar Classic Features Depressed with radiating lines to edges Routine use stopped in the late 1970’s

4. 4 37 years old Black Female Born in Rwanda in 1965 Left deltoid BCG Smallpox

5. 5 37 years old Black Female Born in Rwanda in 1965 Left deltoid BCG Smallpox

6. 6 44 years old Caucasian Female Born in Montreal in 1958 Lived in Spain 1962-66 and 1976-81 Graduated as a nurse in Manitoba, 1983 BCG

7. 7 44 years old Caucasian Female Born in Montreal in 1958 Lived in Spain 1962-66 and 1976-81 Graduated as a nurse in Manitoba, 1983 BCG

8. 8 32 years old Asian Female Born in the Philippines in 1970 Left deltoid BCG

9. 9 32 years old Asian Female Born in the Philippines in 1970 Left deltoid BCG

10. 10 13 years old Male Born in Iraq in 1990 Left deltoid BCG

11. 11 13 years old Male Born in Iraq in 1990 Left deltoid BCG

12. 12 46 years old Female Born in Trinidad in 1956 Left upper arm and shoulder BCG Smallpo x

13. 13 46 years old Female Born in Trinidad in 1956 Left upper arm and shoulder BCG

14. 14 18 years old Asian Female Born in the Philippines in 1984 Left deltoid BCG

15. 15 60 years old Asian Male Born in the Philippines in 1943 Left deltoid BCG

16. 16 60 years old Asian Male Born in the Philippines in 1943 Left deltoid BCG

17. 17 38 years old Male Born in Kerala State, India in 1965 Left arm BCG Smallpo x

18. 18 38 years old Male Born in Kerala State, India in 1965 Left arm BCG

19. 19 38 years old Male Born in Kerala State, India in 1965 Left arm Smallpox

20. 20 38 years old Caucasian Female Born in Winnipeg, Manitoba Health care worker Received BCG vaccine in 1983 Left deltoid BCG Smallpox

21. 21 55 years old Caucasian Female Born in Hungary in 1947 Left deltoid Smallpox

22. 22 26 years old Black Male Born in Sierra Leone in 1976 Right arm SMALLPOX BCG

23. 23 26 years old Black Male Born in Sierra Leone in 1976 Right arm Smallpox BCG

24. 24 And once again… Distinguishing a BCG scar from a Smallpox scar BCG Scar Classic Features Raised centre Left upper arm or, much less commonly, on thigh or forearm Smallpox Scar Classic Features Depressed with radiating lines to edges Routine use stopped in the late 1970’s